Risperidone-Induced Retrograde Ejaculation

Mr. A was a 37-year-old man who was married with three children and who met DSM-IV criteria for paranoid schizophrenia. He was physically healthy, had no apparent concomitant general medical condition, and had never experienced ejaculatory problems. He had his first overt psychotic episode at age 29 and was successfully treated with perphenazine, 32 mg/day, without any major adverse effects. He was admitted to our psychiatric inpatient ward after a second psychotic exacerbation of the disorder and after being drug free for about 6 years. On admission, treatment with risperidone was initiated; the dose was increased to 4 mg/day by 1-mg/day increments and thereafter remained constant.

On days 6, 9, and 14 after the initiation of risperidone treatment, Mr. A engaged in sexual intercourse with his wife, after which he reported having ejaculatory difficulties compatible with retrograde ejaculation. A condom was used during all encounters. He reported a complete failure to emit semen but a normal desire, erection, and sense of orgasm. Postcoital urine was collected after days 9 and 14, and semen was evident on evaluation of the samples on both occasions. A reduction of Mr. A’s risperidone dose to 3 mg/day was associated with partial restoration of anterograde ejaculation.