Penile anesthesia in Post SSRI Sexual Dysfunction (PSSD) responds to low-power laser irradiation: A case study and hypothesis about the role of transient receptor potential (TRP) ion channels
Marcel D. Waldinger; Ruben S. van Coevorden; Dave H. Schweitzer; Janniko R. Georgiadis
European Journal of Pharmacology2015
In plain terms
This paper describes one man who, within a week of starting the antidepressant paroxetine, lost much of the feeling in his skin, including his penis and scrotum, and had erection and ejaculation problems. Feeling elsewhere came back, but his genitals were still numb about two years after he stopped. After an experimental course of low-power laser light on his penis and lower back, he said some feeling for touch and for warm and cold had returned, though far less than before the medicine; his erection and ejaculation problems did not change. The authors suggest an untested explanation involving tiny sensors in nerve endings.
What it doesn’t show: It can't show that the laser caused the improvement or would help anyone else: it is one person's own account, with no comparison or sham treatment, and the authors say a placebo effect can't be ruled out.
Summary (paraphrased)
A man who developed penile anesthesia and scrotal hypesthesia on paroxetine, persisting two years after stopping the drug, received 20 sessions of low-power laser irradiation to the glans penis, the nerve branches at the base of the penis and the lower back over the spinal nerve roots. Tactile and temperature sensitivity partially returned (by the patient's own estimate, a 20-40% improvement compared with his sensitivity before paroxetine), though erectile difficulties and anejaculation did not improve. The authors propose that SSRIs may disturb transient receptor potential (TRP) ion channels in mechano-, thermo-, and chemosensitive nerve endings, offering a peripheral-nerve hypothesis for PSSD genital anesthesia and suggesting two PSSD phenotypes, including one with very early onset during treatment.
Evidence
Extracted from the full text; page numbers refer to the paper. The library’s own notes are labelled as such.
- Design
- Case reportSingle case report of persistent genital anaesthesia after paroxetine, with an uncontrolled experimental treatment (low-power laser irradiation) and a mechanistic hypothesis
- Setting
- The Netherlands, 2012–2014; referred to the first author (Utrecht University and a private psychiatry and neurosexology practice, Amstelveen), laser treatment by the second author (Medisch Centrum Buitenveldert, Amsterdam)
- Population
- One 43-year-old man with a master's degree, treated with paroxetine for depression after a divorce. Lifelong premature ejaculation before treatment; no other particular disease or disorder recorded.
- Size
- 1 · Single patient ("Mr. A.")
- Exposure
- Paroxetine 20 mg/day for about 2.5 years (May 2008 to November 2010). From October 2012, low-power laser irradiation, 20 sessions of 15 minutes, applied to the glans, the nerve branches at the base of the penis and the lower back over the spinal nerve roots (device settings on p. 264). Bupropion was added afterwards (April 2013).
- Compared with
- None (no placebo or sham); improvement was judged against the patient's recalled sensitivity before paroxetine
- Outcome
- Patient-reported penile touch and temperature sensation (his own percentage estimates against his recalled pre-paroxetine sensitivity), ejaculation and erection; hormone levels measured twice in 2013.
- Follow-up
- From first consultation (September 2012) to July 2014
Key results
- Within 7 days of starting paroxetine, loss of smell and taste and reduced skin sensitivity over much of the body, including penis and scrotum, with anejaculation and erectile difficulties; smell and taste returned after 2 months, and skin sensitivity outside the genitals gradually returned · p. 264
- In September 2012, about two years after stopping, penile anaesthesia, reduced scrotal sensation, anejaculation and erectile difficulties were unchanged, with normal sexual desire; general blood tests in May 2012 were normal (testosterone not measured) · p. 264
- After the first 5 laser sessions (October 2012), slight tingling at the glans lasting about two hours; after 20 sessions (January 2013), a self-reported 10–15% improvement in glans sensitivity, with touch felt and warm and cold told apart again · p. 264
- In April 2013, after the sessions ended, he estimated a 20% improvement compared with his erect penis before paroxetine and 40% compared with his flaccid penis; anejaculation and erectile difficulties were unchanged, also after bupropion (May 2013), and his state was unchanged from August 2013 to July 2014 · p. 265
- Hypothesis: SSRIs disturb transient receptor potential (TRP) ion channels in nerve endings that sense touch, temperature and chemicals; there may be two PSSD subtypes, one starting early in treatment with severe genital anaesthesia and one worsening after stopping. Seven of the eight PSSD case reports then published described genital anaesthesia, reduced touch sensation or numbness · pp. 266–267
Limitations the authors note
- No comparison with a placebo treatment
- More patients with PSSD-related genital anaesthesia are needed to evaluate the treatment
- Little is known about his sexual function in the first months of paroxetine, as he had no sexual contact then
- A placebo effect or other central mechanism cannot be excluded
- The laser was applied at three sites, so which site produced the improvement cannot be determined
- The 20–40% improvement is "subjectively" perceived
Also worth weighing (library’s note)
- One patient; the improvement figures are his own estimates against recalled sensation, and no measured sensory testing is reported
- The laser treatment was given by one of the authors (p. 264)
- Before paroxetine he had lifelong premature ejaculation with unusually quick genital responses (p. 264), the baseline his estimates were compared with
- Testosterone was not measured before the laser course (p. 264); the two values reported, 8.8 and 11.5 nmol/l, are from 2013 (p. 265)
- The TRP mechanism and the two subtypes are hypotheses built on this one case and were not tested (pp. 266–267)
- The authors make recommendations to prescribers on the basis of this case and their hypothesis (pp. 267–268)
Funding: None Interests: Not stated
What it can support (library’s note): One documented case of genital numbness that began early in paroxetine treatment and persisted after stopping, with a partial, self-reported return of sensation after an uncontrolled course of laser treatment, and a hypothesis about nerve-ending ion channels. It cannot show that the laser caused the improvement, that it would help others, or that the hypothesis is right.
Why it’s in the corpus
Proposes a mechanistic hypothesis locating PSSD genital anesthesia in peripheral sensory nerves (TRP channels), and by its own account is the first report of low-power laser treatment for genital sensitivity loss in PSSD. Key pathophysiology citation.
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