S/x on Dr/gs Reference
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Clinical evidence

SSRIs / SNRIs

Serotonergic antidepressant·Medication side-effects

Effect across the cycle

DesireInhibitory: Reduced libido is a hallmark effect.
ArousalInhibitory: Impaired arousal and genital response.
PerformanceInhibitory: Erectile dysfunction and genital anesthesia.
ClimaxInhibitory: Delayed or absent orgasm; used deliberately for premature ejaculation.
ExperienceInhibitory: Emotional and sensory blunting of the experience.
MemoryNeutral: Not a primary memory effect.

Mechanism

Raise synaptic serotonin; downstream 5-HT2A/2C and 5-HT1A effects inhibit dopaminergic tone in mesolimbic and spinal pathways, impairing every phase. Paroxetine is among the worst (adds anticholinergic, antidopaminergic and nitric-oxide-synthase-inhibiting properties); fluoxetine milder.

Pharmacokinetics
Effects emerge over weeks; delayed ejaculation is exploited therapeutically for premature ejaculation.
Reversibility
Usually reversible on discontinuation — but see PSSD.

Sex differences & notes

Affects both sexes across desire, arousal, orgasm and genital sensation.

Key sources

  • Psychiatrist.com tardy SD review
  • PMC12524134 (off-label use)