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Sexual Anhedonia: When Sex Stops Feeling Good

woman sleeping on a bed
July 28 2026,
Expert advice
12 min read
Dr Hannah Nearney
Consultant Psychiatrist (MBChB, MRCPsych, MSc, PGDip(CAT), NHS Innovation Accelerator Fellow)
TL;DR
  • Depression is a common cause. Anhedonia is a core symptom of depression, affecting up to seven in ten people who are depressed, and this loss of pleasure often extends to sex.
  • SSRIs and SNRIs are a well-recognised cause too. Sexual side effects are estimated to affect 58–73% of people taking these medications, alongside emotional blunting in 40–60% of users.
  • A rarer, longer-term condition called PSSD (post-SSRI sexual dysfunction) can persist even after stopping medication. The EMA formally acknowledged this in 2019 and requested updated product information.
  • The ADHD and dopamine link is a genuine research question, not a settled explanation. Evidence directly connecting ADHD to sexual anhedonia specifically is limited.
  • This is common and treatable, and worth raising with a GP or psychiatrist. Never stop or change antidepressants without medical advice, as stopping suddenly can be unsafe.

Introduction

If you can still have sex, still reach orgasm, and yet feel little or no pleasure, you may feel very alone and isolated.

This experience in fact, has a name, sexual anhedonia, and in my clinical work, comes up far more often than people expect. It's often mentioned as a throwaway comment, almost as an aside, towards the end of a longer conversation about mood, medication, or a relationship under strain.

Sexual anhedonia describes a reduced or absent ability to feel pleasure from sexual activity or orgasm, even when desire and physical function remain intact [Ref 1].

This can feel strange and unsettling: the body goes through the motions and things seem to “work” as normal, but the rewarding aspect of the experience doesn't arrive. Here, I will explain what's going on, why it may be happening, and what you can do about it, because this is a common and often treatable issue, not something to feel embarrassed about.

I see a real reluctance in patients to bring up sexual difficulties, often more than with other symptoms of depression. People will volunteer that they've stopped enjoying their job or their hobbies, but this particular issue can feel too private, too embarrassing, or too tangled up with a relationship to mention. I'd like this article to make that conversation a little easier, whether that's with your own doctor, your partner, or simply with yourself first.

woman starring in the distance

What Is Sexual Anhedonia?

Sexual anhedonia is not a commonly used medical term, but let's unpack it.

The word anhedonia comes from the Greek “an” (without) “hēdonē” (pleasure), and means a reduced ability to feel pleasure. Anhedonia is considered one of the core symptoms of depression [Ref 4]. It doesn't only impact on obvious sources of enjoyment, like hobbies or time with friends but can affect any part of life where pleasure is normally experienced, and for many people, this includes sex.

With sexual anhedonia, arousal and orgasm can still happen. The physical process still occurs, but the pleasure, the sense of reward or satisfaction that usually goes with it, is muted or missing altogether. When anhedonia is specific to the orgasm itself, this is sometimes described as ejaculatory anhedonia or pleasure dissociative orgasmic dysfunction [Ref 1].

These difficulties are thought to be potentially caused by disrupted reward and motivation pathways and altered dopamine activity in the brain [Ref 1], [Ref 2]. However, as with anhedonia more broadly, understanding this is highly complex and a work in progress. As the exact underlying mechanisms are still being studied, I'd rather be honest about the limits of what we currently know.

Sexual anhedonia can affect adults of any age, gender, or sexual orientation. Although most of the search interest on this topic comes from men, women also experience this, but are, frankly, understudied and less often asked about sexual difficulties in clinical settings [Ref 3]. If a doctor has never asked you about sexual dysfunction directly when assessing for or treating depression, this reflects a gap in how we practise as a profession, rather than an indication that this is not an important area to explore.

It's also worth saying that a loss of pleasure during sex rarely turns up in isolation. When mood is low, it's common to notice a cluster of related changes together: reduced desire or libido, difficulties with arousal or performance, and, for many people, medication side effects layered on top. I've written more about those antidepressant sexual side effects separately, as they deserve their own space.

What Causes Sexual Anhedonia?

Depression

Depression itself can lower both libido and the capacity for pleasure, sexual or otherwise. This is one of the reasons anhedonia is considered a core symptom of a depressive episode, affecting up to seven in ten people who are depressed [Ref 4].

The encouraging part, clinically, is that as depression lifts, whatever the treatment, this side of things often improves too [Ref 3], [Ref 4].

In practice, this means that when someone tells me sex has stopped feeling enjoyable or worthwhile, I want to know about other aspects or their mental health too: loss of interest or pleasure more widely, mood, energy levels, sleep, appetite, motivation, concentration, confidence, and thought patterns. Sexual anhedonia rarely arrives as an isolated complaint. It often can sit within the wider picture of depression, which is useful information, because recognition allows for treating the underlying condition rather than searching for a fix aimed only at this one symptom.

Antidepressants (SSRIs and SNRIs)

Antidepressants, particularly SSRIs and SNRIs, are also a well recognised cause of sexual dysfunction. Sexual side effects, including reduced desire, arousal and orgasm, are estimated to affect somewhere between 58 and 73% of people taking these medications [Ref 3]. Emotional blunting, a related but distinct experience reported by around 40 to 60% of users, can flatten sexual pleasure as well as emotional range more generally [Ref 5], [Ref 6].

