A new study published in the Journal of Social Psychiatry and Psychiatric Epidemiology looked at the frequency of self-reported persistent post-treatment genital hypoesthesia among past antidepressant users in Canada and the US.
“In my counselling practice, I specialize in working with people with Post Selective Serotonin Reuptake Inhibitor (SSRI) Sexual Dysfunction (PSSD), which is a type of sexual dysfunction where sexual function does not return to normal upon discontinuation of commonly prescribed antidepressants such as SSRIs, Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), and some tricyclic antidepressants,” study author Yassie Pirani told us. “PSSD is distinct from sexual dysfunction associated with depression. Genital numbness, also known as persistent post-treatment genital hypoesthesia (PPTGH) is a primary symptom of PSSD.”
Patients report numbness in the genital area similar to receiving a local anesthetic. However, the numbness does not resolve, even after stopping the treatment with the medication. PSSD is a largely unknown disorder due to a lack of research and awareness. It is critical that medical professionals know about PSSD as patients may seek help or describe symptoms of PSSD without knowing about PSSD.
Symptoms of PSSD include genital anesthesia (numbness) or reduced genital sensation, pleasureless, muted, or inability to orgasm (anorgasmia), erectile dysfunction, decreased vaginal lubrication, reduced or lack of sexual desire & response to sexual stimuli, premature or delayed ejaculation, reduced or lack of sensitivity in sexually sensitive areas (e.g nipples), and ancillary non-sexual symptoms related to emotional numbing, cognitive impairment, depersonalization, and other sensory problems.
“Some cases of PSSD resolve with time, however many persist indefinitely,” Pirani told us. “PSSD may occur at any age, in all sexes, and can start as soon as the first administered dose or become apparent only after discontinuation of the medication. Currently, there is no treatment for PSSD. After working with dozens of people with this condition, I learned that a big question that those affected have is about how common the condition is. This study sought to provide some clarity about this.”
Due to a lack of research and awareness, stigma about sexuality, and shame about sexual issues, PSSD is a largely unknown disorder. Case reports have been in the literature for many years, but quantitative data are scarce. Only one other study has aimed to estimate the risk of PSSD, which estimated the risk for PSSD was 1 in 216 patients (0.46%).
“Due to the lack of data, myself and my collaborators at Simon Fraser University investigated PSSD symptoms in a general survey of sexual and gender minority youth,” Pirani told us. “A total of 2179 people with a history of psychiatric treatment participated in this study. It excluded people without sexual experience or genital surgeries 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 class of psychiatric medication. The research team found that past antidepressant users were 14 times more likely to report persistent genital numbness compared to the other group.
“Despite this recognition in scientific and official regulatory channels, there is a lack of PSSD awareness in everyday clinical practice,” Pirani told us. “The reason for this is likely related to the fact that PSSD arises because of a medication indicated for depression, and sexual dysfunction can be a symptom of depression. For this reason, patients and healthcare professionals tend to believe that PSSD might be depression returning after discontinuing the medication.”
However, the researchers stress that genital anesthesia, the main symptom of PSSD, is not explained by depression and that it establishes PSSD as a unique etiological condition. One of the most important aspects of the new epidemiological study is that it focuses on genital anesthesia and not on other symptoms that could be confused with depression.
“Patients often commence treatment with this class of medication without warning of potential long-term adverse effects,” Pirani told us. “Transparency and meaningful informed consent about the risk of PSSD is needed at time of prescribing. Prescribers should also clinically assess sexual functioning at baseline to ascertain symptom severity before, during, and after treatment – as well as symptom duration post-cessation.”
The study results emphasize the necessity for clear warnings, proper informed consent processes about persistent sexual dysfunction risks associated with antidepressants, and transparent patient education practices. Regulatory agencies should also be active in monitoring and reporting long-term adverse effects of antidepressants. For example, since 2011, the US product information for Prozac (fluoxetine) has warned that “symptoms of sexual dysfunction occasionally persist after discontinuation of fluoxetine treatment.”
“PSSD is commonly overlooked or misdiagnosed,” Pirani told us. “Symptoms can be incorrectly perceived as somatic or psychological rather than iatrogenic (from the medication). Misattributing PSSD symptoms to psychogenic or psychosomatic can compound suffering and lead to self-blame, mistrust towards medical professionals, and alienation. It is crucial for prescribers and other health professionals to be knowledgeable about PSSD such that patient concerns can be addressed appropriately.”
Health providers can validate and seek to understand patient experiences to prevent feelings of shame, self-blame, and alienation. Many people with sexual trauma from PSSD draw parallels with sexual assault, as acquiring PSSD without being warned of the risk is akin to a non-consensual act. They can validate patient feelings of anger, grief, and confusion.
“The findings also underscore the urgent need for detailed investigation into prevalence and risk factors of PSSD,” Pirani told us. “Further research is needed to explore this condition more deeply, including studies of all PSSD symptoms (including the non-sexual symptoms) and their development over time before and after treatment.”