SSRIs Will Worsen, Not Restore, Sexual Drive
SSRIs consistently decrease libido in both men and women, including those with sexual offending histories—they do not restore or increase sex drive. Your doctor may be confusing SSRIs' therapeutic use for premature ejaculation (delaying orgasm) with an effect on sexual desire, but these are entirely separate sexual functions. 1, 2
How SSRIs Actually Affect Sexual Function
SSRIs cause sexual dysfunction through multiple mechanisms that decrease sexual function across all domains:
- Decreased libido occurs in 6-9% of patients in FDA-reported trials, though real-world rates are vastly underreported and likely 30-70% when actively assessed 3, 4
- Men experience significantly greater impairment in sexual drive/desire (38-50%) compared to women (26-32%) when directly questioned 4
- Sexual dysfunction with SSRIs is strongly dose-related, with higher doses causing more frequent erectile dysfunction and decreased libido 5, 6
Why SSRIs Are Used in Sexual Offender Treatment
The therapeutic rationale for using SSRIs in sexual offenders is precisely because they suppress sexual drive and function:
- SSRIs cause ejaculatory delay/failure, which is why they're used therapeutically for premature ejaculation—this represents decreased sexual function, not increased 1, 5
- Paroxetine provides the strongest ejaculation delay (8.8-fold increase over baseline) but has a 70.7% overall sexual dysfunction rate 2, 7
- The American Urological Association explicitly recommends SSRIs to delay ejaculation, not enhance sexual function 1
The Distinction Your Doctor May Be Missing
SSRIs affect different phases of sexual response differently:
- Sexual desire/libido: Consistently decreased in 6-9% (FDA data) to 30-70% (validated assessment tools) 3, 4
- Arousal/erectile function: Impaired in a dose-dependent manner 5, 6
- Orgasm/ejaculation: Significantly delayed or absent—this is the "therapeutic" effect for premature ejaculation, but represents dysfunction, not improvement 1, 7
Evidence Across All SSRIs
No SSRI increases sexual drive—all decrease it to varying degrees:
- Paroxetine: Highest sexual dysfunction rates at 70.7%, with significantly more delay of orgasm/ejaculation and impotence than other SSRIs 2, 7
- Sertraline: 14% ejaculatory failure in males, 6% decreased libido in combined male/female populations (FDA data underestimates true rates) 3
- Fluoxetine, citalopram: Intermediate sexual dysfunction rates, but still cause decreased libido 2
- All SSRIs: Cause ejaculatory delay/failure, which is why they're used for premature ejaculation treatment 5
Critical Safety Context
SSRIs should be avoided in patients with bipolar depression due to risk of mania, which could theoretically increase impulsivity and risk behaviors 1, 8
Common Clinical Pitfall
The confusion likely stems from the fact that depression itself causes decreased libido, so treating depression may restore baseline sexual function. However, the SSRI medication itself simultaneously suppresses sexual function below that restored baseline 9. The net effect depends on the severity of depression versus the severity of SSRI-induced dysfunction, but the medication itself never increases drive above normal.
In a non-depressed individual (or one whose depression is already treated), SSRIs will only decrease sexual drive and function 9, 4.