To the Editor.
—Dr Hollander1 states that fluoxetine has a 1.9% incidence of sexual dysfunction, with impotence or ejaculatory problems occurring in less than 1% of patients. Although the Physicians' Desk Reference lists 1.9% as the rate of sexual dysfunction with fluoxetine,2 several case series and open studies have found rates ranging from 7.8% to 75%.3 The most common sexual problem associated with fluoxetine in these reports is anorgasmia. In one survey, 60 consecutive male patients who received fluoxetine (20 mg/d) were specifically questioned about ejaculatory changes, and 45 (75%) reported retarded ejaculation or ejaculatory incompetence.3Hollander also states that he is unaware of any information on whether fluoxetine has a direct effect on improving sexual dysfunction. There are a few reports in the literature that suggest that fluoxetine's "adverse" sexual effects may be beneficial for some patients. Stratta et al4 found fluoxetine helpful for two
Hopkins HS, Gelenberg AJ. Fluoxetine and Sexual Dysfunction. JAMA. 1995;273(19):1489-1490. doi:10.1001/jama.1995.03520430025021