Background and significance
Sexual and mental health are deeply intertwined.
Post SSRI Sexual Dysfunction (PSSD) is a type of sexual dysfunction associated with commonly prescribed antidepressant including Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), and some tricyclic antidepressants. PSSD is distinct from sexual dysfunction associated with depression. Genital numbness, also known as persistent post-treatment genital hypoesthesia (PPTGH) is a common symptom of PSSD.
PSSD is a largely unknown disorder from a lack of research and awareness. It is critical that sexual health clinicians know about PSSD to be able to support people who may seek help or describe symptoms of PSSD.
Patients commonly report reduced genital sensitivity or numbness in the genital area. However, in these cases the numbness does not resolve, even after they stop taking the antidepressant medication long-term. Research has found that some people experiencing PSSD have permanent damage to the erectile tissue found in the nipples, penis, and clitoris.
In 2021, Health Canada issued a safety report warning that SSRIs and SNRIs may cause long-lasting sexual dysfunction that can persist after discontinuing medication, and that persistent sexual side effects of antidepressants are likely underreported.
A group of researchers at Simon Fraser University asked about PSSD symptoms in a general survey of sexual and gender minority youth.
Summary of evidence
A total of 2179 people with a history of psychiatric treatment participated in this study. We excluded people without sexual experience, who have had genital surgery, and controlled for factors like hormonal therapy, age, and sex. Among those who had stopped treatment, 13% of past antidepressant users (93/707) reported persistent genital numbness compared to 1% (1/102) among past users of another psychiatric medication. We found that past antidepressant users were 14 times more likely to report persistent genital numbness compared to the other group (OR: 14.2; 95% CI: 2.92 to 257).
Implications for practice
PSSD can be a debilitating and emotionally devastating condition. It can severely affect a person’s quality of life, mental health, and has been a factor in suicide for some. PSSD can start as soon as the person starts taking antidepressant medication, or it may become apparent only after discontinuation. Some cases of PSSD resolve with time – however many persist indefinitely. There is no known treatment for PSSD.
Our key recommendations include that:
- Policy-makers include information about PSSD on the product monograph of antidepressant medication.
- Clinicians should engage in discussions about potential complications before initiating treatment.
- Research is needed to better understand the prevalence and symptoms of PSSD to inform evidence-based guidance.
People often start treatment without any knowledge about the possibility and long-term effects of PSSD. Clinicians should support people in making an informed decision before starting treatment. Prescribers should also assess sexual functioning and symptoms before, during, and after treatment.
PSSD is commonly overlooked or misdiagnosed. When symptoms are misattributed to psychological causes, this can create further alienation. Clinicians can validate patient experiences to prevent feelings of shame and self-blame.
Other sexual symptoms of PSSD can be viewed here. Non-sexual symptoms of PSSD are related to emotional numbing, cognitive impairment, depersonalization, and other sensory problems.
In 2022 diagnostic criteria were published that can be utilized by clinicians to determine a diagnosis (see resources below). Currently there is limited support available for people experiencing PSSD. Sexual health clinicians can play a key role in advocating for meaningful support in the healthcare system.
For more information
Pirani Y, Delgado-Ron JA, Marinho P, Gupta A, Grey E, Watt S, MacKinnon KR, Salway T. Frequency of self-reported persistent post-treatment genital hypoesthesia among past antidepressant users: a cross-sectional survey of sexual and gender minority youth in Canada and the US. Soc Psychiatry Psychiatr Epidemiol. 2024 Sep 20. doi: 10.1007/s00127-024-02769-0. Epub ahead of print. PMID: 39302425.
Antidepressant use and genital numbness among sexual and gender minority youth – Information for healthcare providers
Antidepressants & genital numbness – Information for youth
RxIsk – RxISK: Making medicines safer for all of us
PSSD Canada – Canadian PSSD Society
PSSD Network – The PSSD Network
Sidefxhub – PSSD & PFS Patient Organization
References
Bolton JM, Sareen J, Reiss JP. Genital anaesthesia persisting six years after sertraline discontinuation. J Sex Marital Ther. 2006;32(4):327-30.
Canada Vigilance Program. (2021). Adverse Reaction Number 000925645. View here: hips://www.pssdcanada.ca/new-page-77
Search Health Canada Adverse Drug Response database: hips://www.- canada.ca/en/health-canada/services/drugs-health-products/medeffect- canada/adverse-reac-on-database.html
Clayton AH, Croft HA, Handiwala L. Antidepressants and sexual dysfunction: mechanisms and clinical implications. Postgrad Med. 2014 Mar;126(2):91-9. doi: 10.3810/pgm.2014.03.2744. PMID: 24685972..
Chinchilla Alfaro, K., van Hunsel, F., & Ekhart, C. (2022). Persistent sexual dysfunction after SSRI withdrawal: A scoping review and presentation of 86 cases from the netherlands. Expert Opinion on Drug Safety, 21(4), 553-561. https://doi.org/ 10.1080/14740338.2022.2007883
Healy D, Bahrick A, Bak M, Barbato A, Calabrò RS, Chubak BM, et al. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med. 2022;33(1):65–76.
Healy D, Le Noury J, Mangin D. Post-SSRI sexual dysfunction: Patient experiences of engagement with healthcare professionals. The International journal of risk & safety in medicine. 2019;30:167-178.
Healy, D. (2018). Citizen petition: Sexual side effects of SSRIs and SNRIs. International Journal of Risk and Safety in Medicine, 29(3-4), 135-147. Retrieved from: hips://www.ncbi.nlm.nih.gov/pmc/ar-cles/PMC6004927/
Healy, D., Le Noury, J, & Mangin, D. (2018). Enduring sexual dysfunction after treatment with an-depressants, 5α-reductase inhibitors and isotretinoin: 300 cases. International Journal of Risk and Safety in Medicine 29(3-4), 125–134. Retrieved from: hips://pubmed.ncbi.nlm.nih.gov/ 29733030/
Health Canada. Summary Safety Review – Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs). https://hpr-rps.hres.ca/ reg-content/summary-safety-review-detail.php?lang=en&linkID=SSR00254
Hogan C, Le Noury J, Healy D, Mangin D. One hundred and twenty cases of enduring sexual dysfunction following treatment. Int J Risk Saf Med. 2014;26(2):109-16.
Pirani Y, Delgado-Ron JA, Marinho P, Gupta A, Grey E, Watt S, MacKinnon KR, Salway T. Frequency of self-reported persistent post-treatment genital hypoesthesia among past antidepressant users: a cross-sectional survey of sexual and gender minority youth in Canada and the US. Soc Psychiatry Psychiatr Epidemiol. 2024 Sep 20. doi: 10.1007/s00127-024-02769-0.
Reisman Y. Post-SSRI sexual dysfunction. British Medical Journal. 2020;368:m754. PMID 32107204.