Restoring Intimacy: Navigating Sexual Dysfunction in Schizophrenia and Your Treatment Options

If schizophrenia is impacting your sex life, you’re far from alone. Research suggests that more than half of people with schizophrenia experience some type of sexual issue, which can include erectile dysfunction, loss of libido, and difficulty achieving orgasm.e60dc2a1-f33c-4a05-9b50-8e3e8e597629639e4211-bcd6-4d25-aa12-8a01626d737e This is not a personal failing, emphasizes Alex Dimitriu, MD , psychiatrist and founder of Menlo Park Psychiatry and Sleep Medicine in California and medical reviewer for Everyday Health. “The disease itself likely has impacts on sexual function, and medication for schizophrenia can also play a significant role,” he says. “For example, treatment may include strong dopamine blockers that can inhibit sex drive.” This can be a challenging issue to talk about, both with your partner and with your doctor, but it isn’t something you just have to live with. Here’s a look at how schizophrenia and its treatment can impact your sexual health and management strategies that may help.
Antipsychotics and Intimacy Why It Happens Sexual dysfunction can take many different forms, including:e60dc2a1-f33c-4a05-9b50-8e3e8e597629b10f7114-a524-4b5b-b6f6-0758e1137004 No interest in sex Difficulty becoming aroused Lubrication issues in women Erectile dysfunction in men Trouble achieving orgasm While sexual dysfunction happens for many different reasons, it’s a known side effect of several types of medications. That includes antipsychotic drugs, which are often used to manage schizophrenia, explains Suraj Modi, MD , psychiatrist at Orlando Health Medical Group Behavioral Health in Florida. Researchers say one reason this occurs is due to the way these meds affect dopamine receptors.e60dc2a1-f33c-4a05-9b50-8e3e8e597629226e371e-150c-4007-8a4e-0dbcd56e9a27 Dopamine is both a hormone and a brain chemical that’s related to motivation, mood, attention, and memory. Cleveland Clinic notes that its main role is as a “reward center” in the brain, and it can influence feelings of pleasure and arousal.e60dc2a1-f33c-4a05-9b50-8e3e8e59762988c1626f-d92b-49bd-95df-f21b544f1a6b Dampening dopamine can improve many schizophrenia symptoms, but it also raises the level of a protein called prolactin, which reduces sex drive at higher amounts, says Dr. Modi. The surge in prolactin stops your brain from sending out another chemical called gonadotropin releasing factor (GnRH), which then causes your body to make less of the sex hormones testosterone and estrogen.e60dc2a1-f33c-4a05-9b50-8e3e8e59762971f9896f-752d-4cf0-b1e2-126fb2e43bba “This ripple effect of lower dopamine, increased prolactin, and lower GnRH can significantly affect sexual function,” Modi says. “Stronger dopamine blockers like risperidone are more likely to cause this, while other medications like quetiapine or aripiprazole are less likely.”
Effects of Sexual Dysfunction How It Hurts Sexual problems related to schizophrenia and its treatment can be very distressing. They can create distance between you and your partner and negatively affect your quality of life, according to research.e60dc2a1-f33c-4a05-9b50-8e3e8e59762926221acd-6ba6-4ba8-ae52-3665418796be Schizophrenia already puts you at risk for social isolation, and sexual dysfunction can add to that.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297fa0b30f-30e2-4875-ac38-f341ac54768ce60dc2a1-f33c-4a05-9b50-8e3e8e59762972e364d9-9cf9-4e88-8986-b08dcdda1e88 Sexual dysfunction is also a leading reason people say they stop taking schizophrenia medications — sometimes without discussing it with their doctor first. This can significantly increase the likelihood of relapse and hospitalization.e60dc2a1-f33c-4a05-9b50-8e3e8e59762926221acd-6ba6-4ba8-ae52-3665418796be A study in Addictive Behaviors Reports that included 585 people who stopped taking antipsychotics — some of them going cold turkey rather than tapering down — noted that 72 percent experienced withdrawal effects that included nausea, anxiety, tremors, agitation, and headaches. About half of those experiencing these difficulties rated them as severe.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fff7ea86-927a-49cf-b419-841e94041af0
Management Strategies How to Manage It’s important not to stop taking your medication or change the dose without talking to your doctor. While many people who take antipsychotics are reluctant to bring up sexual side effects with their healthcare provider, it’s crucial for getting help. “Communicate freely and openly with your provider so they can address your concerns,” Modi says. “Sometimes it may warrant a dose reduction or medication change. Sometimes other medication classes can offset these unwanted side effects if symptoms of psychosis and functioning have been well managed.”
For example, antipsychotic medications like aripiprazole (Abilify), quetiapine (Seroquel), and olanzapine (Zyprexa) tend to have lower sexual side effects, says Dr. Dimitriu. There are also medications like sildenafil citrate (Viagra) or tadalafil (Cialis), which can be helpful for specific issues like erectile dysfunction. Identifying and treating depression may also help, Dimitriu says, because sexual dysfunction is a common issue with depression. As many as one-third of people with schizophrenia also have major depressive disorder, and research has found that those whose treatment included antidepressants or antianxiety medications were less likely to have sexual problems.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295fd50f3a-b567-4183-bf94-e2846f42d145 Another important step is to implement meaningful lifestyle habits, Dimitriu adds. “Exercise, sufficient sleep, and a nutritious diet help a great deal,” he says. “Your brain lives in your body, so do everything you can to boost your physical health. Exercise directly improves circulation, sleep restores neurotransmitters, and diet is the fuel to make it all happen. These can all play a role in restoring sexual function and intimacy.”
The Takeaway Sexual dysfunction is common in those with schizophrenia, but it can be a difficult issue to talk about. In many cases, sexual issues may be related to the use of antipsychotics, which are often prescribed to help manage schizophrenia symptoms. Talking with your doctor and taking charge of your health overall can go a long way toward helping to alleviate sexual health and intimacy challenges.
Resources We Trust Mayo Clinic: SchizophreniaCleveland Clinic: SchizophreniaJAMA Psychiatry: Sexual Dysfunction in SchizophreniaSchizophrenia Bulletin: The Facts About Sexual (Dys)function in Schizophrenia: An Overview of Clinically Relevant FindingsExpert Review of Neurotherapeutics: Managing Antipsychotic-Related Sexual Dysfunction in Patients With Schizophrenia

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