Abstract
INTRODUCTION AND OBJECTIVES:
Post-SSRI Sexual Dysfunction (PSSD) is identified in patients with no sexual dysfunction prior to SSRI use and, after stopping medication, have persistent sexual dysfunction ≥ 6 months. We assessed sexual symptoms and hormonal, neurologic and vascular pathophysiologies in men at our clinic diagnosed with PSSD.
METHODS:
Charts between 2009 - 2024 of men who met inclusion criterion for PSSD were reviewed. Data at initial presentation included hormone blood tests, quantitative sensory testing involving vibration, warmth and cold perception threshold testing, and vascular testing using grayscale/duplex Doppler ultrasound (G/DUS) during pharmacologic erection. Using Fuji version 1.53, percent hypoechoic area in proximal, mid-shaft, and distal regions were analyzed and compared to non-PSSD men with ED from: 1) blunt penile/perineal trauma history and 2) vascular risk factor exposure. Two-way ANOVA followed by post-hoc pairwise comparisons between groups within each penile region were performed using Tukey’s test.
RESULTS:
43 men, mean age 27.6 y (range 16-43), met inclusion. Median age starting the SSRI was 21.2 (11-35y) with 30.2% <18 y (minors). Median duration of SSRI use was 12 (0.13-252) months; 20.5% used SSRI <1 month. Median time off SSRI use was 21 (3.5-324) months. 88% had abnormal IIEF-EF domain scores,with median desire domain 3 (range 2-10), and median orgasm domain 6 (range 1-10). Reduced genital sensation was reported by 92%. There was significant sexual distress (mean SDS-R score 37.4). Mean IIEF of patients presenting with ED was 8.8±8.0, consistent with severe ED. Testosterone/dihydrotestosterone blood tests were in the upper tertile in only 21.9%/14.8%, respectively. Quantitative sensory testing revealed 89% had abnormal results. GUS findings showed erectile tissue inhomogeneity similar to the older (65.6±8.5 y) controls (n=16) with vasculogenic ED, and significantly greater (p<0.0001) than the similar age cohort (32.1±8.3 y) with ED from perineal/penile trauma (n=15).
CONCLUSIONS:
This is the largest chart review of PSSD to date. PSSD occurs in young men, is associated with severe ED and other sexual issues. It is hypothesized that: ED is in part from SSRI-induced increased intracavernosal oxygen radical formation causing diffuse erectile tissue fibrosis; and reduced sensation/orgasm/libido is from SSRI-induced altered CNS neuron, synapse and neurotransmitter function. Informed consent prior to use of SSRI is appropriate.