I want to be really clear here: both depression and its treatment can affect sex, and it isn't always obvious which is doing what in any individual case. This is exactly the kind of thing worth an open, unhurried conversation with your doctor, rather than a decision made alone [Ref 3]. Please don't stop or change your medication without medical advice. Doing so suddenly can carry its own risks, including withdrawal effects and relapse of depression.

Post-SSRI Sexual Dysfunction (PSSD)

There's also a rarer, but recognised, longer term condition called post-SSRI sexual dysfunction, or PSSD. This involves persistent sexual dysfunction, including genital numbness and pleasureless orgasm, that can continue even after medication has been stopped [Ref 3], [Ref 7].

In 2019, the European Medicines Agency's safety committee formally acknowledged that this kind of dysfunction can persist beyond stopping treatment, and requested that product information for these medications be updated to reflect it [Ref 7], [Ref 8]. PSSD is thought to be uncommon, though it's likely underreported, partly because so few people are asked about it directly.

man jumping in a field

Dopamine and ADHD

Because dopamine plays such a central role in reward and motivation, some people, particularly those with ADHD, ask me whether their brain wiring is behind their experience of sexual anhedonia. It's a reasonable question, but I'd urge some caution here.

The relationship between ADHD and dopamine is far more nuanced than “low dopamine equals ADHD equals anhedonia” [Ref 9], and the evidence directly linking ADHD to sexual anhedonia specifically is limited [Ref 9]. This is genuinely a question researchers are still exploring, not a settled explanation, and I'd rather say that plainly than reach for a tidy answer that isn't there yet.

What I do see more often in my ADHD patients is something slightly different: cognitive hyperactivity, that constant background of busy thoughts, internal distractibility, and mind wandering, which can make it very difficult to stay “present” during intimate moments, and can greatly affect sexual connection and pleasure.

What You Can Do

If any of this sounds familiar, please know that this is a common, entirely discussable medical issue. A GP or psychiatrist will not be embarrassed to talk about it with you, and in my experience, most patients feel a real sense of relief once it's finally out in the open [Ref 3].

Curious whether Flow might be a fit for your depression treatment? Take our two-minute quiz

If antidepressant side effects turn out to be part of the picture, there are options to explore together with your doctor, from reviewing your current medication to considering non-medication treatments for depression alongside or instead of it.

It can help to prepare a little before that appointment. Jot down roughly when the change started, whether it lined up with starting or increasing a medication, and whether desire and arousal are affected too, or whether it's really the pleasure itself that's missing. None of this needs to be perfectly precise; it simply helps your doctor understand the full picture rather than a single symptom in isolation.

You do not have to manage this alone. Sexual anhedonia is common and often treatable, and your GP or psychiatrist will not be embarrassed to talk about it. Do not stop or change any medication without medical advice, as stopping suddenly can be unsafe. If antidepressant side effects are the issue, your doctor can help you weigh your options.

Where Flow Fits

This is where Flow, the treatment I work with as UK Medical Director, becomes relevant to this conversation, though I want to be precise about what I am, and am not, claiming.

Flow is a non-invasive, FDA approved and CE certified medical device, used within the NHS, that treats depression across the full range from mild to severe. It delivers a gentle electrical current to the dorsolateral prefrontal cortex, or DLPFC, an area of the brain we know to be underactive in depression [Ref 10].

In terms of side effects, Flow does not cause sexual dysfunction, weight gain or sedation, and 95% of users report no side effects at all [Ref 11]. It can be used alongside antidepressant medication or as a standalone treatment, and that decision should always be made together with your doctor [Ref 11], [Ref 3].

I want to be honest about what this does and doesn't mean. I'm not suggesting Flow treats sexual anhedonia directly; we simply don't have the evidence for that. What I can say is that because reduced libido and loss of pleasure are so often part of depression itself, treating the underlying depression can, for some people, help that side of things recover too.

Key takeaways

1
Sexual anhedonia means arousal and orgasm can still happen,
but the pleasure is muted or missing. It's often linked to low mood and affects all genders, though women are less often asked about it.
2
Depression, SSRIs and SNRIs, and, rarely, PSSD are recognised causes.
Never stop or change antidepressants without speaking to your doctor first.
3
The dopamine and ADHD link is a genuine area of research interest,
not a settled explanation, and shouldn't be treated as one.
4
This is common and often treatable.
Talk to your GP or psychiatrist rather than managing it alone.

Closing Thoughts

If you recognise yourself in any of this, please hear me when I say: sexual symptoms are common, and not your fault. Sex and pleasure are just one more part of life that low mood, and sometimes its treatment, can impact. Like most things in psychiatry, the way forward starts with a conversation, so please do talk to your doctor.

References

About the Author

Dr Hannah Nearney MBChB, MRCPsych, MSc, PGDip(CAT) is a Consultant Psychiatrist specialising in general adult psychiatry, including adult ADHD, autism, and women's mental health. She is UK Medical Director at Flow Neuroscience and a founding partner at Anchor Psychiatry Group in East Anglia. She is a Fellow on the NHS Innovation Accelerator programme (2026 cohort), which provides support to scale evidence-based innovations like Flow tDCS in the NHS to enhance patient outcomes and service delivery. Follow her on Instagram: @psychiatristhannah.