A Clinical Guide to Rare Male Sexual Disorders. (Incl. PFS, PSSD, PAS/PRS)

Gül, Murat, et al. “A Clinical Guide to Rare Male Sexual Disorders.” Nature Reviews Urology, Sept. 2023, pp. 1–15. www.nature.com, https://doi.org/10.1038/s41585-023-00803-5.


Conditions referred to as ‘male sexual dysfunctions’ usually include erectile dysfunction, ejaculatory disorders and male hypogonadism. However, some less common male sexual disorders exist, which are under-recognized and under-treated, leading to considerable morbidity, with adverse effects on individuals’ sexual health and relationships. Such conditions include post-finasteride syndrome, restless genital syndrome, post-orgasmic illness syndrome, post-selective serotonin reuptake inhibitor (SSRI) sexual dysfunction, hard–flaccid syndrome, sleep-related painful erections and post-retinoid sexual dysfunction. Information about these disorders usually originates from case–control trials or small case series; thus, the published literature is scarce. As the aetiology of these diseases has not been fully elucidated, the optimal investigational work-up and therapy are not well defined, and the available options cannot, therefore, adequately address patients’ sexual problems and implement appropriate treatment. Thus, larger-scale studies — including prospective trials and comprehensive case registries — are crucial to better understand the aetiology, prevalence and clinical characteristics of these conditions. Furthermore, collaborative efforts among researchers, health-care professionals and patient advocacy groups will be essential in order to develop evidence-based guidelines and novel therapeutic approaches that can effectively address these disorders. By advancing our understanding and refining treatment strategies, we can strive towards improving the quality of life and fostering healthier sexual relationships for individuals suffering from these rare sexual disorders.

Key points

  • Rare male sexual disorders include post-finasteride syndrome, restless genital syndrome, post-orgasmic illness syndrome, post-elective serotonin reuptake inhibitor sexual dysfunction, hard–flaccid syndrome, sleep-related painful erections and post-retinoid sexual dysfunction.

  • The exact mechanisms of these disorders are unclear and the conditions could involve both physical and psychological components.

  • Post-finasteride syndrome symptoms can persist for months or even years after discontinuing treatment with 5α reductase inhibitors.

  • Symptoms of restless genital syndrome include unwanted and unpleasant genital sensations, often perceived as an imminent orgasm without sexual desire or stimuli, and a sense of restlessness in the genital area.

  • Post-orgasmic illness syndrome presents as a combination of local (mucosal) and systemic flu-like and allergic symptoms.

  • Post-selective serotonin reuptake inhibitor sexual dysfunction symptoms can occur even with a single dose of the drug and are not necessarily dose dependent.

  • Hard–flaccid syndrome often occurs following penile trauma, such as excessive masturbation.

  • In post-retinoid sexual dysfunction, symptoms can occur during retinoid treatment and persist after discontinuation, whereas in some patients symptoms can appear or worsen after isotretinoin is stopped.


Anything of particular interest that caught your eye? @Dubya_B

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PRSD (PAS) and PSSD are discussed rather matter-of-factly. That is, their existence as legitimate “organic” illnesses resulting from their respective drug classes isn’t called into question. Yet, the PFS section cites this article and reiterates it through an entire paragraph.

The post-drug syndromes are discussed as almost entirely disparate entities.

Propeciahelp is actually hyperlinked within the article as a support group for PRSD, but not PFS (?) or PSSD.

The authorship has established backgrounds in urology and sexual medicine.

Physical and psychiatric/neurological components of PFS are mentioned, but PRSD and PSSD are described as standalone sexual disorders.

Post-drug manifestation of symptoms is briefly mentioned in relation to PRSD, but not for PFS or PSSD.

A case report is featured describing sabal fruit (saw palmetto berry) as an anecdotal treatment for PFS.

It points to a need for prospective trials, patient registries, and greater recognition among medical professionals for all syndromes discussed.

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“The post-drug syndromes are discussed as almost entirely disparate entities.” I know you and I have briefly discussed this matter a few months ago @Dubya_B.

After spending most of 2023, dedicating a few hours every day to searching through literally every single post on all the post-drug syndrome forums dating back for the past 20 years, I have come to the clear conclusion that I suffer from “post-finasteride syndrome.” It sounds ridiculous because I never took finasteride; I took Accutane. I know that in the eyes of the community, I have “Post-Accutane Syndrome,” but I just know, from watching all the other young men on PFS Network YouTube and Moral Medicine, that I am experiencing the exact same horrible disease as them.

I was looking at some comments on Ryan Russo’s YouTube videos about his experience with “post-finasteride syndrome” and saw people understandably struggling to grasp the concept that Ryan had acquired a disease called “post-finasteride syndrome” from a Lion’s Mane supplement.

I’ve seen this topic pop up on forums before, so I’m not claiming it’s some original idea. But, you know, it’s become clear to me that the need for an umbrella term for these conditions is vital. It might not be the most feasible idea yet because we don’t know the exact underlying mechanisms, and essentially what I am saying is guesswork, as there’s no concrete proof they’re all linked.

That being said, having this umbrella term could really help the general population understand and accept the disease more. Imagine if we all just said we had ‘Post-Endocrine Disruption Syndrome,’ which is caused by a bunch of different drugs and supplements. This would make it so much easier for the general person to wrap their heads around the idea, it would further unite the communities and overall increase awareness.

I appreciate a few of my points from above is what you conveyed to me a couple months ago @Dubya_B, such as the idea of an anti-androgenic syndrome connecting the dots. I just felt like it would be nice for some of the wider community to comment on the matter aswell.


Would you consider telling your story on Moral Medicine? The channel invites all the post drug syndromes on. Awareness is so important!


Thanks Crembo. This is one of the key goals of Moral Medicine: to start to articulate the bigger picture problem. Would love to have you on the channel, keeppushingforward.


What’s more distressing than the post-drug syndromes being treated as completely unrelated is that they are increasingly pigeonholed as nothing more than sexual disorders.

The “SD” acronyms are an additional curse upon “PRSD” and PSSD patients.

I didn’t suddenly start waking up feeling as if I was dragged into an alley and literally poisoned and beat from head to toe, to the point of brain damage, because I developed a post-drug sexual disorder.

The member stories here, including PSSD patients, describe more than sexual dysfunction.

There isn’t one post-drug suicide I am aware of who suffered only from sexual dysfunction.

The common post-drug crash is also rarely, if ever, mentioned in the literature. Shout out to the authors of this study for at least hinting at it in the diagnostic criteria for “PRSD.”

Despite the glaring flaws in the current body of research, the increasing recognition is awesome. I look at it as publicity hype before these conditions being properly characterized becomes the standard.