The Facts About Sexual (Dys)function in Schizophrenia: An Overview of Clinically Relevant Findings

Abstract

A limited number of studies have evaluated sexual functioning in patients with schizophrenia. Most patients show an interest in sex that differs little from the general population. By contrast, psychiatric symptoms, institutionalization, and psychotropic medication contribute to frequently occurring impairments in sexual functioning. Women with schizophrenia have a better social outcome, longer lasting (sexual) relationships, and more offspring than men with schizophrenia. Still, in both sexes social and interpersonal impairments limit the development of stable sexual relationships. Although patients consider sexual problems to be highly relevant, patients and clinicians not easily discuss these spontaneously, leading to an underestimation of their prevalence and contributing to decreased adherence to treatment. Studies using structured interviews or questionnaires result in many more patients reporting sexual dysfunctions. Although sexual functioning can be impaired by different factors, the use of antipsychotic medication seems to be an important factor. A comparison of different antipsychotics showed high frequencies of sexual dysfunction for risperidone and classical antipsychotics, and lower frequencies for clozapine, olanzapine, quetiapine, and aripiprazole. Postsynaptic dopamine antagonism, prolactin elevation, and α 1 -receptor blockade may be the most relevant factors in the pathogenesis of antipsychotic-induced sexual dysfunction. Psychosocial strategies to treat antipsychotic-induced sexual dysfunction include psychoeducation and relationship counseling. Pharmacological strategies include lowering the dose or switching to a prolactin sparing antipsychotic. Also, the addition of a dopamine agonist, aripiprazole, or a phosphodiesterase-5 inhibitor has shown some promising results, but evidence is currently scarce.

Use of neuro-psychiatry medicines in patients with sexual dysfunction: a retrospective study

“…Several factors including postsynaptic dopamine blockade, rise in prolactin level are known to play a role in sexual dysfunction seen with antipsychotic medicines. 17 In accordance with the literature, in our study too, risperidone was the most commonly used antipsychotic.…”

“…The first-generation antipsychotics are associated with more sexual dysfunction. 7,17 Whereas among second generation antipsychotics risperidone is associated with more rates of sexual dysfunction. Lower incidence is seen with other atypical agents such as clozapine, olanzapine, quetiapine, and aripiprazole.…”

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

“…Several factors are involved, including blockade of dopaminergic activity, hyperprolactinemia, and alpha-1 receptor blockade 18 . Hyperprolactinemia and related hypogonadism seems to be strongly implicated in sexual dysfunction, being sometimes accompanied by infertility, amenorrhea, gynecomastia and galactorrhoea 19,20 .…”

Heboidophrenia and Pseudo-Psychopathic Schizophrenia: Current Knowledge and Critical Perspective

“…Troubled sexuality has often been reported [2,14], but a specific sexual pattern to Hd/PSS cannot be ascertained [33]. Psychopaths show a strong sexual drive while schizophrenia patients often experience impairments in addition to reduced sexual desire [14,34]. Stereotyped behavior patterns are often absorbed routinely in these people, sometimes as sterile or apragmatic behaviors [10,13,27,29,33].…”