Genital sensory loss in persistent sexual dysfunction following SSRI exposure

The uro-neurology unit at the National Hospital for Neurology and Neurosurgery, Queen Square, reviewed 55 consecutive patients referred with genital sensory impairment between 2019 and 2024; nine (mean age 35, eight men) met the published PSSD criteria (CROSS-002). All nine had abnormal sensory examination with von Frey hairs or a Neurotip, with loss greatest over the glans and the distal and mid shaft, symmetrical and more marked on the ventral surface. Rates of abnormal examination did not differ significantly from patients with other causes, but PSSD patients more often reported ejaculatory dysfunction (75% vs 20%) and sexual dysfunction (100% vs 65%). Pelvic neurophysiology (tibial, S2 and S3 dermatomal, and pudendal somatosensory evoked potentials) was normal in eight of the nine. The authors read this mismatch as excluding a significant large-fibre neuropathy or dorsal-column dysfunction, and propose that PSSD's genital sensory loss reflects a central disturbance in how erogenous sensation is processed (possibly lasting serotonergic dysregulation of reward circuits) rather than peripheral nerve damage. They suggest ejaculatory dysfunction as a clinical marker separating PSSD from other causes of genital numbness.