Paroxetine-induced vaginal anaesthesia

Drug eruptions and the vulva

Drug reactions affecting the vulva are understudied and underreported, with some having the potential to cause serious morbidity through long-term sequelae. We conducted a literature review to investigate the current evidence about vulval drug eruptions. We aimed to establish the extent of drug reactions affecting the vulva, identify the common culprit drugs, and review current evidence and guidelines regarding their management. The vulval involvement seen in Steven-Johnson syndrome, toxic epidermal necrolysis and fixed drug eruption forms the focus of this review, but we also summarize the current evidence regarding less common reactions.

Psychiatric disorders and sexual dysfunction

Sexual problems are highly prevalent among patients with psychiatric disorders. They may be caused by the psychopathology of the psychiatric disorder but also by its pharmacotherapy. Both positive symptoms (e.g., psychosis, hallucinations) as well as negative symptoms (e.g., anhedonia) of schizophrenia may negatively interfere with interpersonal and sexual relationships. Atypical antipsychotics have fewer sexual side-effects than the classic antipsychotics. Mood disorders may affect libido, sexual arousal, orgasm, and erectile function. With the exception of bupropion, agomelatine, mirtazapine, vortioxetine, amineptine, and moclobemide, all antidepressants cause sexual side-effects. Selective serotonin reuptake inhibitors (SSRIs) may particularly delay ejaculation and female orgasm, but also can cause decreased libido and erectile difficulties. SSRI-induced sexual side-effects are dose-dependent and reversible. Very rarely, their sexual side-effects persist after SSRI discontinuation. This is often preceded by genital anesthesia. Some personality characteristics are a risk factor for sexual dysfunction. Also patients with eating disorders may suffer from sexual difficulties. So far, research into psychotropic-induced sexual side-effects suffers from substantial methodologic limitations. Patients tend not to talk with their clinician about their sexual life. Psychiatrists and other doctors need to take the initiative to talk about the patient's sexual life in order to become informed about potential medication-induced sexual difficulties.

Sensory disturbances associated with serotonin reuptake inhibitors: brief review

Serotonin reuptake inhibitors (SRIs) are occasionally associated with sensory symptoms, which are one of the less recognized adverse effects. A PUBMED search supplemented with manual search was made to review the relevant literature. Anesthesia, paresthesia, and mastalgia have been reported to occur with this group of medications. The possible pathophysiology and management strategies are discussed.

Adverse effects of drug therapies on male and female sexual function

Sexual dysfunctions (SD) are adverse effects of common drug therapies that have rarely been considered in investigations so far. Possibly it is barely known that many widespread and frequently prescribed medications and drug therapies can have significant impact on vascular and nerval processes as well as on endocrinologic and psychoneuroendocrinologic systems and therefore can influence sexual functions. Impotence and disorders of the erectile function can mainly be caused by antidopaminergic mechanisms, whereas ejaculatory disorders and anorgasmia often can be explained by antiserotoninergic effects. Anticholinergic and adrenoloytic agents can also cause a particular impairment of erectile functions. The following considerations will show that the detection and treatment of SD (also in women!) should be given much more attention since drug-induced SDs occur predominantly in indications where a SD itself can be a symptom of the disease.

Serotonin reuptake inhibitor induced sensory disturbances

Serotonin reuptake inhibitor induced sensory disturbances are reported rarely in the literature. This case report describes numbness and dysmorphic symptoms in the upper facial area associated with fluoxetine. There is no previous report of such an adverse reaction with any serotonin reuptake inhibitor in the literature and this report is intended to draw attention towards these unusual adverse effects.

Fluoxetine-induced changes in tactile sensation and sexual functioning among clinically depressed women

Sexual side effects resulting from serotonin specific reuptake inhibitors (SSRIs) use may be mediated by a number of peripheral mechanisms, including alterations in tactile sensitivity. It was hypothesized that sexual difficulties resulting from SSRI use arise in part from an over-sensitivity or under-sensitivity of tactile sensation. Tactile sensitivity was examined on the index finger and lower lip in clinically depressed women at baseline (pre-medication), week 1, week 4, and week 8 of drug treatment (fluoxetine group n = 12, control n = 13). Analyses indicated that fluoxetine treatment resulted in decreased orgasm functioning. Fluoxetine-induced sexual changes were not mediated by tactile sensation. An independent association was found between sexual arousal functioning and finger sensation. Novel to this study, an independent association was found between sexual desire and finger sensation.