Why do SSRIs cause sexual side effects?

SSRI antidepressants, such as sertraline and citalopram, raise the level of serotonin, a chemical messenger in the brain and body. Serotonin seems to work like a brake on desire, arousal and orgasm. For some people these problems stay after the last tablet. This is called post-SSRI sexual dysfunction (PSSD), and nobody knows why yet.

PSSD is more than sex, even though the name says so. In 2022 doctors and researchers agreed a checklist to recognise it. At its core is a lasting change in how the genitals feel, often numbness. It also lists feeling emotionally numb, problems with concentration and memory, and changes in other senses.

Doctors have a working explanation for the brake while you’re on the tablets. Why it sometimes stays on after you stop is still unexplained. One person in a 2019 study said a gynaecologist told them: “they know this happens but they do not know why”.

How do SSRIs lower your sex drive?

They turn down the brain’s “go” signals for sex. Nerve cells, the body’s wiring, pass messages using chemicals like serotonin. Once the message is passed on, they soak it back up. An SSRI blocks that, so more serotonin stays around. That’s the “reuptake” in the name: selective serotonin reuptake inhibitor.

Serotonin holds back two other messengers, dopamine and noradrenaline, a 2010 review explains. Both help you want sex and get aroused. Dopamine powers the brain’s reward system, which makes you want things.

It also cuts nitric oxide, a chemical that lets blood flow into the genitals, the same review says. Less of it can mean a weaker erection or less natural lubrication.

Don’t treat this as settled. In 2010, two doctors writing for psychiatrists called the evidence linking serotonin to sexual problems “inconclusive”. One reason: no medicine acts on serotonin alone.

What is known, and what isn't

On the tablets

Serotonin brakes sexThere is a working explanation.

After the last tablet

The drug leaves the bodyThe effects are expected to clear.

Months or years later

For some, the problems remainNobody knows why yet.

Why do SSRIs dull orgasm and genital feeling?

Serotonin slows the build-up to orgasm and ejaculation. The effect is strong enough that one SSRI, dapoxetine, is licensed to delay ejaculation.

Taken daily for depression, the same effect can go too far. The UK sertraline leaflet says not being able to ejaculate may affect more than 1 in 10 people. In women, the 2010 review lists problems with orgasm and lubrication.

Feeling changes too. Most of the body’s serotonin sits outside the brain, where it can directly dull feeling in the genitals, the review says. The authors of the 2022 checklist go further: they write that almost everyone who starts an SSRI has some change in genital feeling within an hour, though not everyone notices.

In PSSD that numbness gets stronger and stays. Some people say their genitals feel “like they were exposed to an anesthetic”, the checklist notes.

Connor told BBC News about it. Numbness was his first side effect on sertraline. Almost a year after his last tablet, it was still there.

Play video: Connor on genital numbness after sertraline (BBC News, extract)

Why do the problems carry on after stopping?

A 2022 review calls the biology behind PSSD “unclear”.

For some people, the problems are still there months or years after the drug has left the body. Daryl kept asking his doctors when it would go away.

Play video: Daryl on asking when it would go away (extract)

First a few weeks, he says they told him, then a few months, then a year or more. When he gave the interview, it had been 13 years. There’s no way yet to tell who will be affected, or whether it will ease.

Researchers have theories. None has been proven in people with PSSD:

• The brain’s settings stay changed. Serotonin passes on its message through docking points on nerve cells, called receptors. Some may adapt to the drug and stay turned down (2018 review).
• Genes are switched on or off differently. A drug can change how genes work without changing the genes. An Italian team gave rats paroxetine, another SSRI. A month after the last dose, a few genes were still working differently in a brain area involved in sex.
• The brain’s own steroids shift. These are hormone-like chemicals the brain makes itself. The same team, led by Professor Roberto Melcangi in Milan, thinks changes in them may also link PSSD to post-finasteride syndrome, which follows the hair-loss drug finasteride.
• Cells keep an electrical memory. In a 2020 paper, tiny flatworms soaked in fluoxetine (Prozac) still had changed electrical charge in their cells a week later. The authors say this hasn’t been shown in human tissue.

