Sexual Dysfunction and Schizophrenia
Schizophrenia is a mental illness characterized by significant, often debilitating problems in perception, social interaction, thoughts and emotional responsiveness. The condition has an estimated prevalence in the United States of around 1.1 percent of the adult population, or about 2.8 million people ages 18 and older. It's further estimated that only 60 percent of people with the condition are treated within a given year.
Men are usually diagnosed with schizophrenia in their late teens and early 20s, and women in their early 20s to early 30s.
While schizophrenia is not the most common mental health illness, it is a serious condition.
The impact of schizophrenia
Some symptoms of schizophrenia are delusions, hallucinations, confused thoughts and significant social withdrawal. Treatment can help, but the condition is a lifelong challenge with social, financial and health consequences. Schizophrenia is a top-15 leading cause of disability worldwide and can seriously impact a person's ability to work, socialize and engage in meaningful activities.
One of the most significant impacts of schizophrenia is how it can impair relationships, including sexual and intimate relationships. However, this does not mean relationships are a lost cause. Largely, the problem stems from a lack of discussion concerning the sexual health challenges of schizophrenia. This problem is worsened by the condition's stigma and misinformation about symptoms.
Robert, who preferred not to give his last name, is an American writer living in southeast Asia with his wife and children. He was diagnosed with schizophrenia in his early 20s, but said he had heard voices since he was a child. He takes antipsychotic medication and antidepressants, which improve his symptoms but don't eliminate them altogether. Robert said he has learned to live with the voices for the most part but still grapples with anxiety, depression and a lack of motivation.
Many people assume schizophrenia is only about hearing voices, but other symptoms are distressing, too.
Mark Rego, M.D., a psychiatrist and writer in Connecticut, explained there are both positive and negative symptoms of schizophrenia. Positive symptoms include hearing voices that are not real, delusions—seeing or experiencing events that are not real—and disorganized thoughts. Negative symptoms include depression, lack of motivation and withdrawal.
"Positive and negative symptoms can impact social skills and the ability to nurture relationships," he added.
Robert noted that all of his symptoms contribute to a general lack of interest in sex and intimacy.
"When the voices get too loud and mean, it's hard to feel interested in anything, never mind sex," he explained. "Also, sometimes the voices say things that interfere with my relationship and wear me down."
Although medication helps, Robert needs to work hard to ignore the voices so he can be present in his relationship. He also said depression and lack of motivation make it difficult for him to initiate and enjoy sex.
"I don't have the staying power of most men when it comes to sex," he said. "[It] can be a real challenge sometimes."
Schizophrenia and sex
The "staying power" Robert mentioned could also be due to side effects from medication that reduce sexual desire, sensations and arousal.
A 2022 study published in Frontiers in Psychiatry indicated the most common issues around sexual dysfunction in medicated people with schizophrenia are decreased arousal and sex drive, erectile dysfunction (ED) and problems reaching orgasm. Additionally, many patients with sexual dysfunction have higher-than-average negative schizophrenia symptoms, which impact relational skills and intimacy.
In his practice, Rego explained, many patients with schizophrenia report losing interest in sex altogether due to side effects of medication. Studies show that sexual side effects are one of the biggest reasons people discontinue their medications.
"Sexual side effects are usually due to the impact of the medications on blood pressure, sedation and prolactin secretion, a sex hormone produced by the pituitary," Rego said. "Newer antipsychotics are a little better regarding sexual side effects, but it's still a problem for many."
However, there is hope for people with schizophrenia who experience sexual dysfunction. Although Robert struggles deeply with his illness as well as the medications, he has a successful sex life with his wife. Robert credited their success to a shared belief in "communicating openly with each other and looking outside the box."
Robert explained he and his wife talk very intimately about each other's needs, and what works and what doesn't, and they are not afraid to do things differently. Since he struggles with keeping erections and feeling motivated, he finds that focusing on his wife's pleasure first helps them feel closer to each other.
"There are many ways to have sex," he said. "Intercourse isn't the only way."
Robert and his wife enjoy oral sex and other forms of sex and intimacy that don't necessarily involve intercourse. They don't try to fit their sex life into preconceived notions of what sex should be. Instead, they find creative ways to please each other and achieve the intimacy required to stay sexually and emotionally connected.
Relax and don't overthink
The level at which a person with schizophrenia can enjoy sexual intimacy varies from person to person. According to Rego, some people may not be able to fully experience sex due to the severity of the illness and medication side effects.
However, people with schizophrenia who can engage in sex should be motivated to bring up sexual dysfunction in appointments with their doctor. In this case, treatment may need to be adjusted or changed to help the person reduce the sexual side effects of the medications.
"If I could give others advice, it would be to try and relax and not overthink things," Robert said. "Be sure to communicate with your partner first and foremost, and recognize that satisfying sex doesn't have to follow a set of normalized rules."
Sexual dysfunction is a concern for many people living with schizophrenia. However, a research review indicated the sooner a person can be diagnosed and treated for schizophrenia, the better their chances of achieving a fulfilling life.
According to Rego, prompt treatment can help the patient prevent the debilitating effects of the illness from getting too entrenched in their daily functioning. This means early treatment can help in every part of their life, and the benefits can extend to a more successful sex life as well.