By Amanda Hall, AccCOSRT.
What is it?
Sexual dysfunction is a well-known possible side effect of many anti-depressants and it is widely assumed that this resolves when they are discontinued. However, since the formal recognition of Post SSRI Sexual Dysfunction (PSSD), awareness is increasing that, for some individuals, the difficulties can persist or even worsen on cessation. Prevalence is unknown at present and more research is required. A recent study by Pirani et al. (2025) showed that among those who had stopped treatment, 13% of past antidepressant users reported persistent genital numbness compared to 1% among past users of another psychiatric medication. They 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).
PSSD was recognized by European Medicines Agency in 2019. In the UK, in February 2025, it was expressly referred to in a request for a debate on harms caused by antidepressants to the House of Commons. The Medicines and Healthcare products Regulatory Agency (MHRA) has started using a MedDRA code for the condition 10086208. In March 2025 the Royal College of Psychiatrists in the UK updated their information on antidepressants, specifically mentioning PSSD.
Are you PSSD Aware?
I am writing this because I was unaware of PSSD until a client came into my therapy room with an article that resonated with their experience. I tried to learn fast, but ultimately I was not able to offer ongoing support for that client. Perhaps I would have if only I had been PSSD-informed. I am aware that for all sufferers of PSSD, it is distressing to having to educate, and even convince, the professionals supporting them of its existence. It is therefore critical that, as therapists, we know about PSSD to be able to support those who describe the symptoms. Since that time, I have learned more through reading and joining a clinical supervision group for therapists supporting PSSD patients with members located in the UK, Canada, and the US, and have been able to support other clients who experience PSSD.
What are the sexual symptoms?
These include, but are not limited to
- Reduced genital and nipple sensitivity, genital numbness or prickling or burning sensations.
- Reduced desire and arousal.
- Anorgasmia or delayed orgasm or pleasureless orgasm.
- Eliminated or reduced fantasy and response to sexual stimuli.
- Erectile dysfunction and a reduced experience of spontaneous erections.
- Genital tissue changes.
It is important to note that PSSD symptoms can extend beyond the sexual to emotional, cognitive and physical changes for many. Ancillary non-sexual symptoms are related to emotional numbing or anesthesia, generalized anhedonia, loss of ability to feel motivation or anticipation, cognitive impairment, depersonalization, memory issues, sensory problems, vision changes, numbness in extremities, head pressure, tinnitus, loss of creativity and dreaming, and more.
PSSD might be especially difficult to recognize in patients who took antidepressants before or during adolescence, due to a lack of baseline or limited sexual experiences. Additionally, acquiring PSSD is not dose dependent. There are many cases where people acquired PSSD from just one pill. Additionally, if people have previously used these medications safely in the past, this does not mean that they may not acquire PSSD with future use – many patients acquire PSSD the 3rd or 4th time they use medication.
How can we support our clients?
There is currently no known cure, but some people experience partial or full recovery over time, and research is ongoing. Balancing hope with realism can be challenging. It is essential to be fully present with the client, validating their experience and believing their perspective. You may be the first person with whom they feel safe enough to communicate openly and truly be heard.
A risk assessment is essential, including enquiring into suicidal ideation and intent because many PSSD sufferers experience this. Open an accepting conversation to explore coping mechanisms that may be causing harm: some clients are so desperate to feel something they may be causing physical damage to their bodies.
Processing the grief of their loss and welcoming the expression of all the complexity of emotions they may be experiencing, from rage to despair, is important. An approach similar to the psychological support needed after a loss of sexual function for medical reasons (e.g. cancer) may be helpful. A sexual trauma informed approach can also be considered, because many people experience it as similar to a sexual assault, with parallels around power dynamics, lack of consent and the shame of speaking out.
Relationship counselling may be important so that all parties can create a shared understanding of PSSD and process the trauma and grieve together before, hopefully, co-creating a way to move forward with a different understanding of intimacy which may not include shared sexual experiences.
With Psychosexual Therapy it is important to stress that difficulties are not psychological, but some interventions may be helpful on a client-led basis. A slow exploration with sensate focus of what sensation is available and a shift to prioritizing connection and pleasure rather than orgasm and penetration may be beneficial. For those that retain limited sensation, the use of stronger vibrating toys such as Hitachi Magic Wand and male masturbators such as Fleshlights can make a difference. Pelvic floor exercises and psycho-education (e.g. regarding lube) may assist for some.
Supporting informed consent
PSSD patients around the world are dismayed at the fact that no-one discussed the possibility of the risk of these adverse effects at the time of prescribing. Many prescribers are unaware of PSSD so do not fully discuss the risk of enduring and life altering changes and hence informed consent is not achieved.
SSRIs are frequently prescribed and some patients find them beneficial, although research by Dr. Joanna Moncrieff and others (2022) has challenged the efficacy of SSRIs, showing that their benefits over placebo are minimal. When accounting for methodological issues like unblinding in clinical trials, the true antidepressant effect of SSRIs appears even weaker. For some, if offered true informed consent, the possible risks may not outweigh the possible benefits.
If we are not able to prescribe, it is not our role to tell clients whether to take medication or not, this is for client and prescriber to decide. However, informed choice is only possible when people have full information of all the benefits and risks associated with the proposed medication. For clients considering starting prescribed psychiatric medication, therapists may wish to enquire whether the client’s prescriber has discussed these with them, including the possibility of PSSD. Further considerations and full guidance for therapists on working with clients who are considering starting, currently taking, or considering withdrawing from psychiatric drugs can be found at: Guidance for Psychological Therapists – Presented by the APPG for Prescribed Drug Dependence
For therapists interested in learning more and in joining the clinical supervision group for therapists, please contact Yassie Pirani at info@willowleafcounselling.ca
Further sources of information
Csoka AB, Shipko S. Persistent sexual side effects after SSRI discontinuation. Psychother Psychosom. 2006;75(3):187-8.
Healy, D. (2024). MHRA Adopts Code for Post-SSRI Sexual Dysfunction. RxISK. Retrieved from https://rxisk.org/mhra-adopts-code-for-post-ssri-sexual-dysfunction/
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. (2021). The challenge of diagnosing post-SSRI sexual dysfunction in adolescents. Journal of Psychopharmacology, 35(7), 803-810.
Healy D (2020). Post-SSRI sexual dysfunction & other enduring sexual dysfunctions. Epidemiology and Psychiatric Sciences 29, e55, 1–2.
Healy, D., Noury, J. & Mangin, D. (2018). Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases. International Journal of Risk & Safety in Medicine. 29. 1-10.
Moncrieff, J., & Horowitz, M. A. (2022). The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry. Nature
Pirani, Y. (2025). Post SSRI Sexual Dysfunction: Antidepressants and irreversible genital numbness. Home | SmartSex Resource
Royal College of Psychiatrists. (n.d.). Antidepressants. Retrieved March 3, 2025, from https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/antidepressants
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.
UK PSSD Association. www.pssd-uk.org