J Gandhara Med Dent Sci

July - September 2026

ORIGINAL ARTICLE

https://doi.org/10.37762/jgmds.13-3.858

How to cite this article

FREQUENCY OF SEXUAL DYSFUNCTION AMONG PATIENTS RECEIVING SELECTIVE

SEROTONIN REUPTAKE INHIBITORS

1 1

Amir Wahab , Israr Ud Din , Sumaira Mehreen

Wahab A, Din IU, Mehreen S .

Frequency of Sexual Dysfunction

Among Patients Receiving Selective

Serotonin Reuptake Inhibitors. J

Gandhara Med Dent Sci. 2026; 13(3):

25-28.

Date Submission: 29-01-2026

Date Revised: 21-05-2026

Date Acceptance: 22-05-2026

Clinical Psychologist, Department of

Psychiatry, Lady Reading Hospital

Correspondence

Israr Ud Din, Assistant Professor,

Department of Psychiatry, Lady

Reading Hospital, Peshawar

+92-333-9242689

drisrar@yahoo.com

ABSTRACT

OBJECTIVES

This study aims to determine the frequency of sexual dysfunction among

patients undergoing SSRI treatment.

METHODOLOGY

A cross-sectional study was conducted at the Department of Psychiatry, MTI

Lady Reading Hospital, Peshawar, from December 2023 to June 2024. Using

non-probability consecutive sampling, 288 patients aged 20-40 years receiving

SSRIs for at least 12 weeks for various psychiatric disorders were enrolled.

Patients with severe medical illnesses, substance dependence, or pre-existing

sexual dysfunction were excluded. Sexual dysfunction was assessed using the

Arizona Sexual Experience Scale (ASEX). Data were analyzed using SPSS

version 26. Chi-square test was applied, and p≤0.05 was considered

statistically signicant.

RESULTS

The mean age of the patients was 27.20±5.40 years. The mean duration of SSRI

use was 2.61±1.12years. The p-value >.05 indicated that there is no

statistically signicant correlation between SSRI duration (1-3 years vs. >3

years) and sexual dysfunction. Among the participants who had sexual

dysfunction, 56 (62.2%) were male, while 34 (37.8%) were female and aged 2-

30 years, but the association was not statistically signicant (χ² = 1.34, p =

0.246, φ = 0.07). The chi-square result shows no statistically signicant

dierence between demographic and clinical variables and sexual dysfunction,

and the eect size shows a very small association.

CONCLUSION

A substantial proportion of patients receiving SSRIs experienced sexual

dysfunction, highlighting the need for routine screening and counseling in

psychiatric practice.

KEYWORDS: Sexual Dysfunction, Ssri, Antidepressants, Selective Serotonin

Reuptake Inhibitors

INTRODUCTION

DSM-5-TR criteria dene sexual dysfunction linked to

drugs or other substances as either pain related to sexual

activity or a disruption in the processes that make up the

sexual response cycle (desire/arousal-excitement-

orgasm-resolution). The use of medicine is the only

explanation for the dysfunction, which causes signicant

discomfort or interpersonal issues; the symptoms appear

within a month of starting the prescription, or the

medication's usage is etiologically linked to the

disturbance

. Selective serotonin reuptake inhibitors

(SSRIs) are a common class of drugs that are mainly

administered to treat depression and other mental

illnesses. They work by raising the brain's serotonin

levels, which are thought to improve mood and

emotional stability. SSRIs are preferred over previous

antidepressants due to their safety and tolerability, which

makes them a rst-line treatment option for illnesses like

obsessive-compulsive disorder, anxiety disorders, and

even rehabilitation from a stroke.

2,3,4

Selective serotonin

reuptake inhibitors (SSRIs) have a well-established side

effect of sexual dysfunction. Reduced libido, erectile

dysfunction, trouble having an orgasm, and diminished

sexual satisfaction are some of the ways this problem

might show itself. Although the frequency and severity

of these side eects vary from person to person, they can

signicantly aect patients’ quality of life and adherence

to therapy.

According to a study, sexual dysfunction

affected 84% of female patients using SSRIs; the rates

varied depending on the SSRIs, with sertraline (66.6%),

uoxetine (86.20%), and escitalopram (86.76%).

Another case study conducted on post-SSRI sexual

dysfunction (PSSD) showed chronic sexual dysfunction

with psychosocial repercussions. Patients expressed

feelings of discomfort, low self-esteem, and strained

relationships, highlighting the necessity for

comprehensive management measures.

The probability

of sexual dysfunction may vary depending on the type of

SSRI taken. For instance, compared to other SSRIs,

paroxetine has been linked to a higher rate of sexual

dysfunction.

The signicant impact of these side eects

Peshawar

J Gandhara Med Dent Sci

July - September 2026

is highlighted by the fact that patients with sexual

dysfunction reported worse ratings in the social

connections and environmental categories of quality of

life.

Sexual dysfunction can create distress, which can

result in pharmaceutical non-adherence and complicate

treatment outcomes.

