Insights into the peripheral nature of persistent sexual dysfunction associated with post-finasteride, post-SSRI and post-accutane syndromes: lessons learned from a case study.

Abstract

Purpose: Retinoids for acne, finasteride/saw palmetto for hair loss/BPH, and selective Serotonin Reuptake inhibitors (SSRIs) for depression, have all been implicated in severe, persistent sexual dysfunction that occurs after stopping these medications. The underlying mechanism of this post-drug syndrome is unknown, nor is an effective treatment available. The purpose of this investigation is to use a retrospective chart review to characterize a cohort of patients who suffer from post-drug syndrome and to determine if improvement in symptoms is feasible when focusing treatment on the peripheral nerves of the genitalia.

Methods: Three male patients seen in our urology clinic were sequentially treated with high frequency electrical stimulation and low intensity extracorporeal shock wave therapy for a total of 16 weeks. Symptom improvement was assessed using the International Index of Erection Function (IIEF), the Masturbation Erection Index (MEI), global response assessment scale, corneal confocal microscopy, the FirmTech® Ring to monitor nocturnal erections pre- and post-peripheral nerve treatment and von Frey filament testing.

Result: Mild-moderate erectile function improvement, mild penile sensitivity improvement, and mild nocturnal erection improvement were seen across all three patients. Peripheral neuropathy was noted in two patients via corneal confocal microscopy, however central symptoms remain.

Conclusion: The post-drug syndrome appears to consist of a peripheral component which may be treatable using our regimen, as we saw overall improvement in penile sensitivity and erections following treatments. However, patients were still profoundly affected by their symptoms post-treatment and thus there is an urgent need for additional research on this syndrome.