The Impact of Mental Illness on Sexual Dysfunction

Abstract

Sexual dysfunction is prevalent among psychiatric patients and may be related to both the psychopathology and the pharmacotherapy. The negative symptoms of schizophrenia limit the capability for interpersonal and sexual relationships. The first-generation antipsychotics cause further deterioration in erectile and orgasmic function. Due to their weak antagonistic activity at D2 receptors, second-generation antipsychotics are associated with fewer sexual side effects, and thus may provide an option for schizophrenia patients with sexual dysfunction. Depression and anxiety are a cause for sexual dysfunction that may be aggravated by antidepressants, especially selective serotonin reuptake inhibitors (SSRIs). SSRI-induced sexual dysfunction may be overcome by lowering doses, switching to an antidepressant with low propensity to cause sexual dysfunction (bupropion, mirtazapine, nefazodone, reboxetine), addition of 5HT2 antagonists (mirtazapine, mianserin) or coadministration of 5-phosphodiesterase inhibitors. Eating disorders and personality disorders, mainly borderline personality disorder, are also associated with sexual dysfunction. Sexual dysfunction in these cases stems from impaired interpersonal relationships and may respond to adequate psychosexual therapy. It is mandatory to identify the specific sexual dysfunction and to treat the patients according to his/her individual psychopathology, current pharmacotherapy and interpersonal relationships.

Asexuality: A Mixed-Methods Approach

“…For nearly all significant correlations in both men and women, there was a general pattern of more sexual response difficulties with more personality and psychologic impairment (e.g., in women: self-deceptive enhancement, alexithymia, hostile control, suicidal thinking, alcohol use; in men: acting out, psychotic features, alienation, and impression management). This supports the finding among nonasexuals that sexual dysfunction and psychopathology are significantly related (Zemishlany & Weizman, 2008). However, for women, there was a paradoxical positive correlation between depression and arousal, and between alienation and orgasmic function.…”

Mental Disorders and Female Infertility

“…The extent of disturbance varies with nutrition and weight (Schweiger et al, 1992;Poyastro Pinheiro et al, 2007). It has been demonstrated that women with eating disorders often suffer from sexual dysfunction, which may contribute to infertility (Zemishlany and Weizman, 2008). Women with infertility tend not to discuss behavioral problems with their physicians (Domar et al, 2012).…”

Therapy of female sexual dysfunction in multiple sclerosis

“…U pacjentek leczonych z powodu depresji, w celu uniknięcia dysfunkcji seksualnych powodowanych przez trójpierścieniowe leki przeciwdepresyjne (TLPD) i inhibitory zwrotnego wychwytu serotoniny (selective serotonin re-uptake inhibitors -SSRI), można próbować stosować minimalne skuteczne dawki tych leków, zmienić na lek o mniejszym potencjale wywoływania dysfunkcji seksualnych (bupropion, mirtazapina, reboksetyna, mianseryna, trazodon), ewentualnie dodawać do terapii inhibitory fosfodiesterazy 5 (PDE-5) -syldenafil, wardenafil lub tadalafil [48].…”