The measurement of general

prevalence is complicated by the fact that certain patients

may have post-SSRI sexual dysfunction (PSSD), which

is persistent sexual dysfunction even after stopping

SSRIs.

While there exists an abundance of research on

sexual dysfunction caused by SSRIs, local data from

Pakistan, particularly from Khyber Pakhtunkhwa,

remain limited. Sociocultural factors and stigma may

contribute to the underreporting of such side eects.

Therefore, this study aimed to determine the frequency

of sexual dysfunction among patients treated with SSRIs

at Lady Reading Hospital, Peshawar. We hypothesized

that a signicant proportion of patients using SSRIs

experience sexual dysfunction.

METHODOLOGY

A cross-sectional study was conducted on 288 patients

aged 2-40 years of both genders using SSRIs for more

than 12 weeks for various psychiatric indications at the

Department of Psychiatry, MTI Lady Reading Hospital,

Peshawar. Although the minimum inclusion duration for

SSRI use was 12 weeks, many participants had been

receiving long-term treatment, resulting in a mean

duration of 2.61 years. The age range of 20-40 years was

selected to minimize the confounding eects of age-

related sexual dysfunction and chronic comorbidities

that are more prevalent in older populations. Patients

with diabetes mellitus, hypertension, cardiovascular

disease, gonadal injury, endocrine problems, substance

misuse, and sexual dysfunction before starting

antipsychotic medications (determined on history and

medical record) were excluded. The study period was

from 17 December 2023 to 17 June 2024. Approval was

obtained from the hospital’s ethical board [Approval No.

585/LRH/MTI]. Written informed consent was obtained

from patients after the purpose of the study was

explained. A non-probability consecutive sampling

technique was utilized. Demographic details like age,

gender, marital status, education, occupation, socio-

economic status, indication of SSRIs, and duration of

SSRI use were collected. Data regarding their presenting

complaint(s), history of substance misuse, psychiatric

illness, or medical illness, and what physical

investigations they had undergone were noted.

Condentiality and anonymity of participants were

strictly maintained. For assessment of the patients’

sexual function, the ‘Arizona Sexual Experience Scale’

(ASEX) was used. The Arizona Sexual Experience Scale

(ASEX) is a validated ve-item instrument assessing sex

drive, arousal, vaginal lubrication/penile erection, ability

to reach orgasm, and satisfaction from orgasm. Previous

studies have demonstrated excellent internal

consistency, scale reliability, and strong test-retest

reliability of ASEX across various clinical populations.

Patients with sexual dysfunction were treated as per

hospital protocol. Data were analyzed using SPSS

version 26.0. The mean and standard deviation were

calculated for quantitative variables, such as age and

duration of SSRI use. Frequencies and percentages were

calculated for categorical variables like gender,

occupation, education status, indication of SSRI, and

sexual dysfunction. Eect modiers such as age, gender,

education, employment status, socio-economic status,

SSRI indication, and SSRI duration were addressed

through stratication of the data. Post-stratication chi-

square was applied, and a p-value ≤0.05 was taken as

statistically signicant.

RESULTS

The mean age of the patients in the study was 27.20±5.40

years. The mean duration of SSRI use was 2.61±1.12

years.

Table 1: Descriptive statistics of Demographic variables (N = 288)

Variables Frequency

(n)

Percentage

(%)

Age 20 to 30

31 to 40

223

77.4

22.6

Gender Male

171

59.4

Female 117 40.6

Duration of

SSRIs use (in yrs)

1 to 3 years 205 71.2

> 3 years 83 28.8

Indication

For SSRIs

Depression 138 47.9

GAD 98 34.0

OCD 52 18.1

Table 2: Frequency Distribution of sexual dysfunction

Sexual dysfunction Frequency (n) Percentage (%)

Yes 90 31.3

No 198 68.8

Frequency of Sexual Dysfunction among Patients Receiving

J Gandhara Med Dent Sci

July - September 2026

Table 3: Stratication of sexual dysfunction with Demographic

variables

Variables Sexual

Dysfunction

val

E

ect

Size

Yes No

n (%) n (%)

Age

distribut

ion

20 to 30 74

(82.2)

149(7 5.3)

1.3

0.19 0.07

31 to 40

16 (17.8)

(24.7)

Gender Male 56

(62.2)

115(58.1)

0.2 9

0.51 0.03

Female 34

(37.8)

(41.9)

Indication

for

SSRI

Depress

ion

42 (46.7)

(48.5)

0.4

0.79

0.04

Generali

zed

anxiety

disorder

(36.7)

(32.8)

Obsessiv

compulsi

disorder

(16.7)

(18.7)

Duration

of SSRI

use

1 to 3

years

(66.7)

145(7

3.2)

1.0

0.25 0.06

> 3 years

(24.4)

(26.8)

DISCUSSION

Sexual dysfunction is the most common side eect of

selective serotonin reuptake inhibitors (SSRIs) for

depression, which has a major negative impact on

patients’ quality of life and adherence to therapy.

Research demonstrates that sexual dysfunction varies

among SSRI users, with reports ranging from 27% to

84%.

