How is PSSD diagnosed if there's no test?
PSSD has no test. Doctors diagnose it from your history: genital numbness or other sexual changes linked to an antidepressant that last after stopping.
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There’s no blood test or scan for PSSD, post-SSRI sexual dysfunction. A doctor diagnoses it from your history: sexual changes linked to an SSRI or SNRI antidepressant, above all numbness in the genitals, that last after stopping.
The criteria for diagnosing it were published in a medical journal in 2022, and your GP may never have seen them. So it may fall to you to bring them, and to mention the numbness yourself.
The story in 3 lines
- No test shows PSSD. A doctor diagnoses it from your history, and criteria for this were published in 2022.
- The UK leaflet for escitalopram (Cipralex) warns that sexual problems have, in some cases, continued after stopping.
- The UK government says recognising PSSD in the clinic is outside the medicines regulator's remit. It didn't say whose job it is.
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Rosie developed PSSD after she was prescribed Lexapro (escitalopram). In 2024, as president of the PSSD Network, she talked about symptoms that had lasted about four years. She also talked about how hard it was to get doctors to acknowledge them.
The doctors and researchers behind the criteria see the same problem. Conditions like PSSD are “little known and poorly understood by healthcare professionals”, they write.
How do doctors diagnose PSSD without a test?
From your history. A doctor who knows the condition checks it against the 2022 criteria, written by an international group led by David Healy. They built the criteria from patients’ reports, and expect them to “need modification”.
The deciding sign is a change in how your genitals feel, one that stays after stopping. Some people say it’s as if the area had been numbed. Others say touch still registers but no longer feels sexual.
You took an SSRI or SNRI. Since you stopped, your genitals haven't felt the way they used to.
Lasting loss of desire, erection problems, no orgasm, or orgasms with little pleasure. The problem has lasted three months or more since stopping.
No matching problem before the medicine. No other condition, medicine or substance that could explain it.
The authors say ordinary sexual side effects can linger for days or weeks after the last tablet. Once the problem has lasted three months, PSSD is more likely, they agree.
They also warn that the change in feeling “may be hidden beneath” low desire. So mention it, even if your GP only asks about desire.
Why might my GP not know about PSSD?
Because the criteria sit in a research journal, and none of the official steps since 2019 tells a doctor how to diagnose PSSD. Those steps gave PSSD a leaflet warning and codes for records.
Official steps record PSSD. The criteria came from researchers.
England’s NICE guidance on depression mentions long-term effects on sex while people take antidepressants. It doesn’t mention problems that carry on after stopping.
In May 2025 a member of the House of Lords asked whether the government would recognise PSSD. The answer pointed to the warning and the codes, and to an expert group looking at how leaflets describe the risk. Recognising PSSD in the clinic, it said, is “outside the remit of the MHRA”, the UK medicines regulator.
Could it be depression or withdrawal instead?
It could, and a doctor should consider both. The clue that points to PSSD is a change in how your genitals feel.
Depression itself can affect sex. A 2012 review found it raised the risk of sexual problems in people followed for years.
But the criteria’s authors say the changes in genital feeling “seem distinctive to PSSD”. A current mental health diagnosis “does not prevent” a PSSD diagnosis, they add.
Been told it’s all in your head? They name that risk too: “misdiagnosis as a psychogenic problem”, meaning one blamed on the mind.
Withdrawal has its own symptoms, such as dizziness or feelings like electric shocks, and its own timing. The Cipralex leaflet says they usually go within two weeks, though some people have them for months. So if your GP suggests waiting a little longer, that’s reasonable.
For some people, though, the sexual changes have lasted years after stopping. Jonathan talks about living with PSSD in an interview with Moral Medicine.
What can I do?
These medicines help many people. If you have side effects, that’s a decision for you and your prescriber. Don’t stop suddenly.
Print the criteria, which are free to read, and take a short written history to your GP:
- Your medicine: “Sertraline 50 mg from January 2023, last tablet March 2024.”
