Sexual Dysfunction

The Brain-Body Connection

Editor(s): Balon R. (Detroit, Mich.) 
Table of Contents
Vol. 29, No. , 2008
Section title: Paper
Balon R (ed): Sexual Dysfunction. The Brain-Body Connection. Adv Psychosom Med. Basel, Karger, 2008, vol 29, pp 89-106

The Impact of Mental Illness on Sexual Dysfunction

Zemishlany Z. · Weizman A.
Geha Mental Health Center, Petah-Tikva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

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Sexual dysfunction is prevalent among psychiatric patients and may be related to both the psychopathology and the pharmacotherapy. The negative symptoms of schizophrenia limit the capability for interpersonal and sexual relationships. The first-generation antipsychotics cause further deterioration in erectile and orgasmic function. Due to their weak antagonistic activity at D2 receptors, second-generation antipsychotics are associated with fewer sexual side effects, and thus may provide an option for schizophrenia patients with sexual dysfunction. Depression and anxiety are a cause for sexual dysfunction that may be aggravated by antidepressants, especially selective serotonin reuptake inhibitors (SSRIs). SSRI-induced sexual dysfunction may be overcome by lowering doses, switching to an antidepressant with low propensity to cause sexual dysfunction (bupropion, mirtazapine, nefazodone, reboxetine), addition of 5HT2 antagonists (mirtazapine, mianserin) or coadministration of 5-phosphodiesterase inhibitors. Eating disorders and personality disorders, mainly borderline personality disorder, are also associated with sexual dysfunction. Sexual dysfunction in these cases stems from impaired interpersonal relationships and may respond to adequate psychosexual therapy. It is mandatory to identify the specific sexual dysfunction and to treat the patients according to his/her individual psychopathology, current pharmacotherapy and interpersonal relationships.

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