PSSD or performance anxiety? How to tell

Anxiety can cause erection problems, the NHS says, and so can nerves about sex itself. Numb genitals and weaker orgasms can point elsewhere. If they started on an SSRI antidepressant, such as sertraline, and stayed after stopping, they fit something a UK leaflet warns about: post-SSRI sexual dysfunction (PSSD).

If you were given the tablets for anxiety, anxiety is the obvious explanation, for you and your doctor. PSSD is more than a sex problem, though. The checklist doctors and researchers agreed in 2022 to recognise it also lists feeling emotionally numb, problems with concentration and memory, and changes in senses such as smell or taste.

Guides for telling nerves from a physical cause, including one NHS checklist, ask about your erections. Do they still work on your own, or when you wake up? After an SSRI, those tests can point the wrong way. The better question is how things feel.

Cael was 18 or 19 when his doctor prescribed an SSRI for anxiety and panic attacks. Here he describes the first change: “just a little bit of erectile dysfunction”, and orgasms that took longer. More than a year after his last medicine, he says, his genitals are still numb.

Play video: Cael on the first sexual side effects of his antidepressants (extract)

Can anxiety cause erection problems?

Yes. The NHS says an erection that fails now and then is usually down to stress, tiredness or alcohol. When it happens often, anxiety is one of the causes it lists.

Performance anxiety is worry about sex itself. The International Society for Sexual Medicine describes a man so worried about getting an erection and pleasing his partner that he struggles when the moment comes.

The NHS says that, depending on the cause, you may still get erections at other times, such as when you wake up. An NHS checklist for Scottish doctors counts good erections on your own, or on waking, as a sign the cause may be psychological.

Our guide to erection problems at 20 covers the everyday causes.

How is PSSD different from performance anxiety?

PSSD changes feeling, not only erections. The checklist has one symptom you must have: a lasting change in how your genitals feel, to touch or during sex. Orgasms that feel weak, or bring little pleasure, are another sign.

People describe it as numbness, as if from an anaesthetic. Our page on genital numbness covers its other possible causes, some of which need a doctor quickly.

In 2018, doctors who later helped write the checklist said “neither genital anaesthesia nor pleasureless orgasm are features of depression or anxiety”. A 2015 survey of people from a PSSD forum points the same way: how anxious people were had no link with numbness, or with how bad their sexual problems were. Both looked only at people who came forward, so neither shows how common PSSD is.

If morning erections have faded, note that too. The checklist lists fewer or no night-time erections in men as a possible sign.

1

Is it only with a partner?

Or alone too? Note both for your GP.

2

Does touch feel the same?

A lasting change in genital feeling is the core of PSSD.

3

Does orgasm feel the same?

Weak orgasms, or ones with little pleasure, are another PSSD sign.

4

When did it start?

Before the tablets, while taking them, or after stopping.

Why might a doctor say it’s anxiety?

Perhaps because anxiety is why you were given the tablets. The UK sertraline leaflet lists panic disorder and social anxiety among its uses.

The usual signs can mislead, too. That NHS checklist counts a sudden start, and being unable to ejaculate, as signs of a psychological cause. An SSRI can do both. Researchers behind the PSSD checklist say these medicines can change sex from the first dose, and the sertraline leaflet lists “ejaculation failure” as very common.

A 2024 paper notes how some doctors reason once you’ve stopped: the drug has left your body, so any lasting problem must be psychological. The 2022 checklist warns that PSSD can be mistaken for a psychological problem.

Rosie started escitalopram (Lexapro) in 2020. Within about a month, she says, her emotions had gone flat, sex had become a serious problem and her vision had changed. Here she remembers telling her psychiatrist she couldn’t feel anything. He said it was probably her anxiety, not yet controlled well enough.

Play video: Rosie on being told it was anxiety (extract)

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.

Before you see your GP, write down how things feel, not only whether erections work. For example: “Sertraline 50 mg from January 2023, last tablet March 2024. No problems before. Now touch feels numb, on my own as well as with my partner. Orgasms feel weak.”

Our guide to how PSSD is diagnosed explains the checklist. Many people say it took time to be taken seriously. Bring the leaflet line. 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?

Can I have anxiety and PSSD at the same time? Yes. The checklist says a current mental health diagnosis “does not prevent” a PSSD diagnosis. Researchers behind it have also written that lost desire and erection problems may follow on from the numbness. For low mood, see PSSD or depression.

Could it be porn? Some people online blame porn. A 2019 study of porn users found no link between watching it and how erections changed over a year. It measured erections only, not genital feeling or orgasm.

How soon can it count as PSSD? Not straight away. The checklist says ordinary side effects can linger for days or weeks after the last tablet. Once problems last three months, it says, PSSD is more likely. You don’t have to wait that long to see your GP or report it.

Cael’s first change was a small one, and easy to put down to nerves. If your genitals have felt different ever since the tablets, even on your own, read more about PSSD and report it: a report counts even years later.

