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According to the World Health Organization, sexual health is a state of physical, emotional, mental and social well-being concerning sexuality and it is not merely the absence of disease, dysfunction or infirmity and sequel. Sexual health requires a positive and respectful approach to sexuality and sexual relationships as well as the possibility of having pleasurable and safe sexual experiences free of coercion, discrimination, and violence. Sexuality assessment and record started since the time of Hippocrates, and is given an increasing concern in recent years.
The global studies of sexual attitudes and behaviors stated that lack of interest and inability to reach orgasm during sexual intercourse were the most common sexual problems across the world, ranging from 26% to 43% and 18% to 41%, respectively. Sexual complaints are common problems among the general population in the United States, with an estimated prevalence of 31% in males. These complaints are even more common among people with psychiatric illnesses.
From a psychiatric perspective, sexual dysfunctions can be considered as an alteration in one or more phases of the sexual response cycle, such as sexual desire, sexual excitement, orgasm or climax and resolution.
Epidemiological and clinical studies indicated that depression and anxiety have an impact on sexual function and affect satisfaction even in untreated patients. It occurs in approximately 30% to 70% of patients who received antidepressant medications, and the highest incidence, 50% to 70%, seen primarily in patients who received serotonin reuptake inhibitors (SSRIs). Clinical based study done in India among 80 married female patients with a diagnosis of depressive disorder and receiving a single antidepressant for 3 months showed that 42.5% had sexual dysfunction, 95% had decreased desire, 60% had decreased arousal, 37.5% had decreased lubrication, 63.8% had decreased orgasm, 55% had decreased satisfaction and 25% had pain during sexual activity.
Patients with chronic mental illness like schizophrenia are vulnerable to sexual dysfunctions due to the nature of the illness, particularly related to negative symptoms. Study shows that around half of the patient on antipsychotic medications had sexual dysfunction compared with that patient without the antipsychotic medication. A cross-sectional study done in India on sexual dysfunction due to antipsychotics showed that dysfunction at least one of sexual phases was 66%, and from that erectile dysfunction was present in around half of the patients. A similar result was reported in a study done in Turkey, in which 69.2% of patients on antipsychotic medication had erectile dysfunction.
Substance use is also a growing problem that leads to sexual dysfunction. The use of drugs and alcohol among male resulted 14% sexual dysfunction (11% had inhibited orgasm, 13% pain during sexual intercourse, 5% lack of sexual excitement, 7% for inhibited sexual desire). Smokers, especially those who smokes 20 pieces of cigarettes or more per day, had 50% risk of having sexual dysfunction.
Despite the high prevalence of sexual dysfunction, particularly in patients taking psychotropic medications, most sufferers do not seek help either due to feeling of embarrassment or because they do not view it as a medical problem. Inversely, sexual dysfunction causes anxiety, sadness, depression, low self-confidence, low self-esteem, marital tension, guilt feeling, anger and frustration in relationship a relationship, these lead to exacerbate psychiatric problems and cause a relapse of illnesses.
Medical professionals also pay little attention to the sexual health of their clients. According to evidence, the vast majority of specialists do not ask about sexual dysfunctions of both medical and psychiatric patients in normal clinical conditions.
I believe that sexual health plays a key role in everyone's life. Accordingly, it requires increased attention to itself from both an individual and society as a whole. Detailed studies of the extent of sexual dysfunction among people with mental illness attending follow-up treatment are needed, as this may help professionals who care for this group understand the problem and its interventions.
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