Sexual dysfunction (SD) can often be a side-effect of treatment with antipsychotics (APS). It often jeopardizes long-term adherence to treatment, while deeply affecting the patient’s quality of life. The pathogenic mechanisms may be associated with postsynaptic dopamine antagonism, a1-antagonism and prolactin elevation. APS-induced hyperprolactinemia has been linked to the occurrence of galactorrhea, gynecomastia, amenorrhea and SD.

To synthesize the available evidence on the management of APS-related sexual dysfunction, with a main focus on the second-generation antipsychotics.

A search for randomized controlled trials (RCT) published between 2021 and 2011 on PubMed was made using the keywords “sexual”; “dysfunction”; “antipsychotic” and “treatment”, from which resulted sixteen articles. Only six of those were considered relevant for the study’s objectives.

Three studies focused on the comparison between different APS and prolactin levels and SD occurrence, showing that treatment with aripiprazole is mostly related to prolactin levels with the normal range and a lower incidence of sexual dysfunction. Addition of aripiprazole to previous APS may be associated with normalization of sexual function and pose as a possible management option. Adjunctive treatment with tadalafil showed no significant effect on its primary outcome.

There seems to be a general consensus that patients treated with first-generation antipsychotics (FGA), along with risperidone, paliperidone and amissulpride show higher prolactin levels and incidence of SD. Whether there is a causal relationship between these two variables still remains a question. Larger and more prolonged trials are still needed to evaluate APS-related sexual dysfunction and its management.

No significant relationships.

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor and its extensive use for major depressive disorder and anxiety disorders. Although it has been reported that venlafaxine may have various side effects, as far as we know, spontaneous ejaculation(SE) has not been reported yet.

We aim to describe this clinical case with venlafaxine-induced SE and to discuss the possible etiological factors.

Case report and literature review.

A 53-year-old male with generalized anxiety disorder was initiated venlafaxine treatment with 75 mg/day. After two months patient’s complaints partially regressed and the dose of venlafaxine treatment was increased to 150 mg/day. 10 days after the dose increase, the patient applied with the complaint of SE 2-3 times a day. No urological etiology was found. During outpatient follow-ups, after the 5 days from reducing the daily dose to 75 mg/day, SE complaint completely regressed. After following couple of months, the patient by himself, increased the dose of venlafaxine to 150 mg/day without consulting a psychiatrist. Then SE recurred approximately 15 days later. Venlafaxine treatment dose was reduced again to 75 mg/day and urological complaints spontaneously regressed.

SE, a rare sexual side effect, represents ejaculation that occurs involuntarily and in the absence of any sexual stimuli. The possible mechanism of SE, detected as a side effect in our case, may be that increased adrenergic activity reduces ejaculatory latency and triggers spontaneous ejaculation. Antidepressant-associated sexual dysfunction could be a dose-dependent adverse event. Therefore, reducing the dosage of the treatment to a minimum effective dose could be an option.

No significant relationships.

In this presentation we describe the case of a woman referred to the Sexology Department after having developed symptoms of Persistent Genital Arousal (PGAD) for the last 5 years, during treatment for Depression with Venlafaxine. PGAD is a clinical entity first described in 2001 by Leiblum and Nathan. Despite having received more attention in the last few years, its etiology remains unclear, with numerous causal factors of different natures being suggested.

We aim to describe this clinical case of PGAD and to discuss the possible etiological factors involved as well as to make a brief revision of the literature on this topic.

We conducted a detailed interview, focused on the nature of the complaints, psychological history, medications, diet and neurologic disorders and performed a thorough clinical examination. We also searched for relevant articles in medical databases such as PubMed and Google Scholar.

A 52 year-old woman previously treated for Depression with Venlafaxine complains of involuntary sensations of genital arousal, with perceived vasocongestion, tingling and pulsatlity during her journey to work in public transportations. The symptoms subsided only after getting home 8-10 hours later and reaching orgasm by masturbating. She stopped Venlafaxine in 2015, but these symptoms persisted. Some authors suggest a link between SSRIs/SNRIs and PGAD.

PGAD is a relatively recent addition to our diagnostic catalog with increasingly more cases being reported in the last few years. It is likely that the condition, however, has no discrete etiology and that a customized approach will be necessary to successfully treat most patients.