We live in a world where sex is highly emphasized, and the practice of sexuality for some individuals is as vital to health as eating, sleeping, and exercising.

Some components involved in normal sexuality are also implicated in the cause and treatment of mental disorders, making psychiatric patients more likely to experience difficulties or changes in sexual behavior.

Up to 80% of patients have sexual disorders in psychiatry due to the disease itself or the medications used to treat them, leading to problems in the relationship with the partner and the use of substances without a medical prescription. These consequences can lead to an even riskier outcome, which is the abandonment of psychiatric treatment.

Symptoms such as reduced self-esteem, relationship difficulties, reduced interest, tiredness, among others, are often present in several mental disorders and can cause sexual disorders in psychiatry and a reduction in the frequency and quality of sexual relations.

Antidepressants, antipsychotics, and anxiolytics used in the treatment are associated with an increased risk of drowsiness, decreased sexual desire, erectile dysfunction, and reduced orgasm.

However, the interruption of drug treatment without medical advice, in most cases, can lead to worsening of symptoms, social harm, reduced income, and quality of life. This article is focused on the socio-sexual context and the medical evaluation; therefore, it is essential to clarify the importance of sexuality in the individual’s life and the changes that occurred after his illness.

Medical and psychological follow-ups help broaden the understanding of sexuality and identify other forms of sexual satisfaction, analyzing the needs of each individual without compromising basic treatment.

The gynecological/urological assessment and mental health care exclude clinical causes subject to specific interventions. In some cases, adjusting the patient’s medications or introducing new medications that help alleviate symptoms may be considered.

Sexual health involves the absence of disease and the ability to engage in consensual, safe, respectful, and pleasurable sexual relationships. Bringing it up is the first step in relieving discomfort. Breaking the shame barrier and discussing the issue with professional sexologists involved in the treatment allow for individual therapy and improved quality of life.

Sexual disorders in psychiatry

One of the hallmarks of schizophrenia is the presence of negative symptoms, such as anhedonia, apathy, abulia, and blunted effect. These symptoms influence sexual functioning and decrease the possibilities for interpersonal relationships and sexual experiences.

People with schizophrenia are less interested in and engage in sexual activities and derive less satisfaction from them; this is related to the severity of their psychopathology.  On the other hand, auto-erotic practices are frequent.

The positive symptoms of schizophrenia may be associated with increased libido, but this symptom is only rarely the cause of the sexual assault.  On the other hand, one can observe erotomaniac delusions or delusions linked to sexual identity, as well as coenesthetic hallucinations of a sexual nature.

Sexual disorders are a frequent phenomenon in these patients: according to some studies, more than 70% of men and more than 50% of women who are not hospitalized report sexual disorders. The frequency of sexual desire and orgasms is lower than average, and almost 50% of men suffer from an erectile disorder. In addition, the concern related to the sexual disorder can worsen the psychotic symptomatology.

The introduction of antipsychotics further increases the risk of developing sexual disorders, affecting 60% of patients, or even 90% depending on the studies.

Men mostly report erectile dysfunction or delayed ejaculation, but also a decrease in desire which can be treated by a sexologist. Women mainly report disorders of desire and orgasm, but also dyspareunia.

Antipsychotics cause sexual disorders through several mechanisms, such as hyperprolactinemia and their antidopaminergic effect, but also through their antiadrenergic, antihistamine, and antimuscarinic effect. Some atypical antipsychotics have fewer sexual side effects than typical antipsychotics.

They have a lower risk of increasing plasma prolactin, and more rarely cause extrapyramidal side effects, which may be beneficial for sexual performance. The negative sexual side effects of antipsychotics affect drug compliance in patients.

What are sexual disorders in women?

The sexual problems in women are many and can have more or less significant impacts on the couple’s private lives. Often ignored, these sexual dysfunctions can however be treated effectively.

Sexual problems in women: It is estimated that between 40% and 50% of women have suffered at least one sexual problem. Separating it by age groups, this prevalence would occur in 1 in 4 women between 18-44 years of age, increasing to 45% in women over 45 years of age and 80% in women over 65.

It should be noted that, according to data obtained from a study by the University of California Department of Urology and Psychiatry, 40% of women have never sought treatment or help.

The most common problems are:

  • Inhibited sexual desire: Impossibility of arousal that usually occurs with a lack of erotic feelings. The situation causes dissatisfaction and frustration.
  • It is the most common female sexual dysfunction, 30% of women do not have sexual desire.
  • Anorgasmia: Inability to experience an orgasm, but not arousal. It is quite frequent.
  • Vaginismus: Impossibility to perform sexual intercourse due to the involuntary contraction of the muscles of the lower third of the vagina.
  • Dyspareunia: Also called coitalgia. They are discomforts suffered by women during sexual intercourse, making it painful or difficult.

Sexual problems in men

As for men, erectile dysfunction affects 10% of men, and this percentage increases to 30% in men between 40 and 70 years old.

The most common problems are:

  • Impotence or erectile dysfunction: It is defined as the persistent or recurrent inability to achieve and/or maintain an erection firm enough to be able to consume a satisfactory sexual relationship.
  • Premature ejaculation: Inability to voluntarily control ejaculation. It can appear suddenly or gradually.
  • Anorgasmia: It is the dysfunction in which the ejaculatory response is only partially inhibited. The emission of semen is in the form of a “drip,” and pleasant sensations are absent.
  • Dyspareunia: Painful intercourse that can occur during the same act or later. They can be generated by the extreme sensitivity of the glans due to an injury, lack of hygiene, phimosis, or urethral stricture, among other reasons.
  • Low sexual desire: Persistent or recurrent inhibition of sexual desire or libido, decreased or blocked-in sexual desire.

Most sexual dysfunctions are multi-causal, with both organic (usually vascular) and psychological factors. Alterations in sexual function can appear due to diseases (diabetes, prostate cancer, etc.). Taking certain medications (SSRI antidepressants, antihypertensives, etc.), toxic habits (alcohol or tobacco abuse), and of course, stress, fatigue, and anxiety are also risk factors.

If you want professional help in the field of mental health, get in touch with Marham. Professionals from the Marham clinic offer psychotherapy, psychiatry, and neuropsychology help. Their psychiatrists have experience of more than two decades treating patients. They serve both in the local centers located all over Pakistan and through online sessions by video call.