SSRI use, depression predict worse sexual outcomes

Depression and the use of SSRIs appear to significantly contribute to an individual’s sexual functioning, distress, and pleasure, according to a study.

Specifically, those experiencing moderate to severe depression and using SSRIs have significantly poorer sexual outcomes.

On the other hand, “[s]exual flexibility is associated with lower distress and greater sexual pleasure and sexual functioning and, therefore, may be a target for interventions to support people coping with sexual difficulties secondary to SSRI use and/or depression symptoms,” the researchers said.

A total of 357 participants (mean age 26.8 years) assigned female sex at birth were included in this online cross-sectional study. They were grouped according to SSRI use and depression severity: SSRIs-low depression (n=86), SSRIs-high depression (n=117), no SSRIs-low depression (n=81), and no SSRIs-high depression (n=73).

The researchers used validated measures of depression, sexual function, sexual distress, sexual flexibility, and sexual pleasure. Analyses of variance and multiple regressions were used to explore the association between depression, SSRI use, and sexual being, while moderation analyses were performed to test whether sexual flexibility moderated the link between sexual functioning, distress, and pleasure.

Participants in the SSRIs-high depression group had the worst sexual wellbeing, whereas those in the no SSRIs-low depression group experienced the highest. [J Sex Med 2025;22:1206-1215]

Depression and SSRI use contributed to higher sexual distress and lower sexual functioning, pleasure, and flexibility, accounting for 21 percent to 26 percent of variance. Notably, sexual flexibility moderated the link between functioning and pleasure, showing a stronger impact at lower levels of flexibility.

“Sexual flexibility may improve sexual functioning and pleasure, providing a positive, adaptable framework for therapy,” the researchers said “[T]hus, psychosexual and educational interventions focusing on flexibility could enhance sexual pleasure and reduce distress, fostering sexual resilience and improving relationship dynamics.”

Coping mechanism

Increased sexual flexibility is characterized by less rigid thoughts and behaviours. An individual with greater flexibility has better coping strategies and positive psychosexual outcomes, such as higher satisfaction and reduced distress. [J Sex Marital Ther 2018;44:382-397]

“Sexually flexible individuals who are able to change the way they think about sex or change their behavioural approach to sexual activity are thought to cope better with acute and chronic sexual issues,” the researchers said. [J Psychosoc Oncol 2023;41:267-276] 

The nuanced finding of a potential protective role flexibility plays in sexual experiences despite difficulties suggests the complexity of sexual wellbeing. In addition, various mechanisms appear to influence sexual distress and pleasure.

For instance, “when encountering sexual difficulties (eg, pain with penetration), distress may persist, but sexual flexibility may facilitate engagement in alternative activities that enhance pleasure,” according to the researchers.

“The [current] study supports existing research showing that individuals with higher sexual flexibility tend to cope better with sexual functioning difficulties, displaying greater resilience in areas like sexual pleasure,” they added. [J Psychosoc Oncol 2023;41:267-276; J Sex Marital Ther 2018;44:382-397]

It remains to be known whether sexual flexibility plays a role in the association between dysfunction and distress or pleasure among individuals using SSRI and having depressive symptoms.

“Investigating this relationship could provide a valuable treatment target to support individuals experiencing SSRI and depression-related sexual dysfunction,” the researchers said.