The prevalence of sexual dysfunction remains high in people with schizophrenia, but treating comorbid depression could be effective in improving sexual health.
A systematic review and meta-analysis published in JAMA Psychiatry found that both men and women with schizophrenia often reported sexual dysfunction. While some dysfunction is explained by schizophrenia, lower rates of dysfunction were associated with antidepressant use, suggesting that comorbid depression may underlie some of the sexual health issues.
Attention to sexual health in schizophrenia has increased in recent decades, yet, there is an overall paucity of published data on the subject. The aim of this review and meta-analysis was to determine the prevalence of and common types of sexual dysfunction in people with schizophrenia. As such, review authors searched publication databases through June 2022 for relevant observational studies.
A total of 72 studies published between 1979 and 2021 were included in this analysis. The pooled study population was comprised of 21,076 individuals with schizophrenia or schizoaffective disorder from 33 countries. Most studies (81.9%) used a standard questionnaire to assess sexual dysfunction, and the most frequently used instrument was the Arizona Sexual Experience scale (n=19 studies).
The pooled prevalence of sexual dysfunction was 56.4% (95% CI, 50.5%-62.2%). When stratified by type of dysfunction, the most common was loss of libido (40.6%; 95% CI, 30.7%-51.4%; I2, 96%), followed by orgasm dysfunction (28.0%; 95% CI, 18.4%-40.2%; I2, 97%) and genital pain (6.1%; 95% CI, 2.8%-12.7%).
"[I]mproving the screening and treatment of depression may be an effective strategy to improve sexual health in patients with schizophrenia."
Stratified by gender, sexual dysfunction was reported by 55.7% (95% CI, 48.1%-63.1%) of men, along with erectile dysfunction (44.0%; 95% CI, 33.5%-55.2%) and ejaculation disorder (38.6%; 95% CI, 26.8%-51.8%). Women also reported sexual dysfunction (60.0%; 95% CI, 48.0%-70.8%), as well as amenorrhea (25.1%; 95% CI, 17.3%-35.0%) and galactorrhea (7.7%; 95% CI, 3.7%-15.3%).
Of note, there was a high amount of heterogeneity observed in the comparisons for men (I2, 98%; P <.001) and women (I2, 96%; P <.01). In addition, leave-one-out analyses found significant publication bias for global sexual dysfunction (t, 5.63; P <.001), orgasm dysfunction (t, -3.85; P <.001), ejaculation disorder (t, -2.33; P =.03), and sexual dysfunction among men (t, 4.58; P <.001) and women (t, 2.25; P =.03).
In subgroup analyses, rates of erection disorders were lower among patients using antidepressants (b, -6.30; 95% CI, -10.82 to -1.78; P =.006) and mood stabilizers (b, -13.21; 95% CI, -17.59 to -8.83; P <.001). Similarly, antidepressants (b, -6.10; 95% CI, -10.68 to -1.53; P =.009) and mood stabilizers (b, -11.57; 95% CI, -16.34 to -6.80; P <.001) were associated with lower rates of ejaculation disorders.
The review authors concluded, “[I]mproving the screening and treatment of depression may be an effective strategy to improve sexual health in patients with schizophrenia.”
These meta-analysis findings may be limited, as common factors associated with sexual dysfunction in the general population were not adequately explored in the underlying studies.
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