---
Fluoxetine, N-methyl-3-phenyl-3-[4-(trifluoromethyl)phenoxy]-propan-1-amine hydrochloride, is in a class of drugs called selective serotonin reuptake inhibitors (SSRI). Fluoxetine affects chemicals in the brain that may become unbalanced and cause depression or mood disturbances, eating disorders, or obsessive or compulsive symptoms. To my knowledge, this is the first report of a depressive patient who did not experience any seminal emission side effects during the first period of the drug’s use, but did experience involuntary seminal emission during defecation when taking Fluoxetine a year later.
Case Report
Mr. A was a 34-year-old man. He had no past and familial history of psychiatric and urologic disorders. He was first diagnosed with depression 2 years prior to taking Fluoxetine. He ceased taking the drug a year later. One year later, he was again prescribed Fluoxetine and during this period of taking Fluoxetine, he experienced involuntary seminal emission during defecation without organism. The onset of the involuntary seminal emission took place three weeks after using Fluoxetine for the second time. He reported this symptom to his doctor 8 weeks after it started to occur. He continues to experience involuntary seminal emission during defecation about once every 3 or 4 days. This symptom is not present during micturition in this patient.
Comments
The sexual side effects most frequently observed in selective serotonin reuptake inhibitors (SSRIs) are delayed ejaculation and absent/delayed orgasm.1 Sexual dysfunction is reported for Fluoxetine as 57.7%. 2 The incidence of sexual dysfunction with SSRIs is high, ranging from 58% to 73%, as compared with serotonin-2 (5-HT2) blockers (nefazodone and mirtazapine), moclobemide, and amineptine. 2 There are two case reports of male patients experiencing a semen-like urethral discharge during micturition, induced by mazindol, a psychostimulant. 3 Involuntary sperm emission with Fluoxetine has been reported before, but not with sexual symptoms not appearing during the first use of the drug, and involuntary seminal emission during defecation appearing during the second period of Fluoxetine use4. Similarly, involuntary seminal emission during defecation has been reported during the use of Milnacipran. 5 Patients generally do not discuss sexual dysfunctions with their doctors, and therefore these sorts of side effects may be underestimated. Doctors should be aware of the sexual dysfunction induced by Fluoxetine in terms of involuntary seminal emission during defecation.
References
1. Rosen RC, Lane RM, Menza M: Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol 1999; 19:67-85
2. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F: Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. J Clin Psychiatry 2001; 3:10-21
3. van Puijenbroek EP, Meyboom RHB: Semen-like urethral discharge during the use of mazindol. International Journal of Eating Disorders 1998; 24:111-113
4. Benazzi F: Involuntary sperm emission with fluoxetine. Can J Psychiatry 1995; 40:431
5. Yoshida K, Higuchi H, Takahashi H, Shimizu T: Ejaculation After Defecation Without Orgasm Induced by Milnacipran. J Neuropsychiatry Clin Neurosci 2004; 16:4