Sources

1. NHS, Erectile dysfunction (impotence), page last reviewed 28 July 2023, read 27 October 2026. Occasional problems are “usually caused by stress, tiredness or drinking too much alcohol”; “It can also be a side effect of some medicines.” If it happens often, causes include “depression or anxiety”. “Depending on the cause, you may still be able to get an erection at other times, such as when you wake up.” It names no medicine. It doesn’t say a problem can continue after a medicine is stopped.
2. Lustral (sertraline) 50 mg and 100 mg film-coated tablets, patient leaflet, Viatris, Electronic Medicines Compendium (EMC 2835), last revised December 2025, read 27 October 2026. Section 1: used for depression, social anxiety disorder, post traumatic stress disorder and panic disorder in adults, and obsessive compulsive disorder. Section 2, “Sexual problems”: “In some cases, these symptoms have continued after stopping treatment.” Section 4: “ejaculation failure” very common; “decreased sexual interest” and “erectile dysfunction” common.
3. Baxter R. How can I manage performance anxiety and psychogenic erectile dysfunction (ED)? International Society for Sexual Medicine, Sexual Health Q&A, 20 December 2020. A man may become so anxious about getting an erection and pleasing his partner that he has difficulties during sex. ED sometimes has both psychological and physical causes, so a full medical exam comes first.
4. NHS Lothian, Psychogenic versus organic erectile dysfunction, one-page clinicians’ handout (file dated July 2024). “Suggest psychogenic”: sudden onset; good quality spontaneous, self-stimulated or waking erections; premature ejaculation or inability to ejaculate; among others. “Suggest organic” includes prescription drugs.
5. Healy D, Bahrick A, Bak M and colleagues. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med 2022;33(1):65-76. Proposed criteria agreed by experts, not an official diagnosis. Necessary: “An enduring change in somatic (tactile) or erogenous (sexual) genital sensation after treatment stops”. Additional: “Enduring inability to orgasm or decreased sensation of pleasure during orgasm”. Ancillary sexual symptoms include “decreased or loss of nocturnal erections (males)”; non-sexual symptoms include “emotional numbing”, “other sensory problems involving skin, smell, taste or vision” and “cognitive impairment”. “A current diagnosis of a mental health disorder does not prevent a diagnosis”. Ordinary side effects “may linger for some days or weeks”; “once dysfunction lasts for three months, it is more likely to be PSSD”. Neglect risks “misdiagnosis as a psychogenic problem”.
6. Healy D, Le Noury J, Mangin D. Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases. Int J Risk Saf Med 2018;29(3-4):125-134. Reports sent to RxISK.org, with no comparison group. “Neither genital anaesthesia nor pleasureless orgasm are features of depression or anxiety”. Serotonin reuptake inhibitors “almost invariably affect sexual functioning and do so after a first dose”. Loss of libido and dysfunction against a background of numbness “may reflect secondary effects”.
7. Ben-Sheetrit J, Aizenberg D, Csoka AB and colleagues. Post-SSRI sexual dysfunction: clinical characterization and preliminary assessment of contributory factors and dose-response relationship. J Clin Psychopharmacol 2015;35(3):273-8. Online survey of 532 people recruited through a PSSD forum. Abstract: anxiety did not predict how severe current sexual dysfunction was; “Genital anesthesia did not correlate with depression or anxiety”. Selection and report biases mean it can’t estimate how often PSSD happens.
8. Healy D, Mangin D. Post-SSRI sexual dysfunction: barriers to quantifying incidence and prevalence. Epidemiol Psychiatr Sci 2024;33:e40. “Invalidating responses revolve around the notion that the medication is no longer in the body and therefore any enduring problem must be psychological.”
9. Grubbs JB, Gola M. Is pornography use related to erectile functioning? J Sex Med 2019;16(1):111-125. Three samples of men who used porn (the abstract names the US for two), one followed for a year. No significant link between pornography use and the course of erectile function over time; self-reported “problematic use” went with erection problems at the same point in time. Erectile function only, by questionnaire.
10. Moral Medicine, From Anxiety to PSSD: How Antidepressants Destroyed My Life | Cael’s Story, 18 August 2025 (the title is the channel’s). From the auto-captions, read 12 October 2026: prescribed an SSRI (Lexapro) at “18, 19” for anxiety and panic attacks; later the dose was raised and Effexor (venlafaxine), an SNRI, added. “Just a little bit of erectile dysfunction” and taking longer to orgasm (5:33 to 5:40). His doctor said this was common. More than a year and four months after his last medicine: “my genitals are still numb” (13:49 to 14:01). His story on our site: Cael’s story.
11. Moral Medicine, Interview with PSSD Network President Rosie, 9 July 2024. From the auto-captions: escitalopram (Lexapro) from August 2020 (6:03 to 6:15). Within about a month: emotional blunting, sexual problems, changes in vision and problems concentrating (7:16 to 7:43). Weeks later she told her psychiatrist she couldn’t feel love or anything. He said it was probably because her anxiety wasn’t yet controlled well enough (8:47 to 9:26; the extract stops before he suggests a higher dose).
12. MedDRA lowest level term Post-SSRI sexual dysfunction, code 10086208.

Sources checked on 27 October 2026. AI-assisted writing and review, not clinical review.