Sexual Dysfunction in Schizophenia Patients
Keywords:
Sexual Dysfunction, Schizophrenia, Management of Sexual Dyzfunction
Abstract
Sexual dysfunction (SD) is a significant but often overlooked complication among patients with schizophrenia, with a global prevalence of 56.4%—55.7% in men and 60.0% in women. SD in this population is generally caused by both the symptoms of schizophrenia and the side effects of antipsychotic treatment, leading to diminished motivation for intimacy and potential disruption of marital relationships. Despite its impact on quality of life, SD remains underdiagnosed and stigmatized in clinical practice. This literature review aims to explore the general aspects of sexual dysfunction, its various types in patients with schizophrenia, and potential treatment strategies based on current clinical guidelines and considerations. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Findings show that the global incidence of sexual dysfunction among schizophrenia patients increased by over 65% between 1990 and 2019, affecting an estimated 941,000 to 1.3 million individuals, primarily due to antipsychotic use. Management strategies include reducing antipsychotic dosages or switching to prolactin-sparing medications, with aripiprazole being the most frequently recommended option.
References
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A. H. Clayton, J. Ivkovic, D. Chen, V. George, and M. Hobart, “Effect of Brexpiprazole on Prolactin and Sexual Functioning”, J. Clin. Psychopharmacol., vol. 40, no. 6, pp. 560–567, Nov. 2020. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1097/jcp.0000000000001297
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A. N. Edinoff et al., “Sexual Dysfunction in Schizophrenia: A Narrative Review of the Mechanisms and Clinical Considerations”, Psychiatry Int., vol. 3, no. 1, pp. 29–42, Dec. 2021. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.3390/psychiatryint3010003
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B. Redman, C. Kitchen, K. W. Johnson, P. Bezwada, and D. L. Kelly, “Levels of prolactin and testosterone and associated sexual dysfunction and breast abnormalities in men with schizophrenia treated with antipsychotic medications”, J. Psychiatric Res., vol. 143, pp. 50–53, Nov. 2021. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.jpsychires.2021.08.022
D. L. Kelly and R. R. Conley, “Sexuality and Schizophrenia: A Review”, Schizophrenia Bull., vol. 30, no. 4, pp. 767–779, Jan. 2004. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1093/oxfordjournals.schbul.a007130
D. S. Yudhantara and R. Istiqomah, Sinopsis Skizofrenia Untuk Mahasiswa Kedokteran. Malang: UB Press, 2018.
E. Kirino, “Serum prolactin levels and sexual dysfunction in patients with schizophrenia treated with antipsychotics: comparison between aripiprazole and other atypical antipsychotics”, Ann. General Psychiatry, vol. 16, no. 1, Nov. 2017. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1186/s12991-017-0166-y
H. Häfner, “From Onset and Prodromal Stage to a Life-Long Course of Schizophrenia and Its Symptom Dimensions: How Sex, Age, and Other Risk Factors Influence Incidence and Course of Illness”, Psychiatry J., vol. 2019, pp. 1–15, Apr. 2019. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1155/2019/9804836
H. Knegtering, M. Boks, C. Blijd, S. Castelein, R. J. van den Bosch, and D. Wiersma, “A Randomized Open-Label Comparison of the Impact of Olanzapine Versus Risperidone on Sexual Functioning”, J. Sex & Marital Therapy, vol. 32, no. 4, pp. 315–326, Sep. 2006. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1080/00926230600666378
Hasil Utama Riset Kesehatan Dasar. Kementrian Kesehatan Republik Indonesia. Riskesdas, 2018.
J. C Martín, M. J Acuña, J. Labrador, M. Blanco, and C. Casas, “Sexual dysfunction factors in patients with schizophrenia treated with second generation antipsychotics: not only prolactin”, Actas Esp Psiquiatr, 2018.
J. Eberhard, E. Lindström, M. Holstad, and S. Levander, “Prolactin level during 5 years of risperidone treatment in patients with psychotic disorders”, Acta Psychiatr. Scand., vol. 115, no. 4, pp. 268–276, Mar. 2007. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1111/j.1600-0447.2006.00897.x
J. Ivkovic, A. Lindsten, V. George, H. Eriksson, and M. Hobart, “Effect of Brexpiprazole on Prolactin”, J. Clin. Psychopharmacol., vol. 39, no. 1, pp. 13–19, 2019. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1097/jcp.0000000000000979
K. R. Patel, J. Cherian, K. Gohil, and D. Atkinson, “Schizophrenia: Overview and Treatment Options”, Peer-Reviewed J. Managed Care Hospital Formulary Manage., 2014.
