Frequency of self-reported persistent post-treatment genital hypoesthesia among past antidepressant users: a cross-sectional survey of sexual and gender minority youth in Canada and the US. (2024)

Soc Psychiatry Psychiatr Epidemiol. 2024 Sep 20. doi: 10.1007/s00127-024-02769-0. Online ahead of print.

Frequency of self-reported persistent post-treatment genital hypoesthesia among past antidepressant users: a cross-sectional survey of sexual and gender minority youth in Canada and the US

Yassie Pirani 1 2, J Andrés Delgado-Ron 3, Pedro Marinho 4, Amit Gupta 5 6, Emily Grey 1, Sarah Watt 3, Kinnon R MacKinnon 7, Travis Salway 8 9

Affiliations

1- Canadian Post-SSRI/SNRI Sexual Dysfunction Society, Vancouver, BC, Canada.

2- B.C. Association of Social Workers, Vancouver, BC, Canada.

3- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300 8888 University Drive Burnaby, B.C. V5A 1S6, Burnaby, BC, Canada.

4- Department of Anatomy and Cell Biology, Western University, London, ON, Canada.

5- British Columbia Centre for Disease Control, Vancouver, BC, Canada.

6- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada.

7- School of Social Work, York University, Toronto, ON, Canada.

8- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300 8888 University Drive Burnaby, B.C. V5A 1S6, Burnaby, BC, Canada. travis_salway@sfu.ca.

9- British Columbia Centre for Disease Control, Vancouver, BC, Canada. travis_salway@sfu.ca.

• PMID: 39302425
 
• DOI: 10.1007/s00127-024-02769-0

Abstract

Purpose: Persistent post-treatment genital hypoesthesia (PPTGH) is a primary symptom of post-SSRI sexual dysfunction (PSSD), an iatrogenic syndrome characterized by enduring sexual dysfunction following the discontinuation of some antidepressants. We aimed to estimate the frequency of PPTGH among past users of psychiatric treatments, particularly antidepressants.

Methods: We used a subsample of UnACoRN, a US/Canada survey of sexual and gender minority youth aged 15 to 29. We included participants with a history of psychiatric drug use. We excluded individuals with genital surgeries or without sexual experience. The analysis involved chi-square tests for initial group comparisons, post hoc tests for multiple comparisons, and logistic regression among those who had stopped taking medication. We exponentiated the regression to estimate the odds of PPTGH by drug type, adjusting for age, sex-assigned-at-birth, hormone treatment, and depression severity in three nested models.

Results: 574 of 2179 survey participants reported genital hypoesthesia. They were older and more likely to report male sex assignment at birth, hormonal therapy history, and psychiatric drug history. The frequency of PPTGH among antidepressant users was 13.2% (93/707) compared to 0.9% (1/102) among users of other medications; adjusted odds ratio: 14.2 (95% CI: 2.92 to 257).

Conclusion: Antidepressant discontinuation is strongly associated with PPTGH in the US and Canada where SSRI/SNRI medications account for 80% of antidepressant prescriptions. We call for standardized international warnings and transparent, informed consent. Future research should expand upon our efforts to estimate the risk of PSSD by including all the proposed diagnostic criteria, including documentation of temporal changes in PSSD-related symptoms before and after treatment (≥3 months).

Keywords: Long term adverse effects; PSSD; Selective serotonin reuptake inhibitors; Serotonin and norepinepherine reuptake inhibitors; Sexual dysfunction.

Plain language summary

This study explored the long-lasting sexual side effects—specifically, reduced genital sensitivity—of certain antidepressants, even after stopping the medication, in a diverse group of young people, primarily those identifying as sexual and gender minorities. We analyzed responses from a large survey, focusing on participants with a history of psychiatric drug use but without genital surgeries. Our findings indicate that those who used antidepressants experienced a substantial increase in reports of reduced genital sensitivity—13.2% of antidepressant users compared to 0.9% of users of other medications. This symptom is more common among individuals who had used antidepressants and sedatives. Our results emphasize the necessity for clear warnings and proper consent processes about potential long-term sexual side effects, particularly for young patients, and standardization of these procedures across countries. Further research is needed to explore this condition more deeply, including studies of all related symptoms and their development over time before and after treatment.

© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

References

1. 1. Healy D, Le Noury J, Mangin D (2018) Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases. Int J Risk Saf Med 29:125–134. https://doi.org/10.3233/JRS-180744 - DOI - PubMed - PMC
2. 1. Reisman Y (2020) Post-SSRI sexual dysfunction. BMJ 368:m754. https://doi.org/10.1136/bmj.m754 - DOI - PubMed
3. 1. Chinchilla Alfaro K, van Hunsel F, Ekhart C (2022) Persistent sexual dysfunction after SSRI withdrawal: a scoping review and presentation of 86 cases from the Netherlands. Expert Opin Drug Saf 21:553–561. https://doi.org/10.1080/14740338.2022.2007883 - DOI - PubMed
4. 1. Reisman Y (2017) Sexual consequences of Post-SSRI syndrome. Sex Med Rev 5:429–433. https://doi.org/10.1016/j.sxmr.2017.05.002 - DOI - PubMed
5. 1. Waraich A, Yih J, Goldstein S, Goldstein I (2021) 076 Post-SSRI sexual dysfunction (PSSD): ten Year Retrospective Chart Review. J Sex Med 18:S41. https://doi.org/10.1016/j.jsxm.2021.01.046 - DOI

https://link.springer.com/article/10.1007/s00127-024-02769-0

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Frequenza dell'ipoestesia genitale persistente post-trattamento auto-riferita tra gli ex consumatori di antidepressivi: un'indagine trasversale tra i giovani delle minoranze sessuali e di genere in Canada e negli USA

Abstract

Scopo: L'ipoestesia genitale persistente post-trattamento (PPTGH) è un sintomo primario della disfunzione sessuale post-SSRI (PSSD), una sindrome iatrogena caratterizzata da una disfunzione sessuale duratura dopo la sospensione di alcuni antidepressivi. Il nostro obiettivo è stato quello di stimare la frequenza della PPTGH tra gli utilizzatori passati di trattamenti psichiatrici, in particolare di antidepressivi.

Metodi: Abbiamo utilizzato un sottocampione di UnACoRN, un'indagine condotta negli Stati Uniti e in Canada su giovani appartenenti a minoranze sessuali e di genere di età compresa tra i 15 e i 29 anni. Abbiamo incluso i partecipanti con una storia di uso di psicofarmaci. Abbiamo escluso i soggetti con interventi chirurgici ai genitali o senza esperienza sessuale. L'analisi ha comportato test chi-quadrato per i confronti iniziali tra i gruppi, test post hoc per i confronti multipli e regressione logistica tra coloro che avevano smesso di assumere farmaci. Abbiamo esponenziato la regressione per stimare le probabilità di PPTGH in base al tipo di farmaco, aggiustando per età, sesso assegnato alla nascita, trattamento ormonale e gravità della depressione in tre nested models.

Risultati: 574 dei 2179 partecipanti all'indagine hanno riferito ipoestesia genitale. Erano più anziani e più propensi a riferire l'assegnazione di un sesso maschile alla nascita, l'anamnesi di terapia ormonale e l'anamnesi di farmaci psichiatrici. La frequenza della PPTGH tra gli utilizzatori di antidepressivi era del 13,2% (93/707) rispetto allo 0,9% (1/102) tra gli utilizzatori di altri farmaci; odds ratio aggiustato: 14,2 (95% CI: 2,92-257).

Conclusioni: L'interruzione degli antidepressivi è fortemente associata alla PPTGH negli Stati Uniti e in Canada, dove i farmaci SSRI/SNRI rappresentano l'80% delle prescrizioni di antidepressivi. Chiediamo avvertenze internazionali standardizzate e un consenso informato trasparente. La ricerca futura dovrebbe ampliare i nostri sforzi per stimare il rischio di PSSD includendo tutti i criteri diagnostici proposti, compresa la documentazione dei cambiamenti temporali dei sintomi correlati alla PSSD prima e dopo il trattamento (≥3 mesi).

Parole chiave: Effetti avversi a lungo termine; PSSD; Inibitori selettivi della ricaptazione della serotonina; Inibitori della ricaptazione di serotonina e noradrenalina; Disfunzioni sessuali.