MP78-15 POST-SSRI SEXUAL DYSFUNCTION (PSSD): TEN YEAR RETROSPECTIVE CHART REVIEW
Abstract
INTRODUCTION AND OBJECTIVE:
Post-SSRI Sexual Dysfunction (PSSD) is a poorly understood, iatrogenic, distressing, multidimensional sexual health condition that occurs in young patients and includes ED, hypoactive sexual desire disorder (HSDD), orgasmic dysfunction, and/or decreased genital sensation, that despite discontinuation of SSRI/SNRI agents, persists > 6 mo. We wished to better understand PSSD, the frequency/severity of symptoms, and the results of diagnostic testing.
METHODS:
A retrospective review was performed of charts from 2009 to 2019. Patients reported their symptoms, completed the IIEF, and underwent a grayscale/Doppler ultrasound during pharmacological erection (15.4 MHz probe; Aixplorer® Ultrasound) and Quantitative Sensory Testing (QST) (vibration, hot and cold perception testing).
RESULTS:
43 male patients (mean age 31, range 18 – 59) met the criteria for PSSD; 4% of the male patients seen during this period. The most common symptom was ED in 93% (40/43). The mean IIEF-EF score was 12.9/30. The most common EF domain score was consistent with severe ED 49% (16/33), followed by mild-moderate 24% (8/33), moderate 9% (3/33), and mild 9% (3/33). A total of 9% (3/33) had no ED. For ED patients who underwent grayscale/Doppler ultrasound, 79% (23/29) had varying degrees of erectile tissue inhomogeneity (hypo- and hyperechoic regions noted). The mean cavernosal artery PSV values were left 30.3 cm/sec and right 31.7 cm/sec. Concomitant sexual health concerns of HSDD, orgasmic dysfunction, and decreased genital sensation were noted in 86% (38/43), 72% (31/43), and 67% (29/43) of patients, respectively. For patients with orgasmic dysfunction and/or decreased genital sensation who underwent QST testing, 89% (25/28) had abnormal results.
CONCLUSIONS:
This series of PSSD patients examined clinically is larger than any in the peer-reviewed literature. Consistent with other reports on PSSD, our patients are young, have ED in most cases, and frequently have concomitant HSDD, poor orgasm and decreased genital sensation. New information includes the facts that 1) ED is most often severe, 2) erectile tissue inhomogeneity is common, consistent with erectile tissue fibrosis/decreased erectile tissue expandability as an underlying vascular ED pathophysiology, and 3) decreased genital sensation from neurological dysfunction is frequent in this population. Providers need to be aware that the persistent sexual health consequences following SSRI/SNRI discontinuation are significant and patients should be referred to sexual medicine specialists for management.
Source of Funding:
No funding.