- What changed: “Touch feels numb”, “orgasm with no pleasure”.
- When it started: before, while taking it, or after stopping.
- How it was before: “No problems before 2023.”
- What else they will ask about: other medicines, contraception, alcohol, diabetes, the menopause.
Ask for PSSD to go on your record. Since October 2024, NHS records have had a code for lasting sexual problems after stopping an SSRI.
Many people say it took time to be taken seriously. Bring the leaflet’s line about problems that continue after stopping. You can report it without a doctor agreeing.
Report it: it helps everyone
A doctor’s note helps you. A report to the medicines regulator helps everyone else: it is how patterns get noticed.
- No proof needed. A suspicion is enough, even years after stopping.
- Where: the Yellow Card scheme in the UK, MedWatch in the US.
- Use the right words. If symptoms continued after stopping, write Post-SSRI sexual dysfunction (MedDRA 10086208).
Our reporting guide walks you through it
What else do people ask?
Will I still need blood tests? Possibly. The criteria ask a doctor to rule out other medical causes, and that can mean tests. Borderline hormone levels are sometimes found in PSSD, but they “may be a consequence of the conditions rather than a cause”, the authors note. Normal results don’t rule PSSD out.
Can I be diagnosed while I’m still taking it? It’s possible. For someone who can’t stop their antidepressant, the authors write that “a provisional diagnosis might be warranted”. You don’t have to stop before you raise it with your GP. Any change to your medicine is a decision for you and your prescriber.
Can women be diagnosed with PSSD? Yes. The same criteria apply, and a change in genital feeling counts in the same way. They add one sign for women, less vaginal lubrication, and list reduced nipple sensitivity for everyone. Our article on PSSD in women covers what women describe.
For Rosie, getting her symptoms acknowledged was a struggle. Start with one page about your medicine and what changed, and take it to your GP with the criteria and our page on PSSD.
Sources
- Healy D, Bahrick A, Bak M, et al. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. International Journal of Risk & Safety in Medicine, 2022; 33(1): 65–76. A consensus of 37 authors in ten countries, led from McMaster University, Canada. Drafted from two published case series (Hogan and colleagues, 2014; Healy and colleagues, 2018) built on reports people chose to send to RxISK.org, and revised “until agreement was reached”. The paper reports no test of the criteria on patients. Three authors declare links to RxISK.org. Open access (CC BY-NC 4.0).
- Lundbeck Limited. Cipralex (escitalopram) patient information leaflet, electronic Medicines Compendium. Section 2: sexual problems “have continued after stopping treatment” in some cases. Section 3: withdrawal symptoms usually go within two weeks, and in some people last 2 to 3 months or more.
- Lundbeck Limited. Cipralex summary of product characteristics, section 4.4 (text revised May 2025): “reports of long-lasting sexual dysfunction where the symptoms have continued despite discontinuation”.
- UK Parliament. Written question HL7363, asked by Lord Alton of Liverpool on 12 May 2025, answered for the Department of Health and Social Care by Baroness Merron on 16 May 2025. Covers the 2019 product information update, the 2021 MedDRA term, the SNOMED code added in October 2024, the MHRA’s expert working group on how leaflets communicate the risk, and the MHRA’s remit.
- National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), 2022, recommendation 1.8.3.
- Atlantis E, Sullivan T. Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis. Journal of Sexual Medicine, 2012; 9(6): 1497–507. Six prospective studies of 3,285 people followed for 2 to 9 years.
- Medicines and Healthcare products Regulatory Agency. Yellow Card scheme: “Anyone can report an issue with a medicine”.
- MedDRA lowest level term Post-SSRI sexual dysfunction, code 10086208 (MedDRA version 28.0).
- Moral Medicine. Interview with PSSD Network President Rosie, YouTube, 9 July 2024.
- Moral Medicine. Jonathan’s Experience as a PSSD Sufferer, YouTube, 15 January 2024.
This information does not replace medical advice. Talk to your doctor before you make any decision about your treatment.
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