Sexual dysfunction affects >50 percent of patients with schizophrenia

Sexual dysfunction is highly prevalent in schizophrenia, affecting >50 percent of patients. Treatment of comorbid depression may be an effective strategy to improve sexual health, according to a meta-analysis.

“The attention given to sexual health in schizophrenia has increased since the end of the 20th century,” wrote the researchers. “However, schizophrenia has been associated with increased sexual dysfunction only in a small meta-analysis of 10 observational studies.”

To determine the prevalence of sexual dysfunction in schizophrenia and identify associated factors, the researchers conducted a systematic review and meta-analysis on five databases, including PubMed/MEDLINE, Science Direct, Google Scholar, Google, and Université Sorbonne Paris Cité from inception to 8 June 2022. A total of 72 studies in 21,076 patients with schizophrenia were included. [JAMA Psychiatry 2023;80:1110-1120]

The pooled global prevalence of sexual dysfunction was high, at 56.4 percent (95 percent confidence interval [CI], 50.5─62.2), and heterogeneous (I²=98 percent), with a prevalence of 55.7 percent among male (95 percent CI, 48.1─63.1) and 60.0 percent among female (95 percent CI, 48.0─70.8) patients.

The most common sexual dysfunction was erectile dysfunction in men (44.0 percent), followed by loss of libido in men (40.6 percent), ejaculation dysfunction in men (38.6 percent), orgasm dysfunction in women (28.0 percent), and amenorrhoea in women (25 percent). Of note, the rate of erectile dysfunction in men with schizophrenia was >3 times higher than that in the general population (approximately 12 percent in men <60 years of age).

“Factors associated with heterogeneity were beyond the expected association with antipsychotics,” reported the researchers. Factors related to heterogeneity included study design, time and location, sociodemographic data, alcohol use disorder, psychiatric diagnosis, illness severity, and use of antidepressants and anxiolytics.

Results were contradictory regarding antipsychotic classes (first generation vs second generation) and sexual dysfunction. “It was not possible to identify a class or specific antipsychotic associated with a higher or lower prevalence of sexual dysfunction,” the investigators noted.

Notably, use of antidepressants and use of mood stabilizers were associated with significantly lower rates of erection disorders (antidepressants: β, -6.30; 95 percent CI, -10.82 to -1.78; p=0.006) (mood stabilizers: β, -13.21; 95 percent CI, -17.59 to -8.83; p<0.001) and ejaculation disorders (antidepressants: β, -6.10; 95 percent CI, -10.68 to -1.53; p=0.009) (mood stabilizers: β, -13.21; 95 percent CI, -17.59 to -8.83; p<0.001).

“Screening and treatment of major depressive disorder could be an effective strategy to improve sexual health in patients with schizophrenia,” commented the researchers.