Management Strategies for Antipsychotic-Related Sexual Dysfunction: A Clinical Approach

Abstract

Antipsychotic medication can be often associated with sexual dysfunction (SD). Given its intimate nature, treatment emergent sexual dysfunction (TESD) remains underestimated in clinical practice. However, psychotic patients consider sexual issues as important as first rank psychotic symptoms, and their disenchantment with TESD can lead to important patient distress and treatment drop-out. In this paper, we detail some management strategies for TESD from a clinical perspective, ranging from prevention (carefully choosing an antipsychotic with a low rate of TESD) to possible pharmacological interventions aimed at improving patients’ tolerability when TESD is present. The suggested recommendations include the following: prescribing either aripiprazole or another dopaminergic agonist as a first option antipsychotic or switching to it whenever possible. Whenever this is not possible, adjunctive treatment with aripiprazole seems to also be beneficial for reducing TESD. Some antipsychotics, like olanzapine, quetiapine, or ziprasidone, have less impact on sexual function than others, so they are an optimal second choice. Finally, a variety of useful strategies (such as the addition of sildenafil) are also described where the previous ones cannot be applied, although they may not yield as optimal results.

Sexuality, Quality of Life, Anxiety, Depression, and Anger in Patients with Anal Fissure. A Case–Control Study

“…Previous studies have focused on the relationship between medical diseases or mental disorders including its treatments and patients sexuality, QoL (general or health related), or selected psychological factors highlighting the relationship between these factors and clinical disorders or its treatments [ 5 , 10 , 11 , 13 , 14 , 15 , 19 , 20 , 23 , 25 , 29 , 34 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ]. These include, sex and quality of life [ 10 ]; sexual health and dysfunction in patients with rheumatoid arthritis [ 13 ]; sexuality and mental health [ 15 ]; antipsychotic-related sexual dysfunction [ 19 ]; sexual function in chronic illness [ 20 ]; the impact of physical illness on sexual dysfunction [ 23 ]; sexual dysfunction and chronic illness [ 27 ]; sex and chronic physical illness [ 28 ]; comorbidities in male and female sexual dysfunction [ 60 ]; sexual dysfunction and mental health in patients with multiple sclerosis and epilepsy [ 29 ]; psychiatric disorders and sexual dysfunction [ 63 ]; thyroid autoimmune disease impacting on sexual function in young women [ 64 ]; clinical features associated with female genital mutilation/cutting [ 65 ]; QoL after flatfoot surgery [ 33 ]; anxiety and QoL in patients with type 2 diabetes [ 58 ]; QoL and associated psychological distress in patients with knee arthroplasty [ 59 ]; psychological factors as determinants of medical conditions [ 57 ]; sleep disturbance, depression and anxiety in frail patients with atrial fibrillation [ 61 ]; cognitive behavior counseling in preoperative preparation and enhanced recovery after surgery [ …”

“…There is a long way to go between the research and clinical fields; especially with regard to human sexuality in the clinical settings [ 72 ], which is usually underestimated by clinicians [ 19 ] or even ignored by them in their daily clinical practice. QoL [ 26 ] and sexual function [ 66 ] are rarely studied in patients with surgical diseases, including AFs.…”

“…The relationship between sexuality and mental health is bidirectional [ 15 ]. Mental disorders and psychotropic treatments can impact on patients’ sexual functions with implications for clinical management [ 15 , 16 , 17 , 18 , 19 ].…”

Validation of the Center of Applied Psychology Female Sexuality Questionnaire (CAPFS-Q)

“…The study of female sexual function (FSF) through self-administered questionnaires is a difficult task because of the complex, sensitive and personal nature of the matter, and because the measures are subjective [ 26 ]. These instruments include diverse attitudes, cognitions, and behaviors related to sexuality, personal, couple, relational variables, and other multiple related factors, sexological and other, such as health and its components [ 26 ] and the adverse effects of medications on sexuality [ 14 , 26 , 27 , 28 , 29 ]. Cognitive variables related to sexuality [ 16 , 25 ] may vary between different cultures and geographic regions [ 30 ].…”

Drug-Induced Sexual Dysfunction in Individuals with Epilepsy: Beyond Antiepileptic Compounds

“…Moreover, risperidone has also been associated with ejaculatory dysfunction, such as retrograde ejaculation, as well as reduced lubrication. On the contrary, hyperprolactinemia has rarely been associated with quetiapine, ziprasidone, aripiprazole (which appears to be a drug with fewer SD in males), or clozapine [ 17 , 18 ]. Notably, atypical antipsychotics may cause additional adverse effects on arousal and orgasm function because of their negative activity on the serotonergic pathway [ 18 ].…”