L. C. Barker and S. N. Vigod, “Sexual health of women with schizophrenia: A review”, Frontiers Neuroendocrinol., vol. 57, p. 100840, Apr. 2020. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.yfrne.2020.100840
M. Dossenbach et al., “Effects of atypical and typical antipsychotic treatments on sexual function in patients with schizophrenia: 12-month results from the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) study”, Eur. Psychiatry, vol. 21, no. 4, pp. 251–258, Jun. 2006. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.eurpsy.2005.12.005
M. Dumontaud et al., “Sexual dysfunctions in schizophrenia: Beyond antipsychotics. A systematic review”, Prog. Neuro-Psychopharmacol. Biol. Psychiatry, vol. 98, p. 109804, Mar. 2020. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.pnpbp.2019.109804
M. K. de Boer, S. Castelein, D. Wiersma, R. A. Schoevers, and H. Knegtering, “The Facts About Sexual (Dys)function in Schizophrenia: An Overview of Clinically Relevant Findings”, Schizophrenia Bull., vol. 41, no. 3, pp. 674–686, Feb. 2015. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1093/schbul/sbv001
P. Lodha and A. D. Sousa1,, “Female Sexual Dysfunction and Schizophrenia: A Clinical Review”, J. Psychosexual Health, vol. 2, no. 1, pp. 44–55, Jan. 2020. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1177/2631831820916096
P. Mathur and S. Uniyal, “Antipsychotic drug induced sexual dysfunction.”, Amer. J. Pharmacy Health Res., 2019.
R. Balon, “Update on Sexual Dysfunction Associated with Psychotropic Medications and Its Treatment”, Current Sexual Health Rep., vol. 11, no. 3, pp. 125–131, Jul. 2019. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1007/s11930-019-00202-1
R. Basson and T. Gilks, “Women’s sexual dysfunction associated with psychiatric disorders and their treatment”, Women's Health, vol. 14, p. 174550651876266, Jan. 2018. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1177/1745506518762664
R. Maslim, Buku saku Diagnosis Gangguan Jiwa : Rujukan Ringkas dari PPDGJ-III dan DSM 5. 2013.
S. Anwar and Khairina, “Hyperprolactinemia as a side effect of using antipsychotics In Schizophrenic Patients”, J. Psikiatri Surabaya, vol. 12, no. 2, pp. 84–91, Nov. 2023. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.20473/jps.v12i2.23359
S. Vargas-Cáceres, N. Cera, P. Nobre, and J. A. Ramos-Quiroga, “The Impact of Psychosis on Sexual Functioning: A Systematic Review”, J. Sexual Medicine, vol. 18, no. 3, pp. 457–466, Mar. 2021. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.jsxm.2020.12.007
S. W. Düring, M. Ø. Nielsen, N. Bak, B. Y. Glenthøj, and B. H. Ebdrup, “Sexual dysfunction and hyperprolactinemia in schizophrenia before and after six weeks of D2/3 receptor blockade – An exploratory study”, Psychiatry Res., vol. 274, pp. 58–65, Apr. 2019. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.psychres.2019.02.017
S. Zhao et al., “Is There an Association Between Schizophrenia and Sexual Dysfunction in Both Sexes? A Systematic Review and Meta-Analysis”, J. Sexual Medicine, vol. 17, no. 8, pp. 1476–1488, Aug. 2020. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.jsxm.2020.03.005
Solmi dkk. “Incidence, prevalence, and global burden of schizophrenia - data, with critical appraisal, from the Global Burden of Disease (GBD) 2019 - Molecular Psychiatry.” Nature. Accessed: Jan. 1, 2024. [Online]. Available: https://www.nature.com/articles/s41380-023-02138-4#:~:text=Global%20estimates&text=GBD%202019%20estimated%20that%20in,UI%20=%20246.16–330.88)
T. Korchia et al., “Sexual Dysfunction in Schizophrenia”, JAMA Psychiatry, Sep. 2023. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1001/jamapsychiatry.2023.2696
T.-H. Wu et al., “The Relationships Between Hyperprolactinemia, Metabolic Disturbance, and Sexual Dysfunction in Patients With Schizophrenia Under Olanzapine Treatment”, Frontiers Pharmacol., vol. 12, Aug. 2021. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.3389/fphar.2021.718800
V. Olisah, T. Sheikh, E. Abah, and A. Mahmud-Ajeigbe, “Sociodemographic and clinical correlates of sexual dysfunction among psychiatric outpatients receiving common psychotropic medications in a Neuropsychiatric Hospital in Northern Nigeria”, Nigerian J. Clin. Pract., vol. 19, no. 6, p. 799, 2016. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.4103/1119-3077.180063
“Schizophrenia.” World Health Organization (WHO). Accessed: Jan. 1, 2024. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/schizophrenia
A. H. Clayton, J. Ivkovic, D. Chen, V. George, and M. Hobart, “Effect of Brexpiprazole on Prolactin and Sexual Functioning”, J. Clin. Psychopharmacol., vol. 40, no. 6, pp. 560–567, Nov. 2020. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1097/jcp.0000000000001297
A. L. Montejo, R. de Alarcón, N. Prieto, J. M. Acosta, B. Buch, and L. Montejo, “Management Strategies for Antipsychotic-Related Sexual Dysfunction: A Clinical Approach”, J. Clin. Medicine, vol. 10, no. 2, p. 308, Jan. 2021. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.3390/jcm10020308
A. N. Edinoff et al., “Sexual Dysfunction in Schizophrenia: A Narrative Review of the Mechanisms and Clinical Considerations”, Psychiatry Int., vol. 3, no. 1, pp. 29–42, Dec. 2021. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.3390/psychiatryint3010003
