Schizophrenia and its sexuality

Abstract

The work addresses an aspect that is usually overlooked in the care of the patient with schizophrenia: their sexuality. It is argued that alterations in the sexual area have a negative impact on the evolution of the pathology, reduce self-esteem and hinder relationships, and that a large proportion of patients are sexually active although only a third report a satisfactory sexuality. The peculiarities of sexual activity in these patients are reviewed (greater exposure to sexual abuse, maladaptive behaviours, greater risk of HIV infection and sexual dysfunction), as well as the factors involved in the dysfunction: the symptoms themselves, comorbidity, metabolic diseases and, notably, antipsychotic treatment, whose associated sexual dysfunction is a frequent cause of treatment non-adherence. Primary and secondary prevention strategies are proposed —from the promotion of healthy habits and sex therapy to the adjustment or change of antipsychotic and adjuvant pharmacological treatments—, underlining the importance of openly exploring sexuality in the clinical interview.