Patient education key in treating SSRI-induced sex problems. (Limited Clinical Trial Data).

SAN DIEGO -- "Sexual functioning is complex-and so is talking about it with your patients," Dr. Robert K. Schneider observed at the annual meeting of the American College of Physicians.

The first step in treating sexual dysfunction caused by selective serotonin reuptake inhibitors (SSRIs) is to conduct a thorough health assessment that focuses on pretreatment sexual functioning, the phase of sexual response that is primarily disturbed, and other causes of sexual dysfunction.

"Educating the patient about the relevance of this information is critical to the formulation of a treatment plan," said Dr. Schneider, professor of psychiatry at Virginia Commonwealth University, Richmond. "This information helps explain why prolonged time for arousal may be needed or acclimation to the medication often occurs.

Sexual dysfunction can range from decreased libido, to decreased arousal, to abnormalities involving orgasm. These phases are interrelated, but libido is primarily a central nervous system process (mesolimbic), while arousal and orgasm are peripherally mediated and involve the balance between sympathetic and parasympathetic nervous systems, Dr. Schneider explained.

"Serotonin is involved in all three phases of sexual functioning," he said. "Identifying the primary phase disrupted will help determine a strategy to recommend."

In a recent prospective, multi-center study of 1,022 patients treated with ...