What can I do?

These medicines help many people. If you have side effects now, any change is a decision for you and your prescriber. Don’t stop suddenly.

If problems haven’t lifted since you stopped, tell your GP and give your dates: “Sertraline 50 mg from January 2023, last tablet March 2024.” Say everything that changed, outside sex too, and how things were before.

Many people say it took time to be taken seriously. 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?

Is PSSD in the brain or in the nerves? Nobody can say yet. A small London study in 2026 found normal nerve tests in almost all its patients with PSSD numbness, which the team thinks points to the brain. A US clinic found signs of nerve damage in two of three men with lasting problems after medicines including SSRIs. Our page on numbness studies has more.

Could it just be my depression? Depression itself can lower sex drive. So the checklist asks whether the same problems were there before the medicine. A lasting change in genital feeling is the sign it puts first.

Do SNRIs work the same way? SNRIs, a related group of antidepressants such as venlafaxine and duloxetine, also stop serotonin being soaked back up. In 2019 the EU medicines regulator asked for the same warning on them, about problems lasting after stopping. See which antidepressants are linked to PSSD.

That gynaecologist was honest: it happens, and nobody knows why yet. Not knowing why doesn’t make it any less real. If it’s happened to you, a report puts it on the record. Our PSSD page explains more.

Sources

1. Higgins A, Nash M, Lynch AM. Antidepressant-associated sexual dysfunction: impact, effects, and treatment. Drug Healthc Patient Saf 2010;2:141-150. Serotonin nerve endings target dopamine and noradrenaline pathways “and inhibit their activity”. Both have “a role in the desire and arousal phases”. Also: “serotonin inhibits nitric oxide production”. And: “80% of serotonin is localized in the periphery”, where “it directly reduces sensation” in the reproductive organs.
2. Shaw J, Lai C, Bota P and colleagues. The off-label use of selective serotonin reuptake inhibitors for sexual behavior management: risks and considerations. Healthcare (Basel) 2025;13(19):2433. SSRIs act through serotonin receptors “to inhibit dopaminergic tone in the mesolimbic and spinal pathways” (abstract).
3. Prabhakar D, Balon R. How do SSRIs cause sexual dysfunction? Current Psychiatry 2010;9(12):30-34. “Evidence linking serotonin to sexual dysfunction is inconclusive.”
4. Viatris Products Limited. Lustral (sertraline) package leaflet, electronic Medicines Compendium, last revised December 2025. Section 1: sertraline is an SSRI. Section 2: “In some cases, these symptoms have continued after stopping treatment.” Section 4: ejaculation failure under “Very common (may affect more than 1 in 10 people)”.
5. European Medicines Agency. Priligy (dapoxetine) package leaflet, annex III, article 29 referral, 2012. Section 1: dapoxetine belongs to the SSRIs; it “increases the time it takes to ejaculate”.
6. 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 an expert group. Section 3, necessary criterion: “An enduring change in somatic (tactile) or erogenous (sexual) genital sensation after treatment stops”. Criterion 7: “No evidence of pre-drug sexual dysfunction that matches the current profile”. Ancillary non-sexual symptoms: “emotional numbing”, “depersonalization”, “other sensory problems involving skin, smell, taste or vision”, “cognitive impairment”. Also: “Close to all people taking an SRI have some alteration of genital sensitivity within an hour of starting treatment.” It “may be noticeable or obscured by an apparent benefit”. Some say genitals “feel like they were exposed to an anesthetic”.
