PSSD in women: sexual side effects that last

Women get post-SSRI sexual dysfunction (PSSD) too. PSSD in women can mean dulled genital and nipple sensation, low desire, less lubrication and orgasms that are weak or absent, lasting after the antidepressant is stopped. Yet the one study we know of that estimated the risk from medical records counted men alone, because it searched for prescriptions of erection drugs.

It matters because a woman’s symptoms are easy to put down to depression or the menopause, and both deserve checking. One change points elsewhere: lost or altered genital sensation. We think it sets PSSD apart, and it is the change she is least likely to be asked about.

What PSSD in women looks like

In 2019 the European Medicines Agency (EMA) recommended a new warning about sexual side effects for the leaflets of ten SSRI and SNRI antidepressants: “In some cases, these symptoms have continued after stopping treatment”. It is in UK escitalopram leaflets today; the ten are listed on our page about which antidepressants are linked to PSSD.

What those leaflets say about women is brief. They list “delayed ejaculation, problems with erection, decreased sexual drive”, then add that “women may experience difficulties achieving orgasm”. The US escitalopram label lists “decreased libido and delayed or absent orgasm” for female patients. Neither mentions genital numbness.

Yet that is the one symptom the 2022 diagnostic criteria require: a lasting change in genital sensation after the drug stops. Genitals can feel anaesthetised, or touch can stop feeling sexual. Lower desire, weak or absent orgasm, reduced nipple sensitivity and less lubrication can come with it. After three months, the authors write, “it is more likely to be PSSD”. The criteria are an expert consensus, built on case reports.

What is known about women, case by case

The one attempt we know of to count PSSD from medical records, by Ben-Sheetrit and colleagues in 2023, found that 4 of 866 men who had taken a serotonin-acting antidepressant met their definition, about 1 in 216. The records covered 19 years in one district of Israel’s largest health service. Only men could take part: the researchers wanted a sign that did not rely on self-report, so they used prescriptions for erection drugs such as sildenafil. They accept this may underestimate PSSD, and it could never count women.

A survey published in 2024, led by Yassie Pirani of the Canadian Post-SSRI/SNRI Sexual Dysfunction Society, a patient group, included young sexual and gender minority people assigned female at birth. But it gave one combined figure: 93 of 707 past antidepressant users reported lasting genital numbness, against 1 of 102 on other psychiatric drugs, with no separate figure for women. It measured one self-reported symptom in one group, so it cannot say how often PSSD happens to women.

The trials behind the US escitalopram label did include women: 3% of 737 reported lower desire and 3% no orgasm, against 1% and under 1% on a dummy tablet. Side effects were gathered “primarily by general inquiry”, only during treatment, and the label says such figures are “likely to underestimate” the real rate.

So most of what is known about women comes case by case. Doctors described numbness of the vagina and nipples on fluoxetine in 2000 and loss of vaginal sensation on paroxetine in 2002, each in one woman. A 2018 series of reports to RxISK, a drug-safety website, held 50 from women after these antidepressants, and 171 from men. People chose to send them, so they cannot show how often anything happens, only what women describe.

Four of the 50 described the opposite, persistent genital arousal disorder (PGAD): unwanted genital arousal without desire, which feels painful or altered and is barely relieved by sex. Its link to SSRIs rests on case reports, which cannot say how often it happens. Leiblum and Goldmeier, who described five such women in 2008, called the drugs “not a common cause”, though a possible one. The 2022 criteria’s authors call stopping them “one of its commoner triggers”, and list others, such as pelvic injury.

Two widely used questionnaires, the Arizona Sexual Experience Scale and the Changes in Sexual Functioning Questionnaire, do not ask about genital sensation, Healy and Mangin note in a 2024 commentary. We think the gap is built into how PSSD has been counted. Until women are asked about sensation before, during and after treatment, nobody can say how often it happens to them.

Easy to put down to something else

Part of the reason is language. Men sometimes describe PSSD as erectile dysfunction, while women “commonly frame it as a loss of libido”, Healy and Mangin write. Changes in sensation are “not always volunteered unless asked about directly”. PSSD can also begin, or worsen, only after the tablets stop, which hides the link.

Low desire has many causes, and a careful doctor will check them. Depression is one: the escitalopram label says sexual symptoms “may have other causes, including the underlying psychiatric disorder”. The NHS lists vaginal dryness, low mood and a reduced sex drive among the symptoms of perimenopause and menopause. Other medicines count too, hormonal contraception included. The criteria require all of this to be ruled out, which is not the same as doubting you.

A 2007 case from Texas shows what that looks like. A 32-year-old woman felt “totally numb” in her genital region within days of starting citalopram. A year after her last antidepressant the numbness was unchanged, though hormone, thyroid and neurological checks were normal, psychological assessment found no remaining mental illness, her periods were regular and her depression was in remission. One case, after two antidepressants taken in turn, cannot show how common this is. It shows what the pattern can look like.

Sensation is what points past the other explanations. “No mental health disorder causes anaesthesia of the genitals,” Healy and Mangin note. The criteria’s authors write that the sensory changes “seem distinctive to PSSD”, and that they “may be hidden beneath” low desire.

Recognition can still be hard to get. Rosie, president of the PSSD Network, developed PSSD after being prescribed Lexapro (escitalopram). In this interview with Moral Medicine she describes symptoms lasting over four years, and how hard it was to have them medically acknowledged.

Play video: Interview with Rosie, PSSD Network President

What to tell a doctor, and how to report it

Lead with the change in sensation, not only lost desire. Your doctor may not have come across PSSD, so print the 2022 criteria, which are free to read, or our page on how PSSD is diagnosed. Have these ready:

• Name the medicine, the dose and the dates. Say whether it began on the tablets, after stopping, or both.
• Describe each change. Say whether touch feels dulled or no longer feels sexual, and what changed in arousal, orgasm and nipple sensitivity.
• Say what it was like before. The criteria ask for no sign of the problem before the drug.

You can also do three things yourself:

1. Tell whoever prescribed it, whether you still take the medicine or stopped years ago.
2. Report it. In the UK that is the Yellow Card scheme, run by the Medicines and Healthcare products Regulatory Agency (MHRA). In the US it is MedWatch. You need no proof, and no one has to agree first. Regulators code reports in MedDRA, a medical dictionary in which the condition has its own term.
3. Join the registry. Its members chose to join, so it cannot give a rate either, but it can follow symptoms over years. Whether people fully recover has never been properly investigated.

PSSD has mostly been counted in men and, in women, described one case at a time. What would change that is simple: ask women about genital sensation, and keep asking after they stop. Until then, the record is the one people make themselves, with their prescriber, in a report and 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.