Synonyms
Subdivisions
General Discussion
Selective serotonin reuptake inhibitors (SSRIs) are medications effective in treating a variety of conditions such as depression, obsessive compulsive disorder, post-traumatic stress disorder, anxiety disorders, and many, many more. They are thought to work by increasing the amount of serotonin available at certain receptors in the brain. A known side effect of SSRI use is sexual dysfunction (SD), including low libido (hypoactive sexual desire disorder), decreased sexual arousal (female sexual arousal disorder), and/or difficulty or inability to have an orgasm (anorgasmia)[1].
Treatment of mental health conditions requires multiple approaches including medication, psychotherapy, interpersonal support, and lifestyle changes. It can be difficult when a medicine causes SD and challenges one way of connecting with the person(s) you may rely on for support. Let’s get right down to it, so you have the information you need to talk with your care team and make informed decisions about your sexual health.
Signs & Symptoms
Symptoms may vary based on how your body metabolizes medication, the dose of SSRI, and other components yet to be discovered [2]. The range of SSRI-associated sexual symptoms include:
- Decreased desire for sexual intimacy or activity (hypoactive sexual desire disorder)
- Decreased arousal (both spontaneous and responsive arousal) including vaginal dryness (female sexual arousal disorder)
- Inability or difficulty having an orgasm (anorgasmia)
- Decreased sexual satisfaction
Causes
Serotonin plays many roles in the processes that affect sexual desire, arousal, orgasm, and satisfaction. Serotonin can decrease dopamine, a neurotransmitter that contributes to libido and the feelings of sexual pleasure [3]. Furthermore, dopamine itself also regulates levels of prolactin (another hormone); high levels of prolactin are associated with decreased desire, arousal, lubrication, orgasm, and satisfaction [4-5]. Serotonin may also constrict the blood vessels within the genital tract, decreasing blood flow to the genitals during times of sexual arousal that is important for lubrication, clitoral and labial engorgement, and overall genital sensitivity [3,6]. There are many ways serotonin impacts sexual function.
Affected Populations
Studies show that a total of 38-63% of all females, including those not taking SSRI medications, report some SD [7]. The prevalence of SSRI prescription for females is 27.96% and female sexual dysfunction (FSD) is experienced by 32% to 56.9% of them [6, 8-10]. Another study found a FSD prevalence of 44%, broken down into categories like low desire (39%), low arousal (26%) and problems with orgasm (26%) [12]. In summary, there are different ways to measure rates of FSD, so comparing studies is not exact, but in general, rates of FSD tend to be higher in women who take SSRIs.
Diagnosis
Diagnosis is made by your clinician based on your symptoms, medical history, sexual history, social history and discussion about the details and context of your symptoms. To identify FSD related to SSRI use, it is important to clarify the timeline of starting or increasing SSRI use and the start and/or changes in your FSD symptoms. This clinical conversation can be supported by validated clinical assessments like the Female Sexual Function Index or the Decreased Sexual Desire Screener.
Standard Therapies
Talking with your provider about your concerns and experience is the first step. These side effects are valid and appropriate to bring up with your care team just as you would if a medication was causing other side effects that bothered you, like dizziness or headaches. By bringing it to their attention, you can work together to find a treatment plan that meets your goals and allows you to enjoy healthy sexual experiences. If you are taking an SSRI for a condition that is now in remission, then reducing your dose or tapering off the medication could be an option. If you want to continue treatment, reducing the dose of SSRI medication or switching to a different class of medication may help reduce the sexual side effects. The most agreed upon treatment for sexual dysfunction associated with SSRI medications is bupropion. Bupropion is a different class of medicine, a norepinephrine-dopamine reuptake inhibitor (NDRI), with fewer sexual side effects, and can be taken in addition to an SSRI or in place of an SSRI depending on the patient’s goals and medical history [14-15]. While some studies have shown mild sexual function improvement by switching to another class of medication, Serotonin-Norepinephrine Reuptake Inhibitors (SNRI), the data is inconclusive and since these medications also target serotonin, like SSRIs, changing to this class of medicine may not effectively address SD for all patients [14].