B. J. Sadock and A. V. Sadock, Buku Ajar Psikiatri Klinis, 2nd ed. Jakarta: Penerbit Buku Kedokt. EGC, 2004.
B. Redman, C. Kitchen, K. W. Johnson, P. Bezwada, and D. L. Kelly, “Levels of prolactin and testosterone and associated sexual dysfunction and breast abnormalities in men with schizophrenia treated with antipsychotic medications”, J. Psychiatric Res., vol. 143, pp. 50–53, Nov. 2021. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.jpsychires.2021.08.022
D. L. Kelly and R. R. Conley, “Sexuality and Schizophrenia: A Review”, Schizophrenia Bull., vol. 30, no. 4, pp. 767–779, Jan. 2004. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1093/oxfordjournals.schbul.a007130
D. S. Yudhantara and R. Istiqomah, Sinopsis Skizofrenia Untuk Mahasiswa Kedokteran. Malang: UB Press, 2018.
E. Kirino, “Serum prolactin levels and sexual dysfunction in patients with schizophrenia treated with antipsychotics: comparison between aripiprazole and other atypical antipsychotics”, Ann. General Psychiatry, vol. 16, no. 1, Nov. 2017. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1186/s12991-017-0166-y
H. Häfner, “From Onset and Prodromal Stage to a Life-Long Course of Schizophrenia and Its Symptom Dimensions: How Sex, Age, and Other Risk Factors Influence Incidence and Course of Illness”, Psychiatry J., vol. 2019, pp. 1–15, Apr. 2019. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1155/2019/9804836
H. Knegtering, M. Boks, C. Blijd, S. Castelein, R. J. van den Bosch, and D. Wiersma, “A Randomized Open-Label Comparison of the Impact of Olanzapine Versus Risperidone on Sexual Functioning”, J. Sex & Marital Therapy, vol. 32, no. 4, pp. 315–326, Sep. 2006. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1080/00926230600666378
Hasil Utama Riset Kesehatan Dasar. Kementrian Kesehatan Republik Indonesia. Riskesdas, 2018.
J. C Martín, M. J Acuña, J. Labrador, M. Blanco, and C. Casas, “Sexual dysfunction factors in patients with schizophrenia treated with second generation antipsychotics: not only prolactin”, Actas Esp Psiquiatr, 2018.
J. Eberhard, E. Lindström, M. Holstad, and S. Levander, “Prolactin level during 5 years of risperidone treatment in patients with psychotic disorders”, Acta Psychiatr. Scand., vol. 115, no. 4, pp. 268–276, Mar. 2007. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1111/j.1600-0447.2006.00897.x
J. Ivkovic, A. Lindsten, V. George, H. Eriksson, and M. Hobart, “Effect of Brexpiprazole on Prolactin”, J. Clin. Psychopharmacol., vol. 39, no. 1, pp. 13–19, 2019. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1097/jcp.0000000000000979
K. R. Patel, J. Cherian, K. Gohil, and D. Atkinson, “Schizophrenia: Overview and Treatment Options”, Peer-Reviewed J. Managed Care Hospital Formulary Manage., 2014.