7,5,12,13

The purpose of this study was to ascertain

the frequency of sexual dysfunction in patients at Lady

Reading Hospital in Peshawar who were using selective

serotonin reuptake inhibitors (SSRIs). The result of this

study was in agreement with a study which showed a

prevalence of 39%.

However, it is in contrast with

several earlier studies that discovered that many patients

reported experiencing sexual dysfunction with an overall

incidence of 58% to 73%after receiving antidepressant

therapy. The prevalence of Sexual dysfunction found in

our study is lower than many international studies

reported.

15,16

First, underreporting of sexual symptoms

may be caused by cultural and socio-economic factors in

Pakistan, especially since conversations about sexual

health are often considered sensitive or stigmatized.

Participants may have concealed or reduced symptoms

despite assurances of condentiality due to social norms

that discourage open discussion of sexual functioning,

embarrassment, or fear of being judged. The true

prevalence of sexual dysfunction may have been

underestimated as a result of this reporting bias. In

contrast, other international studies used numerous

assessment tools or more in-depth clinical interviews

that could identify broader dimensions of sexual

dysfunction.

17,18

Differences may also inuence

prevalence estimates across studies in SSRI type, dose,

psychiatric diagnosis, severity of illness, and treatment

duration. The study’s ndings regarding gender

dierences should also be taken into account. Males

reported sexual dysfunction at a slightly higher rate than

females, but the eect size was small, and the correlation

was not statistically signicant. Findings of the present

study dier from some previous studies in which

women, as compared to men, reported greater

impairment in arousal and overall sexual satisfaction.

The present study also found no statistically signicant

dierence between sexual dysfunction and duration of

SSRI use. In one of the research studies, sexual

dysfunction was reported by 95.6% of women and 97.9%

of men who were SSRI patients. Women experienced

more problems in the arousal phase (83.3%), but men

displayed greater dysfunction in the desire (91.2%) and

orgasmic phases (85.1%).

However, in our study,

among the people who have sexual dysfunction(n=90),

62.2% (56) were male, while 37.8% (34) were female.

According to another study, sexual dysfunction aected

31.03% of patients using selective serotonin reuptake

inhibitors (SSRIs), with a higher prevalence in men

(70.37%). Decreased libido was the most often

mentioned problem, impacting 62.96% of dysfunctional

individuals.

Unlike some previous studies

demonstrating increased dysfunction with prolonged

SSRI use, our ndings did not reveal a signicant

association. Cultural stigma and reluctance to discuss

sexual matters in conservative societies such as Pakistan

may have contributed to underreporting of symptoms,

potentially explaining the lower prevalence observed

compared with international literature. In this study,

there is no statistically signicant dierence in the

duration of SSRIs (1-3 years vs. >3 years). A study

showed that the duration of SSRI medication was

signicantly correlated, suggesting that longer SSRI use

may be linked to higher levels of sexual dysfunction.

This requires further research, especially to nd out if

any confounding factors have inuenced the current

results. Although the associations between demographic

and clinical variables and sexual dysfunction were

statistically nonsignicant, the clinical importance of

sexual dysfunction should not be underestimated. While

SSRIs work eectively for dealing with depression, the

sexual dysfunction they induce can cause severe distress

and drive many to stop taking them. This underscores the

need for regular screening and management to address

these adverse eects eectively. Fu rther longitudinal

and multi-center research is needed to investigate the

long-term eects of SSRIs on sexual function, the

impacts of various SSRIs, and the ecacy of therapies

for managing these side eects.

Frequency of Sexual Dysfunction among Patients Receiving

J Gandhara Med Dent Sci

July - September 2026

LIMITATIONS

This study was conducted at a single center; therefore,

the results might not apply to dierent populations or

healthcare environments in Pakistan due to cultural and

healthcare variations. The sole assessment evaluation

used for sexual dysfunction was a single validated

screening instrument (ASEX); this instrument primarily

assesses overall sexual functioning without a detailed

exploration of such specic domains as relational

satisfaction, partner-related factors, or psychological

distress. The use of a single scale may, therefore, limit

the depth of sexual dysfunction interpretation. Only

univariate analysis was performed using the Chi-square

test; multivariable logistic regression analysis was not

conducted to adjust for potential confounding variables.

Future studies are recommended to incorporate multiple

assessment tools or qualitative interviews.

CONCLUSIONS

Sexual dysfunction was frequently observed among

patients receiving SSRIs at a tertiary care hospital in

Peshawar. Although no signicant associations were

found with duration of treatment or psychiatric

diagnosis, the ndings emphasize the importance of

routine screening for sexual adverse eects in

psychiatric practice. Addressing these symptoms

through early counseling and individualized

management may improve treatment adherence and

quality of life.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

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Amir Wahab

Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical Revision;

Supervision; Final Approval

Israr ud Din

Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript;

Critical Revision;

Supervision; Final

Approval

Sumaira Mehreen

Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical Revision;

Supervision; Final Approval

AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

Frequency of Sexual Dysfunction among Patients Receiving