If you prefer to continue taking your current SSRI medication, there are additional sexual dysfunction-specific methods you can try to improve your symptoms. PDE-5 inhibitors, like sildenafil, can increase arousal and orgasm dysfunction in women with SSRI-associated SD [16-17]. However, since these medicines work by dilating blood vessels and are associated with a high level of adverse events like headache, flushing, and temporary visual changes [16-17]. Another option is transdermal testosterone (a self-applied gel), or sub-lingual testosterone in combination with a PDE-5 inhibitor have been shown to increase the number of sexually satisfying events in patients with SSRI-associated SD [18-19]. Overall, more research is needed to better understand how adjunct treatments for sexual dysfunction-specifically can benefit people experiencing SSRI-associated SD.
Investigational Therapies
Support Available
Your healthcare provider can be an excellent partner in your journey to diagnose and address SSRI-dependent sexual dysfunction. ISSWSH.org can help you find a provider in your area who specializes in treating female sexual dysfunction.
References
- Aquino, A. C. Q., Sarmento, A. C. A., Teixeira, R. L. A., Batista, T. N., de Freitas, C. L., Mármol, J. M. P., Lara, L. A. S., & Gonçalves, A. K. (2025). Pharmacological treatment of antidepressant-induced sexual dysfunction in women: A systematic review and meta-analysis of randomized clinical trials. Clinics, 80, 100602. https://doi.org/10.1016/j.clinsp.2025.100602
- Bijlsma, E. Y., Chan, J. S., Olivier, B., Veening, J. G., Millan, M. J., Waldinger, M. D., & Oosting, R. S. (2014). Sexual side effects of serotonergic antidepressants: Mediated by inhibition of serotonin on central dopamine release? Pharmacology, Biochemistry, and Behavior, 121, 88–101. https://doi.org/10.1016/j.pbb.2013.10.004
- Fooladi, E., Bell, R. J., Jane, F., Robinson, P. J., Kulkarni, J., & Davis, S. R. (2014). Testosterone improves antidepressant-emergent loss of libido in women: Findings from a randomized, double-blind, placebo-controlled trial. The Journal of Sexual Medicine, 11(3), 831–839. https://doi.org/10.1111/jsm.12426
- Frohlich, P. F., & Meston, C. M. (2000). Evidence that serotonin affects female sexual functioning via peripheral mechanisms. Physiology & Behavior, 71(3–4), 383–393. https://doi.org/10.1016/S0031-9384(00)00344-9
- Gao, L., Yang, L., Qian, S., Li, T., Han, P., & Yuan, J. (2016). Systematic review and meta-analysis of phosphodiesterase type 5 inhibitors for the treatment of female sexual dysfunction. International Journal of Gynecology & Obstetrics, 133(2), 139–145. https://doi.org/10.1016/j.ijgo.2015.08.015
- Jaafarpour, M., Khani, A., Khajavikhan, J., & Suhrabi, Z. (2013). Female sexual dysfunction: Prevalence and risk factors. Journal of Clinical and Diagnostic Research, 7(12), 2877–2880. https://doi.org/10.7860/JCDR/2013/6813.3822
- Montejo, A. L., Llorca, G., Izquierdo, J. A., & Rico-Villademoros, F. (2001). Incidence of sexual dysfunction associated with antidepressant agents: A prospective multicenter study of 1022 outpatients. The Journal of Clinical Psychiatry, 62(Suppl 3), 10–21.
