“Extremely common” sexual dysfunction 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 by a multinational team of investigators has shown that the majority of men and women with schizophrenia report sexual dysfunction worldwide, with problems ranging from erectile and orgasm dysfunction to a general loss of libido. The findings also noted an association between prescriptions for antidepressants or mood stabilizers and reduced rates of some forms of sexual dysfunction.

Investigators led by Theo Korchia, MD, of Assistance Publique-Hopitaux de Marseille, University of Aix-Marseille, CEReSS – Center for Research and Quality of Life in Health Services in France, sought to synthesize data from observational surveys to interpret the global prevalence of sexual dysfunction among individuals with schizophrenia spectrum disorders. They observed a commonly accepted – although not robustly proven – trend of disturbed sexual health in individuals with schizophrenia since the 20th century; One of the biggest pathophysiological factors is the inhibition of dopamine D2 receptors by the disease.

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

Korchia and colleagues conducted their systematic literature review through online databases featuring studies published through June 8, 2022. Eligible observational studies included reports of sexual dysfunction in patients with schizophrenia or schizoaffective disorder. Exclusion criteria included studies with hospitalized patients and studies that evaluated only treatment-resistant patients.

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

The analysis included 21,076 patients from 33 countries on 6 continents. Most 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 also highly prevalent by the combined 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, the prevalence of sexual dysfunction was estimated at 55.7% (95% CI, 48.1 – 63.1). It is estimated that another 44.0% suffer from erectile dysfunction and 38.6% from ejaculatory dysfunction.

Among women with schizophrenia, sexual dysfunction was even higher – around 60.0% (95% CI, 48.0 – 70.0). It was estimated that a quarter (25.1%) had amenorrhea and 7.7% had galactorrhea.

“We found contradictory results regarding antipsychotic classes (first generation versus second generation) and sexual dysfunction, and we were unable to identify a specific class or antipsychotic associated with a greater or lesser prevalence of sexual dysfunction,” the investigators noted. “Compared to other studies, erectile and ejaculatory dysfunction and loss of libido were significantly lower in studies that included participants treated with antidepressants, and erectile and ejaculatory dysfunction decreased with the percentage of patients treated with antidepressants and mood stabilizers. .”

In reviewing the analyses, Korchia and colleagues emphasized the heterogeneity of outcomes and effects of sexual dysfunction in individuals with schizophrenia. However, they concluded that four decades of data show the extremely high frequency of sexual dysfunction among individuals with schizophrenia.

“In addition to methodological discrepancies that partially explain the heterogeneity, we found important evidence from observational studies that suggests that improving depression screening and treatment may be an effective strategy for improving sexual health in patients with schizophrenia,” they wrote. “Promoting systematic health assessment in studies of sexual dysfunction could also help to better understand the 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

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