7. Healy D, Le Noury J, Mangin D. Post-SSRI sexual dysfunction: patient experiences of engagement with healthcare professionals. Int J Risk Saf Med 2019;30:167-178. Questionnaire answered by 62 people recruited through RxISK.org. Participant P47, section 3.2, quoted as published. Discussion: the drug “may have been out of the patient’s body for months or years”.
8. Peleg LC, Rabinovitch D, Lavie Y and colleagues. Post-SSRI sexual dysfunction (PSSD): biological plausibility, symptoms, diagnosis, and presumed risk factors. Sex Med Rev 2022;10(1):91-98. Abstract: “the underlying neurobiological mechanisms of which are unclear”; theories include “epigenetic gene expression, dopamine-serotonin interactions, serotonin neurotoxicity and hormonal changes”. Read as the abstract only.
9. Healy D, LaPalme J, Levin M. Post-SSRI sexual dysfunction: a bioelectric mechanism? Bioelectricity 2020;2(1):7-13. Planarian flatworms soaked in fluoxetine for 3 days, imaged after 1 week in water. “At present, there is no agreement as to how the sensory changes on SSRIs come about.” “Bioelectric memory has not yet been demonstrated in human patient tissues.” Lidocaine comparison.
10. Bala A, Nguyen HMT, Hellstrom WJG. Post-SSRI sexual dysfunction: a literature review. Sex Med Rev 2018;6(1):29-34. Abstract lists theories including “downregulation of 5-hydroxytryptamine receptor 1A”. Read as the abstract only.
11. Giatti S, Cioffi L, Diviccaro S and colleagues. Transcriptomic profile of the male rat hypothalamus and nucleus accumbens after paroxetine treatment and withdrawal. Mol Neurobiol 2025. Rats treated daily for two weeks; some gene changes in the nucleus accumbens still present at one month of withdrawal. Read as the abstract only. Animal study.
12. Giatti S, Diviccaro S, Cioffi L, Melcangi RC. Post-finasteride syndrome and post-SSRI sexual dysfunction: two clinical conditions apparently distant, but very close. Front Neuroendocrinol 2024;72:101114. Proposes common mechanisms involving neuroactive steroids, neurotransmitters and gut microbiota. Read as the abstract only.
13. Valnarov-Boulter I, Noronha A, Malladi P and colleagues. Genital sensory loss in persistent sexual dysfunction following SSRI exposure. International Continence Society 2026, abstract 302. Pelvic nerve tests normal in eight of nine PSSD patients; the authors suggest “a centrally-mediated mechanism”. Conference abstract.
14. Stachelek J, Zwaans BMM, Shtein R, Peters KM. Insights into the peripheral nature of persistent sexual dysfunction associated with post-finasteride, post-SSRI and post-accutane syndromes. Int Urol Nephrol 2025. Three men treated at a US urology clinic; “Peripheral neuropathy was noted in two patients via corneal confocal microscopy”. Case study, read as the abstract only; the abstract names retinoids, finasteride/saw palmetto and SSRIs as the medicines implicated, without saying which man took which.
15. BBC News, Antidepressants: Should we talk about side-effects?, 11 August 2023. Connor (not his real name), extract 5:54 to 6:27. From the YouTube auto-captions: “the first side effect was total genital numbness” (5:54); “I stopped taking Sertraline almost 12 months ago and I still have numbness in my genitals” (6:08).
16. Moral Medicine, 13 Years of Post SSRI Sexual Dysfunction (PSSD), interview with Daryl, 17 October 2024, extract 8:56 to 9:26: the answers he says he was given, from weeks to a year or more. 13 years at the time of the interview. From the YouTube auto-captions. His story on our site: Daryl’s story.
17. European Medicines Agency, Pharmacovigilance Risk Assessment Committee. PRAC recommendations on signals adopted at the 13-16 May 2019 PRAC meeting, EMA/PRAC/265212/2019, section 1.3: all SSRIs and the SNRIs duloxetine, venlafaxine, desvenlafaxine and milnacipran, “Persistent sexual dysfunction after drug withdrawal”.

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