Clozapine-induced Delayed Ejaculation.

Sir,

Sexuality is an important aspect of human life. The quality of life, pursuit of happiness, relational intimacy, and reproduction depend on human sexuality. Although there were different theories of sexuality being the cause of mental illness, all were proved to be baseless. Enquiring into the sexual health of a person suffering mental illness is utmost important as people often do not disclose in fear of embarrassment.[1] People suffering from schizophrenia are found to have sexual dysfunction, with a reported prevalence of 45%–80% in males and 30%–80% in females.[2] It is difficult to delineate whether sexual dysfunction is the part of primary disorder or due to the introduction of antipsychotics. Antipsychotics such as haloperidol and risperidone which increases the prolactin level can cause significant dysfunction. However, clozapine due to its low prolactin hiking effect, it causes less sexual side effects. Here, we discuss a case who came with clozapine-induced delayed ejaculation.[12]

Case: A 32-year-old male who has been suffering from paranoid schizophrenia was treated with clozapine for the past 7 months due to failed trials of two atypical antipsychotics. He did not have any sexual dysfunction before 7 months. The patient started complaining of extremely delayed ejaculation sometimes even dry ejaculation for the past 2–3 months. His spouse also corroborated the history. As the patient was planning of having a child, it was distressful for the couple. His serum prolactin level was checked and found to be within the normal limit. Urologist consultation was done from a specialty center and found to be normal. Hence, we came into a decision that side effect could be due to clozapine.

Discussion: Although a relatively rare side effect, clozapine can cause sexual dysfunction in few patients. Due to weak D2 inhibition in the tuberoinfundibular pathway and potent antiserotonergic function, clozapine has a less sexual side effect in relation to other antipsychotics. Delayed ejaculation is not a very common complaint by patients as it rarely impairs the sexual health of an individual suffering from the psychiatric disorder although often seen with the use of an antidepressant. Here, in our case, we have noticed delayed ejaculation in the absence of decreased libido or erectile dysfunction which is extremely rare in use of clozapine. This case teaches us to validate concern of the relatively rare side effect of clozapine rather than totally devaluing the complaints of patients.[23]

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