Sex and the Selective Serotonin Reuptake Inhibitor (Ann’s Guide to Masturbating on SSRIs)


They were supposed to be the modern wonder drug. Designed to treat mood disorders, selective serotonin reuptake inhibitors, or SSRIs, were supposed to be safer and more effective than the tricyclics and MAO inhibitors they preceded. Mood disorders, as we knew them, would be a thing of the past.

Naturally, real life turned out to be more complicated than that. SSRIs are fairly popular, but the old drugs are still on the market, mostly because the SSRIs aren’t perfect. Most of the reasons are beyond the scope of this column, but there is one problem I can sensibly discuss, and that’s the sexual side effects.

I’ve been on three of these things: Paxil, Welbutrin and Cymbalta. The first two were for post-partum depression and anxiety. Combining surprise motherhood with disability and divorce is a stressful business. The third is an experimental treatment for fibromyalgia that has showed promise in early trials.

So I have some up-close experience with these drugs. I know that for those for whom they work, they can be a miracle indeed, but they’re not a free miracle. They cause a wide range of often-contradictory problems, including nausea, dizziness, sleepiness, insomnia, weight gain, weight loss, withdrawal problems, and the infamous sexual side effects, which occur at rates between 5-65% depending on which drug is being used. That’s a lot of frustrated people.

In cases where the entire libido itself goes, this might be just fine as long as the affected person isn’t partnered. Long periods of celibacy can be very productive. However, that doesn’t work well for most of us, and finding one’s sex drive completely down the tubes is disconcerting at best, as are issues like delayed orgasm or even the inability to reach orgasm at all. SSRIs can also cause disturbances in arousal that affect lubrication or erection. They can, in other words, hit every single area of sexual response.

So what does one do when the drugs are necessary?

There isn’t really much one can do except figure out how to work with it, and that’s often possible. Every SSRI I’ve been on has had some impact on my sexual functioning, for good or ill, and yes, sometimes the results are good. Paxil was a complete wash, sexually speaking. Arousal was infrequent and orgasms difficult to achieve, but with Welbrutrin, my fuse got slightly shorter, and while it takes ages with Cymbalta, the payoff is correspondingly higher, much more intense than when I’m not taking it.

Some men have found an unexpected benefit in SSRIs. It’s estimated that as many as one third of men deal with some form of premature ejaculation, by its broader definition. Setting aside for now how broad that definition really needs to be, one of the most common sexual side effects of SSRIs in men is delayed ejaculation. It’s so well-documented that many doctors now prescribe low-dose anti-depressants for men with chronic PE, and the results are so promising that a PE-specific version of these drugs is in the pipeline now.

The problem, of course, is side effects. SSRIs are nothing to mess around with, but for a man whose depression, OCD or anxiety is accompanied by premature ejaculation, anti-depressants can kill both birds with one stone.

So it’s worth experimenting a bit before going to the doctor for help, and if the experiments don’t work out well, do talk to your doctor. It might be possible to lower your dose or even switch drugs, because the frequency and severity of sexual side effects vary widely depending on which drug is used. With patience and clear communication, it should be possible to find a treatment that works without destroying your sex life.

Since our sex life begin with masturbation, that’s a good starting point to figuring out how your re-wired brain is going to respond to sexual stimulation. It’s also, for some of us, our entire sex lives, as not everyone is partnered all of the time, so because it’s universal, I’m going to give you what I call Ann’s Guide to Masturbating on SSRIs. Naturally, all of this can be done with a partner.

1. Be patient. SSRIs are at their most disruptive for the first few weeks, and it may take some time and a couple of tries before anything works. In the meantime, ice cubes wrapped in a washcloth can relieve sore, swollen genitals that just can’t fire. If you’ve only been on the drug for a week or two, try again later, after the other side effects have subsided. You may get a better result.

Orgasm may also take more time to reach. What used to require about five or ten minutes might need closer to half an hour and involve a few false starts. Obviously if you’re getting sore or bored, it’s time to cool down and try again later, but just because things don’t work the way they used to doesn’t mean they don’t work at all.

2. Be experimental. Orgasm on SSRIs can require a completely different kind or intensity of stimulation than it used to. This is the perfect time to play with vibrators, stimulating lubes, beads or prostate massage, even if they haven’t seemed very interesting before.

It might be wise, though, to stick with softer toys, especially if your body is demanding more stimulation or firmer pressure. Hard plastic or anything with sharp edges, even small ones, might cause injury. Fortunately, there are a lot of softer options out there, like silicone, latex and elastomer.