L. C. Barker and S. N. Vigod, “Sexual health of women with schizophrenia: A review”, Frontiers Neuroendocrinol., vol. 57, p. 100840, Apr. 2020. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.yfrne.2020.100840
M. Dossenbach et al., “Effects of atypical and typical antipsychotic treatments on sexual function in patients with schizophrenia: 12-month results from the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) study”, Eur. Psychiatry, vol. 21, no. 4, pp. 251–258, Jun. 2006. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.eurpsy.2005.12.005
M. Dumontaud et al., “Sexual dysfunctions in schizophrenia: Beyond antipsychotics. A systematic review”, Prog. Neuro-Psychopharmacol. Biol. Psychiatry, vol. 98, p. 109804, Mar. 2020. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.pnpbp.2019.109804
M. K. de Boer, S. Castelein, D. Wiersma, R. A. Schoevers, and H. Knegtering, “The Facts About Sexual (Dys)function in Schizophrenia: An Overview of Clinically Relevant Findings”, Schizophrenia Bull., vol. 41, no. 3, pp. 674–686, Feb. 2015. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1093/schbul/sbv001
P. Lodha and A. D. Sousa1,, “Female Sexual Dysfunction and Schizophrenia: A Clinical Review”, J. Psychosexual Health, vol. 2, no. 1, pp. 44–55, Jan. 2020. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1177/2631831820916096
P. Mathur and S. Uniyal, “Antipsychotic drug induced sexual dysfunction.”, Amer. J. Pharmacy Health Res., 2019.
R. Balon, “Update on Sexual Dysfunction Associated with Psychotropic Medications and Its Treatment”, Current Sexual Health Rep., vol. 11, no. 3, pp. 125–131, Jul. 2019. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1007/s11930-019-00202-1
R. Basson and T. Gilks, “Women’s sexual dysfunction associated with psychiatric disorders and their treatment”, Women's Health, vol. 14, p. 174550651876266, Jan. 2018. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1177/1745506518762664
R. Maslim, Buku saku Diagnosis Gangguan Jiwa : Rujukan Ringkas dari PPDGJ-III dan DSM 5. 2013.
S. Anwar and Khairina, “Hyperprolactinemia as a side effect of using antipsychotics In Schizophrenic Patients”, J. Psikiatri Surabaya, vol. 12, no. 2, pp. 84–91, Nov. 2023. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.20473/jps.v12i2.23359
S. Vargas-Cáceres, N. Cera, P. Nobre, and J. A. Ramos-Quiroga, “The Impact of Psychosis on Sexual Functioning: A Systematic Review”, J. Sexual Medicine, vol. 18, no. 3, pp. 457–466, Mar. 2021. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.jsxm.2020.12.007
S. W. Düring, M. Ø. Nielsen, N. Bak, B. Y. Glenthøj, and B. H. Ebdrup, “Sexual dysfunction and hyperprolactinemia in schizophrenia before and after six weeks of D2/3 receptor blockade – An exploratory study”, Psychiatry Res., vol. 274, pp. 58–65, Apr. 2019. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.psychres.2019.02.017
S. Zhao et al., “Is There an Association Between Schizophrenia and Sexual Dysfunction in Both Sexes? A Systematic Review and Meta-Analysis”, J. Sexual Medicine, vol. 17, no. 8, pp. 1476–1488, Aug. 2020. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1016/j.jsxm.2020.03.005
Solmi dkk. “Incidence, prevalence, and global burden of schizophrenia - data, with critical appraisal, from the Global Burden of Disease (GBD) 2019 - Molecular Psychiatry.” Nature. Accessed: Jan. 1, 2024. [Online]. Available: https://www.nature.com/articles/s41380-023-02138-4#:~:text=Global%20estimates&text=GBD%202019%20estimated%20that%20in,UI%20=%20246.16–330.88)
T. Korchia et al., “Sexual Dysfunction in Schizophrenia”, JAMA Psychiatry, Sep. 2023. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.1001/jamapsychiatry.2023.2696
T.-H. Wu et al., “The Relationships Between Hyperprolactinemia, Metabolic Disturbance, and Sexual Dysfunction in Patients With Schizophrenia Under Olanzapine Treatment”, Frontiers Pharmacol., vol. 12, Aug. 2021. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.3389/fphar.2021.718800
V. Olisah, T. Sheikh, E. Abah, and A. Mahmud-Ajeigbe, “Sociodemographic and clinical correlates of sexual dysfunction among psychiatric outpatients receiving common psychotropic medications in a Neuropsychiatric Hospital in Northern Nigeria”, Nigerian J. Clin. Pract., vol. 19, no. 6, p. 799, 2016. Accessed: Jan. 1, 2024. [Online]. Available: https://doi.org/10.4103/1119-3077.180063
Published
2025-07-29
How to Cite
Yustika Izziyatu Anindita, & Erikavitri Yulianti. (2025). Sexual Dysfunction in Schizophenia Patients. International Journal of Health, Economics, and Social Sciences (IJHESS), 7(3). https://doi.org/10.56338/ijhess.v7i3.8210
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Copyright (c) 2025 Yustika Izziyatu Anindita, Erikavitri Yulianti
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