Insights into the peripheral nature of persistent sexual dysfunction associated with post-finasteride, post-SSRI and post-accutane syndromes: lessons learned from a case study

The paper frames persistent sexual dysfunction after finasteride/saw palmetto, SSRIs, and retinoids as a single post-drug syndrome of unknown mechanism with no effective treatment, and asks whether targeting the peripheral genital nerves can help. Three men seen in a urology clinic received 16 weeks of high-frequency electrical stimulation plus low-intensity extracorporeal shockwave therapy, assessed by IIEF, Masturbation Erection Index, global response scales, corneal confocal microscopy, nocturnal-erection monitoring, and von Frey filament testing. All three showed mild to moderate improvement in erectile function, mild gains in penile sensitivity and nocturnal erections; corneal microscopy showed peripheral neuropathy in two patients. Central symptoms did not resolve, and patients remained profoundly affected. The authors conclude the syndrome has a treatable peripheral component but stress the urgent need for more research.