3. Be open to whatever happens. A false start, for example, isn’t the same thing as not having any orgasm at all, and a change in arousal pattern doesn’t mean that something’s going wrong. It only means that things are different.

Masturbation is very much a matter of habit mentally as well as physically, so sexual fantasies may change. Let them. A weird fantasy is only a problem if it’s acted on without the full, informed consent of the participants. Left in our heads, they’re completely harmless.

Even the cues indicating arousal may different. A woman might need extra lube, or maybe less lube. A man may find his erections have a different texture than they used to. Body parts may be sensitive long before they swell, or swell without being all that sensitive.

Being open to whatever happens also means accepting emotional reactions. Frustration is normal, as is fear. Especially if sexual response has undergone extreme changes, it’s unsettling to find your body and mind responding in an unfamiliar way, and it’s strange to have to re-learn how to do something you’ve been doing since you were twelve. Tears are not unreasonable here, nor is a certain amount of creative cussing.

Our internal templates for sex can be surprisingly fixed, not just by culture but by our own personal responses. Changes in those responses can feel like a loss rather than a simple change, and it can take some hard work to get through. Fear and grief are normal, but given time and care, they can pass.

The bottom line is pleasure itself. Can you enjoy sexual touch and response even when it doesn’t match up to your preconceived notions? Is it your body that’s flawed, or the notions? My own belief is that sex is so personal that every time someone’s body doesn’t conform, it’s the notions that are at fault. As long as you’re not inflicting serious injury in order to get off, you’re fine. A sudden fascination for prostate stimulation isn’t a pathology.

4. Be kind to yourself. Internal recriminations don’t help and might make things worse, because that kind of self-talk can become a self-fulfilling prophecy. There’s a world of difference between thinking that something didn’t work out this one time, and thinking that it will never work again. There may be a few days when you have to bring out the ice in the washcloth, but once you figure out where your new buttons are and learn to push them consistently, it gets easier. Eventually, it even gets comfortable.

Keep in mind that mood disorders and chronic pain can interfere with sexual response, so your familiar baseline may not actually be normal. You may be impaired by whatever condition you’re being treated for. This doesn’t mean that your response on medication is normal, either, only that a change from one thing to another isn’t necessarily a change from normal to abnormal. It’s just a change.

5. If nothing works, talk to your doctor. They’ve all heard it before, and there are several alternatives that can be explored.

What can partners do? Be patient and keep an open mind, which is far easier said than done. The changes in response can bring out beliefs and even prejudices about sex that are so taken for granted they are hidden in plain sight; SSRIs are a bit like putting a reagent on a note written in invisible ink. This, like the physical and mental changes, is going to demand some adaptation and as with everything else associated with these drugs, there’s no way to know in advance what’s going to happen.

The decision to go on SSRIs is a personal one that must be made keeping all issues in mind, including side effects, but side effects alone shouldn’t be the deciding factor, especially when it’s possible to plan ahead. If you know the drug you’re taking has a low probability of causing trouble, you might not have to change anything, but if you’re on Paxil, Prozac, Zoloft or any of the other more infamous offenders, some advance planning can ease the stress. This is a good time to try a thicker lube, a stronger vibrator, or a change in position.

Our sexuality is so much a part of us that we take its expression for granted, but SSRIs aren’t the only thing that can cause disturbances in it, because sex isn’t just a thing we do, it’s part of who we are. It’s integrated into our bodies and minds, and anything that alters us in one way can easily alter us sexually. It’s disconcerting to say the least.

The trick to surviving these alterations is to understand that acceptance isn’t the same thing as resignation. In fact, they’re opposites. Being resigned to a thing is actually a form of rejection. We see this thing, these changes, as unacceptable, but unalterable, and it’s only when we accept a thing that we can begin to work with it. Accepting the sexual side effects of SSRIs is the first step to working with them.

Ann Regentin
January 2008

© 2008 Ann Regentin. All rights reserved. Content may not be copied or used in whole or part without written permission from the author.

About the Author: Ann Regentin was introduced to erotica at a tender age, when a raid of her mother’s bookshelves netted such gems as The Perfumed Garden and Lady Chatterly’s Lover. She started writing it during her ninth grade biology class, then dropped it for about twenty years to become a musician, a college student, a cripple, a bookstore clerk, an artist, a model, a mother, a parrot rescuer, and finally a reference writer before coming full circle back to erotica.
Her stories and articles have appeared in a variety of places both online and in print, and she is a Contributing Editor at She lives in the Midwest with her son, two parrots, and an elderly Gibson guitar.
Visit Ann Regentin at:

Smutters Lounge Categories

Smutters Lounge Authors

Smutters Lounge Archives

Pin It on Pinterest