Persistent Sexual Dysfunction After SSRIs and SNRIs: A Clinical Framework for Assessment, Counseling, and...

Sexual dysfunction during SSRI/SNRI treatment is common, but persistent sexual dysfunction after discontinuation remains clinically contested and poorly quantified. This structured narrative review and evidence-informed framework-development exercise integrates published and regulatory evidence available to 14 May 2026 on clinical assessment, sexual-domain documentation, differential diagnosis, counseling, risk minimization, and pharmacovigilance reporting. Persistent symptoms may represent a plausible and potentially severe adverse drug reaction when temporality, persistence, phenotype specificity, and assessment of stronger alternative explanations support that interpretation. Genital sensory change, orgasmic or ejaculatory anhedonia, and a clearly documented change from baseline are high-value clinical features, but no single symptom is pathognomonic. Current evidence does not justify precise prevalence claims, mechanistic certainty, or curative-treatment recommendations. Because monitoring cannot guarantee prevention and abrupt discontinuation may cause withdrawal or psychiatric relapse, risk communication should be proportionate and individualized. Immediate priorities are shared decision-making, direct follow-up questioning, structured differential diagnosis, support for distress and relationship impact, and higher-quality adverse-event reports.