How is PSSD diagnosed?
PSSD is diagnosed from your history, not a test, using criteria published in 2022. They are not official guidance, so you may need to bring them.
PSSD is diagnosed from your history, because there is no test for it. Criteria published in 2022 ask for two things: you took an SSRI or SNRI antidepressant, and the feeling in your genitals changed and stayed changed after you stopped. Yet those criteria are a proposal from 37 doctors and researchers, not official guidance, and your doctor may not have come across them.
That gap matters more than the missing test. A diagnosis from history works only when the doctor knows what to ask, and the change that decides this one, in genital sensation, can hide behind low desire. Until the criteria are part of official guidance, recognition often depends on you bringing them.
How PSSD is diagnosed without a test
The 2022 criteria are a consensus, not a tested tool, and for PSSD they have three parts.
- Two things must be present. You took a serotonin reuptake inhibitor, such as an SSRI or SNRI antidepressant. And your genital sensation changed, in touch, sexual feeling or both, and stayed changed after you stopped.
- Other signs support it. Lasting loss of desire, erection problems and weaker or absent orgasms also count.
- Other explanations must be absent. There should be no matching problem before the drug, and nothing else, such as another condition, medicine or substance, that could explain it.
The authors’ consensus is that “once dysfunction lasts for three months, it is more likely to be PSSD”, a judgement rather than a measured line. They wrote the criteria “in the absence of a biomarker”, a measurable sign such as a blood result. Quantitative sensory testing of the penis may help assess touch where it is offered, but for sexual sensation the paper says “there are no available tests”.
A journal paper, not a guideline
The criteria come from a paper in the International Journal of Risk & Safety in Medicine by 37 authors in ten countries, led by David Healy of McMaster University in Canada. They drafted the criteria from two case series, of 120 and 300 cases, drawn from reports people sent to RxISK.org, a drug safety website, and revised them “until agreement was reached”.
That makes the criteria a consensus, with the limits of one. The reports came from people who chose to send them, and the paper reports no test of the criteria on patients. It also declares that three authors are linked to RxISK.org, and says several petitioned regulators for the label warnings.
Official bodies have taken three steps since 2019, and none of them tells a doctor how to diagnose PSSD.
Official bodies warned, coded and recorded it. Researchers wrote the criteria.
The UK escitalopram label, updated like every SSRI label in 2019, says: “There have been reports of long-lasting sexual dysfunction where the symptoms have continued despite discontinuation”.
But a label records reports. Telling a doctor what to look for is the job of clinical guidance, which in England is written by NICE. Its 2022 guideline on depression lists “long-term effects on sexual function” among the risks of taking antidepressants long term. It does not mention sexual problems that continue after stopping, and nor does NICE’s 2022 guideline on medicines linked to withdrawal symptoms.
In May 2025 a member of the House of Lords asked whether the government planned to recognise PSSD as a condition. The answer pointed to the label, the dictionary term and the record code. It added that the MHRA, the UK medicines regulator, has an expert group on patient leaflets, but its work “will not address the clinical recognition” of PSSD, “as that is outside the remit of the MHRA”. It did not say whose remit it is.
We think the kind of evidence explains both the limits of the criteria and the gap in guidance. Guidance tends to follow numbers. Case reports can show that something happens but never how often, and clinical trials “do not routinely include follow-up” of sexual side effects, the criteria’s authors note. A consensus is a fair way to begin when there is no test, and the authors expect their criteria to “need modification”. A study applying them to people who did and did not take an antidepressant would show how well they work.
Ruling out other causes, fairly
If you have been told it is anxiety, depression or “in your head”, the criteria’s authors have described that risk. These conditions are “little known and poorly understood by healthcare professionals”, they wrote, and neglecting them risks “misdiagnosis as a psychogenic problem”, meaning one assumed to come from the mind.
The question behind it is still fair. A 2012 review of six studies, following 3,285 people for two to nine years, found depression raised the risk of sexual problems by about 50 to 70%, a relative figure: the review gives no starting rate. That held in two of its three analyses, and six studies is a small base.
The criteria do not treat PSSD as whatever is left over: they require a change in genital sensation, which the authors say seems “distinctive to PSSD”. A 2026 review also uses genital numbness to tell PSSD apart from returning depression, though it only summarises studies published up to April 2024. A mental health diagnosis, the criteria add, does not rule PSSD out.
Withdrawal is told apart by time, and by the kind of symptom. The escitalopram label says withdrawal symptoms, which include “electric shock sensations”, usually clear within two weeks, though in some people they “may be prolonged (2-3 months or more)”. The three-month mark sits at the edge of that range, so a doctor who suggests waiting when you are six weeks past your last dose is not being unreasonable.
For some people, the waiting ends with symptoms that do not pass. Jonathan talks about living with PSSD in an interview with the Moral Medicine channel.
Do not stop or change a medicine because of anything on this page.
You do not need to stop a medicine to raise this with a doctor: for someone who cannot stop, the criteria say "a provisional diagnosis might be warranted". The UK prescribing information for escitalopram says "abrupt discontinuation should be avoided". Any change belongs in a conversation with the person who prescribed it.
The last checks cover other medicines, substances and medical conditions, which can mean blood tests, including hormone levels, and a check of the nerves. Borderline hormone levels are sometimes found in PSSD, the criteria note, and “may be a consequence of the conditions rather than a cause”. Normal results do not count against PSSD. They count against the other explanations.
Taking the criteria to your GP
The paper is free to read, so print it and take it with a written history: which medicine you took and roughly when, when the change began, how long it has lasted since your last dose, and what things were like before. Then name the kind of change, whether touch feels dulled or registers but no longer feels sexual. PSSD in women covers the signs women describe.
- Ask for it to be recorded. Since October 2024, NHS records have had a SNOMED code for persistent sexual dysfunction after stopping an SSRI. What your notes say is what the next doctor reads.
- Report it. Anyone can report to the MHRA’s Yellow Card scheme, so you do not need a doctor to agree with you. Use the term in the box below, from MedDRA, the dictionary regulators use to file reports.
- Join the patient registry. A report is a snapshot. The registry follows people over months and years, and how many people recover fully “has never been properly investigated”, the criteria’s authors write. Its members chose to join, so it cannot say how common PSSD is.
MedDRA code 10086208
English term: Post-SSRI sexual dysfunction
Use it if you took an SSRI or SNRI and the problems continued after you stopped. Write that exact wording in the free-text box, then describe your symptoms in your own words. “PSSD” on its own is not in the dictionary. Our reporting guide covers the UK, the US and other countries.
No test proves PSSD, and the criteria mean none is needed to recognise it. What recognition needs is a doctor who knows they exist. Until official guidance carries them, that often starts with you: the paper, your history, and your record in the registry.
If you are struggling with your mental health, the Samaritans are on 116 123 in the UK, free, at any hour. In the US, call or text 988.
This information does not replace medical advice. Talk to your doctor before you make any decision about your treatment.
570+ people have joined the registry.
Join them, then report your side effects.
- Put your condition on the record
- Be first to hear about studies you can join
- Then report your side effects to your regulator