Sexual dysfunction in psychiatric settings: is there a place for psychotherapy?

Abstract

Sexual dysfunctions (SD) are often associated to psychiatric disorders, either as part of the psychopathology, or as adverse effect of psychotropic medication. When sexual complains are secondary to the clinical condition, it is expected to remit with treatment. Substance-induced sexual dysfunctions, on the other hand, tend to persist, even after pharmacotherapy is over, with deleterious impact in sexual function. Therefore, it is plausible to affirm that a significant number of patients in psychiatric settings, and even a relevant percentage of the general population, will be exposed to the deleterious effects of psychotropic medication in sexual function 1 . These problems deeply affect patients' and partners' sexual satisfaction, threatening relationship stability and partnership-related quality of life aspects. It also negatively impacts pharmacotherapy adherence, thus affecting therapeutic outcomes 2 .Current medical literature provides a two-step approach for sexual problems in this population: (a) improve sexual function and satisfaction assessment and (b) hone methods aiming to reduce SD incidence and its negative consequences. In this sense, there is clear recommendation for directly and routinely asking patients about sexuality from baseline, throughout the duration of pharmacological treatment. This active approach would also be helpful in collecting data often neglected nowadays, that could potentially lead to better comprehension of factors associated to sexual complains and, consequently, inform more effective interventions 3 . Even though there are some available therapeutic options to manage sexual adverse effects of psychotropic medication, evidence of efficacy is still controversial and clinical outcomes are often insufficient to impact sexual satisfaction 4,5 . Besides that, there is consistent data highlighting the lack of attention to sexual problems given by practitioners as well as barriers reported by patients in addressing sexuality with health professionals 6 . Mediating factors between SD, tolerance to sexual adverse effects of medication and treatment adherence warrant further investigation.Being aware that SD is multifactorial, and that gold standard treatment approaches are often multidisciplinary, is probably a key element to better address the problem in psychiatric settings. Literature emphasize the relevant role of psychotherapy in managing SDs, notably cognitive-behavioral interventions [7][8][9] . Empirical data demonstrate yet that maladaptive sexual beliefs might act as a vulnerability factor to SD development 10 , and that non-erotic automatic thoughts in sexual situations are a distinctive phenomenon in sexually dysfunctional patients´ experience of sex 11 . It is therefore noteworthy to address and restructure sexual cognitions when treating SD. Curiously, however, sexual psychotherapy has not been yet studied or systematically considered as a therapeutic option in managing SD in psychiatric patients, been