- Kadioglu, P., Yalin, A. S., Tiryakioglu, O., Gazioglu, N., Oral, G., Sanli, O., Onem, K., & Kadioglu, A. (2005). Sexual dysfunction in women with hyperprolactinemia: A pilot study report. The Journal of Urology, 174(5), 1921–1925. https://doi.org/10.1097/01.ju.0000176456.50491.51
- Lach, F., Bottemanne, H., Hingray, C., Papeta, D., Rousseau, A., & Javelot, H. (2024). Management strategies for antidepressant-related sexual dysfunction. L’Encephale, 50(5), 578–581. https://doi.org/10.1016/j.encep.2023.11.025
- Lyons, D. J., Ammari, R., Hellysaz, A., & Broberger, C. (2016). Serotonin and antidepressant SSRIs inhibit rat neuroendocrine dopamine neurons: Parallel actions in the lactotrophic axis. The Journal of Neuroscience, 36(28), 7392–7406. https://doi.org/10.1523/JNEUROSCI.4061-15.2016
- Masiran, R., Sidi, H., Mohamed, Z., Mohd Nazree, N. E., Nik Jaafar, N. R., Midin, M., Das, S., & Mohamed Saini, S. (2014). Female sexual dysfunction in patients with major depressive disorder treated with selective serotonin reuptake inhibitors and its association with serotonin 2A-1438 G/A polymorphisms. The Journal of Sexual Medicine, 11(4), 1047–1055. https://doi.org/10.1111/jsm.12452
- Nurnberg, H. G., Hensley, P. L., Heiman, J. R., Croft, H. A., Debattista, C., & Paine, S. (2008). Sildenafil treatment of women with antidepressant-associated sexual dysfunction: A randomized controlled trial. JAMA, 300(4), 395–404. https://doi.org/10.1001/jama.300.4.395
- Parish, S. J., Goldstein, A. T., Goldstein, S. W., Goldstein, I., Clayton, A. H., Simon, J. A., Kingsberg, S. A., et al. (2019). The International Society for the Study of Women’s Sexual Health process of care for the identification of sexual concerns and problems in women. Mayo Clinic Proceedings, 94(5), 842–856. https://doi.org/10.1016/j.mayocp.2019.01.009
- Rappek, N. A. M., Sidi, H., Kumar, J., Kamarazaman, S., Das, S., Masiran, R., Baharuddin, N., & Hatta, M. H. (2018). Serotonin selective reuptake inhibitors and female sexual dysfunction: Hypothesis on its association and options of treatment. Current Drug Targets, 19(12), 1352–1358. https://doi.org/10.2174/1389450117666161227142947
- Rothmore, J. (2020). Antidepressant-induced sexual dysfunction. The Medical Journal of Australia, 212(7), 329–334. https://doi.org/10.5694/mja2.50522
- Sanchez-Ruiz, J. A., Leibman, N. I., Larson, N. B., Jenkins, G. D., Ahmed, A. T., Nunez, N. A., Biernacka, J. M., Winham, S. J., Weinshilboum, R. M., Wang, L., Frye, M. A., & Ozerdem, A. (2023). Age-dependent sex differences in the prevalence of selective serotonin reuptake inhibitor treatment: A retrospective cohort analysis. Journal of Women’s Health, 32(11), 1229–1240. https://doi.org/10.1089/jwh.2022.0484
- Sidi, H., Asmidar, D., Hod, R., & Guan, N. C. (2012). Female sexual dysfunction in patients treated with antidepressants: Comparison between escitalopram and fluoxetine. The Journal of Sexual Medicine, 9(5), 1392–1399. https://doi.org/10.1111/j.1743-6109.2011.02256.x
- Tarchi, L., Merola, G. P., Baccaredda-Boy, O., Arganini, F., Cassioli, E., Rossi, E., Maggi, M., Baldwin, D. S., Ricca, V., & Castellini, G. (2023). Selective serotonin reuptake inhibitors, post-treatment sexual dysfunction, and persistent genital arousal disorder: A systematic review. Pharmacoepidemiology and Drug Safety, 32(10), 1053–1067. https://doi.org/10.1002/pds.5653
- Zeiss, R., Malejko, K., Connemann, B., Gahr, M., Durner, V., & Graf, H. (2024). Sexual dysfunction induced by antidepressants: A pharmacovigilance study using data from VigiBase™. Pharmaceuticals, 17(7), Article 826. https://doi.org/10.3390/ph17070826
