Schizophrenia has high prevalence rates of sexual dysfunction; however, antipsychotic medications explain a significant source of variability in these prevalence rates. Antipsychotics have varying effects on sexual function due to their impact on dopamine D2 receptors, particularly in the tuberoinfundibular pathway, which leads to elevated serum prolactin levels. Binding at alpha-1 adrenergic and histamine 1 receptors may also negatively impact sexual functioning. A meta-analysis of sexual dysfunction in individuals with schizophrenia spectrum disorders, spanning over four decades and across six continents, found the pooled global prevalence of sexual dysfunction was 56.4%. For men, this prevalence was 55.7% and for women it was 60.0%. Prevalence rates for specific types of sexual dysfunction were high and heterogenous, with erectile dysfunction being the most common (Figure 1). The study highlighted factors contributing to heterogeneity, such as study design, date of publication, geographical location, and the use of validated tools. It also suggested that addressing comorbid major depression and improving screening and treatment for depression may be crucial in improving sexual health among individuals with schizophrenia. Limitations of the study included potential publication bias and methodological differences among the included studies. Furthermore, certain factors commonly associated with sexual dysfunction, like hypertension, diabetes, and obesity, were not extensively explored in the reviewed studies. In conclusion, the study emphasized the high prevalence of sexual dysfunction in schizophrenia and the need for improved screening and treatment, especially for comorbid major depression.

Reference:

Korchia T et al. JAMA Psychiatry 2023;e232696. Abstract