How is PSSD diagnosed if there's no test?
How doctors diagnose PSSD without a test, why your GP may not have heard of it, and whether it could be depression or withdrawal.
Looking for a test that shows PSSD? There isn’t one. No blood test or scan picks up post-SSRI sexual dysfunction (PSSD), a condition that can last after stopping an SSRI or SNRI antidepressant.
Instead, a doctor diagnoses it from your history, using proposed criteria from 2022.
Rosie developed PSSD after she was prescribed Lexapro (escitalopram). In 2024, as president of the PSSD Network, she described symptoms that had lasted about four years, and how hard it was to get doctors to acknowledge them.
Your GP may never have seen the criteria. Their authors say conditions like PSSD are “little known and poorly understood by healthcare professionals”.
So how does a diagnosis work, and what can you do?
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. These are proposed criteria, built from reports people sent to a drug-safety website and not yet tested on patients. The authors expect them to “need modification”.
PSSD is more than sexual problems. Its core is a lasting change in how the genitals feel, often numbness, and the criteria also list emotional numbing, problems with cognition and changes in other senses.
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. “Emotional and genital numbing commonly go together,” they add. So mention both, 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 changes have lasted years after stopping. Watch Jonathan describe living with PSSD in his 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.
Three questions for your GP
- Have you seen the 2022 criteria for PSSD?
- What else could explain my symptoms, and how do we check?
- Can PSSD go on my record while we look into it?
You could start with: "My symptoms started with an antidepressant and haven't gone since I stopped. Can we go through these criteria?"
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, 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.
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.
Rosie had to fight to be heard. Take one page about your medicine and what changed 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.
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