Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin

David Healy*, Audrey Bahrick, Maarten Bak, Angelo Barbato, Rocco Salvatore Calabrò, Barbara M Chubak, Fiammetta Cosci, Antonei B Csoka, Barbara D'Avanzo, Silvia Diviccaro, Silvia Giatti, Irwin Goldstein, Heiko Graf, Wayne J G Hellstrom, Michael S Irwig, Emmanuele A Jannini, Paddy K C Janssen, Mohit Khera, Manoj Therayil Kumar, Joanna Le NouryMichał Lew-Starowicz, David E J Linden, Celine Lüning, Dee Mangin, Roberto Cosimo Melcangi, Omar Walid Muquebil Ali Al Shaban Rodríguez, Jalesh N Panicker, Arianna Patacchini, Amy M Pearlman, Caroline F Pukall, Sanjana Raj, Yacov Reisman, Rachel S Rubin, Rudy Schreiber, Stuart Shipko, Barbora Vašečková, Ahad Waraich

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: A set of enduring conditions have been reported in the literature involving persistent sexual dysfunction after discontinuation of serotonin reuptake inhibiting antidepressants, 5 alpha-reductase inhibitors and isotretinoin.

OBJECTIVE: To develop diagnostic criteria for post-SSRI sexual dysfunction (PSSD), persistent genital arousal disorder (PGAD) following serotonin reuptake inhibitors, post-finasteride syndrome (PFS) and post-retinoid sexual dysfunction (PRSD).

METHODS: The original draft was designed using data from two published case series (Hogan et al., 2014 and Healy et al., 2018), which represent the largest public collections of data on these enduring conditions. It was further developed with the involvement of a multidisciplinary panel of experts.

RESULTS: A set of criteria were agreed upon for each of the above conditions. Features of PSSD, PFS and PRSD commonly include decreased genital and orgasmic sensation, decreased sexual desire and erectile dysfunction. Ancillary non-sexual symptoms vary depending on the specific condition but can include emotional blunting and cognitive impairment. PGAD presents with an almost mirror image of unwanted sensations of genital arousal or irritability in the absence of sexual desire. A new term, post-SSRI asexuality, is introduced to describe a dampening of sexual interest and pleasure resulting from a pre-natal or pre-teen exposure to a serotonin reuptake inhibitor.

CONCLUSIONS: These criteria will help in both clinical and research settings. As with all criteria, they will likely need modification in the light of developments.

Original languageEnglish
Pages (from-to)65-76
Number of pages12
JournalInternational Journal of Risk and Safety in Medicine
Issue number1
Early online date26 Oct 2021
Publication statusPublished - 22 Feb 2022


  • Post-SSRI sexual dysfunction
  • antidepressants
  • selective serotonin reuptake inhibitors
  • finasteride
  • isotretinoin


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