5 Signs of Sexual Dysfunction

Disclaimer. Please consult a medical health professional for proper diagnosis and treatment. 

Most medications include side effects, especially antidepressants. The most common type of antidepressant is an SSRI or selective serotonin reuptake inhibitor. SSRIs do exactly as their name states– prevent your body from absorbing all of the serotonin. This process leaves more serotonin in your brain and helps relieve symptoms of depression. SSRIs treat various mental health issues like major depressive disorders, bulimia, obsessive-compulsive disorders, post-traumatic stress disorder, anxiety, and other panic disorders. Side effects and other factors vary on dosage. 

One of the side effects of an SSRI, depending on the dose, is post-SSRI sexual dysfunction or PSSD. This symptom can present itself during or after the use of an SSRI.

There is no specific explanation for the pathophysiology of the symptoms of PSSD; hence treatment can be challenging. 

Here are five common symptoms of PSSD. 

• Genital anesthesia

Genital anesthesia refers to a change in sensation or general numbness of reproductive organs. Though damage, compression, or inflammation of peripheral nerve roots located at the bottom of the spinal cord can usually cause genital numbness, SSRIs can also lead to numbness.  

Because SSRIs produce a general dampening of the brain’s reactivity, physicians believe that hormonal and neurological changes in the central and peripheral nervous system are responsible. 

Unfortunately, this symptom can persist for several months and sometimes years after no longer taking antidepressants. As of now, there is no definite cure for this symptom, but it can be treated. If you are experiencing this symptom, please seek professional medical treatment.  

• Low libido

Another sign that you may be experiencing PSSD is a low libido. Though libido can be a symptom of depression, usage of SSRIs can also cause this symptom. There are various theories as to why SSRIs can cause lower libido. One posits that increased serotonin levels make patients feel calm and relaxed. This relaxation period can lead to a lower sex drive. Another possibility relates to epigenetic changes caused by SSRIs. Researchers Csoka and Szyf found that SSRIs increase the binding and stimulation of 5-hydroxytryptamine receptor A1 in the brain. This causes downregulation of serotonin; thus increasing transmission of serotonin in the brain. In simpler terms, antidepressants prevent serotonin from leaving the brain, which leads to the accumulation of serotonin and stimulation of 5HTA1. Too much stimulation can produce methyl binding proteins that affect the frontal cortex, the dentate gyrus of the hippocampus, and the caudateputamen. 

• Unable to enjoy sexual activities

Part of the symptomatic triad of PSSD is sexual dysfunction. Usually, medications that contain 5α-reductase inhibitors such as finasteride and dutasteride cause erectile dysfunction in men. However, certain compounds found in SSRIs can work similarly to these inhibitors and cause similar results. In women, sexual dysfunction often is present in the form of pain and discomfort.  

One theory for this points to hormonal changes. SSRIs can cause neurochemical changes in the central and peripheral nervous system. For example, an increase in prolactin production, a blockage of α1-adrenergic receptors, and a decrease in dopamine, testosterone, and oxytocin. These changes occur in the peripheral nervous system. 

• Pleasure-less or weak orgasm 

A typical reaction of SSRIs is pleasure-less or weak orgasms. This symptom can be quite distressing for patients, but it can be due to neurochemical reactions of the medication on the nervous system. The central nervous system is responsible for orgasms and it can be affected when taking SSRIs. 95% of serotonin receptors are located outside of the brain and communicate with the central nervous system. As such, when taking SSRIs, the interplay between these two systems can sometimes cause dysfunction. Researchers Damsa and colleagues found that SSRIs inhibit dopamine receptors, which are responsible for sexual arousal. 

• Ejaculation disorders

The last symptom is ejaculation disorders, which affect mostly men. Symptoms of PSSD are a bit difficult to place because they are also symptoms of depression. However, analysts Mathew and Weinman collected data and found that 15% to 20% of depressive patients reported problems with orgasms and ejaculation. Though the data does not distinguish whether these symptoms are caused by depression or antidepressants, most psychologists see it as a side effect of SSRIs. 

The reason for this side effect is not known. Please seek medical treatment if this symptom persists.  

Antidepressants make peoples’ lives a bit easier by relieving mental health issues. But, it is important to inform yourself and talk to your doctor about what medication works best. Before beginning treatment, it is important to note that tricyclic antidepressants such as clomipramine, amitriptyline, imipramine, and doxepin showed the highest incidence of sexual dysfunction symptoms. Speak to your physician for more information, and as always…

Take care! 

Additional Sources:

Bala, A., MD, Tue Nguyen, H., BA, & Hellstrom, W. J., MD, FACS. (2018). Post-SSRI Sexual Dysfunction: A Literature Review. Sexual Medicine Reviews,6, 29-34. Retrieved December 30, 2020, from https://www.smr.jsexmed.org/article/S2050-0521(17)30072-0/pdf

Bhandari, S. (2019, June 27). How Antidepressants Work: SSRIs, MAOIs, Tricyclics, and More. Retrieved December 31, 2020, from https://www.webmd.com/depression/how-different-antidepressants-work

Calabrò, R. S., De Luca, R., Manuli, A., Portaro, S., Naro, A., & Quattrini, F. (2019). Towards Improving Post-SSRI Sexual Dysfunction by Using Nutriceuticals: Lessons from a Case Study. Journal of sex & marital therapy, 45(6), 562–565. https://doi.org/10.1080/0092623X.2018.1556755

Cherney, K. (2019, April 04). Managing Antidepressant Sexual Side Effects. Retrieved December 31, 2020, from https://www.healthline.com/health/erectile-dysfunction/antidepressant-sexual-side-effects

Coleman, R., & MacDonald, D. (2003, September 22). Effects of isotretinoin on male reproductive system. Retrieved December 31, 2020, from https://www.sciencedirect.com/science/article/abs/pii/S0140673694928037

Hogan, C., Le Noury, J., Healy, D., & Mangin, D. (2014, January 01). One hundred and twenty cases of enduring sexual dysfunction following treatment. Retrieved December 31, 2020, from https://content.iospress.com/articles/international-journal-of-risk-and-safety-in-medicine/jrs617

MayoClinic Staff. (2019, September 17). The most commonly prescribed type of antidepressant. Retrieved December 31, 2020, from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825

Pietrangelo, A. (2017, December 05). What Is Sexual Dysfunction? Retrieved December 31, 2020, from https://www.healthline.com/health/what-sexual-dysfunction