Sexual Dysfunction "Extremely Frequent" in Patients with Schizophrenia

Sexual dysfunction is highly prevalent among individuals with schizophrenia relative to the general population, according to a new meta-analysis.

New research from a multinational team of investigators showed a majority of both men and women with schizophrenia reported sexual dysfunctions globally, with issues ranging from erectile and orgasm dysfunction, to a general loss of libido. The findings additionally observed an association between patient antidepressant or mood stabilizer prescriptions and lessened rates of some forms of sexual dysfunction.

Investigators led by Theo Korchia, MD, of the Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, CEReSS - Health Service Research and Quality of Life Center in France, sought to synthesize observational research data to interpret global prevalence of sexual dysfunction among individuals with schizophrenia-spectrum disorders. They noted a commonly accepted—yet not robustly evidenced—trend of sexual health disruption in individuals with schizophrenia since the 20th century; one of the greatest pathophysiological factors is the disease’s inhibition of dopamine D2 receptors.

“Antipsychotic-induced sexual dysfunctions may also occur independently of increased prolactinemia due to increased antiparkinsonian adverse effects, including blunted affect and anhedonia,” they noted. “Anti–α1-adrenergic receptor inhibition may also induce sexual dysfunctions through relaxation of the intracavernosal smooth muscle fibers, inducing erection and ejaculation dysfunctions in men.8 Anti–H1 receptor inhibition induces sedation, which may alter satisfactory sexual activity.”

Korchia and colleagues conducted their systematic literature review through online databases featuring studies published up to June 8, 2022. Eligible observational studies included reported sexual dysfunction in patients with schizophrenia or schizoaffective disorder. Exclusion criteria included studies with inpatients and studies only assessing treatment-resistant patients.

The team identified 72 relevant studies published between 1979 – 2021. Among them, 35 studies included data on prevalence of orgasm dysfunction among individuals with schizophrenia; 34 included data on loss of libido; 33 on erectile dysfunction; 19 on ejaculation dysfunction; 10 on genital pain; 6 on amenorrhea; and 5 on galactorrhea.

The analysis included 21,076 patients from 33 countries across 6 continents. A majority of studies (n = 59 [81.9%]) used a standardized questionnaire to assess sexual dysfunctions.

The pooled estimate of sexual dysfunction was 56.4% (95% CI, 50.5 – 62.2) among individuals with schizophrenia. Other forms of sexual dysfunction were additionally highly prevalent by pooled estimates:

• Loss of libido, 40.6% (95% CI, 30.7 – 51.4)
• Orgasm dysfunction, 28.0% (95% CI, 18.4 – 40.2)
• Genital pain, 6.1% (95% CI, 2.8 – 12.7)

Among men with schizophrenia, sexual dysfunction prevalence was an estimated 55.7% (95% CI, 48.1 – 63.1). Another 44.0% were estimated to experience erectile dysfunction, and 38.6% ejaculation dysfunction.

Among women with schizophrenia, sexual dysfunction was even greater—an estimated 60.0% (95% CI, 48.0 – 70.0). One-fourth (25.1%) were estimated to experience amenorrhea and 7.7% galactorrhea.

“We found contradictory results concerning antipsychotic classes (first generation vs second generation) and sexual dysfunctions, and it was not possible to identify a class or specific antipsychotic associated with a higher or lower prevalence of sexual dysfunction,” investigators noted. “Compared to other studies, erectile and ejaculation dysfunctions and loss of libido were significantly lower in studies including participants treated with antidepressants, and erectile and ejaculation dysfunctions decreased with the percentage of patients treated with antidepressants and mood stabilizers.”

In reviewing the analyses, Korchia and colleagues emphasized the heterogeneity of sexual dysfunction outcomes and effects on individuals with schizophrenia. Nonetheless, they concluded that the 4 decades’ worth of data show the extremely high frequency of sexual dysfunction among individuals with schizophrenia.

“Beyond methodological discrepancies partially explaining heterogeneity, we found important evidence in observational studies suggesting that improving the screening and treatment of depression may be an effective strategy to improve sexual health in patients with schizophrenia,” they wrote. “Promoting systematic health assessment in sexual dysfunction studies could also help better understand associations between sexual dysfunction and metabolic parameters.”

Reference

^{Korchia T, Achour V, Faugere M, et al. Sexual Dysfunction in Schizophrenia: A Systematic Review and Meta-Analysis. JAMA Psychiatry. Published online September 13, 2023. doi:10.1001/jamapsychiatry.2023.2696}