Women's sexual dysfunction associated with psychiatric disorders and their treatment

Abstract

Impairment of mental health is the most important risk factor for female sexual dysfunction. Women living with psychiatric illness, despite their frequent sexual difficulties, consider sexuality to be an important aspect of their quality of life. Antidepressant and antipsychotic medication, the neurobiology and symptoms of the illness, past trauma, difficulties in establishing relationships and stigmatization can all contribute to sexual dysfunction. Low sexual desire is strongly linked to depression. Lack of subjective arousal and pleasure are linked to trait anxiety: the sensations of physical sexual arousal may lead to fear rather than to pleasure. The most common type of sexual pain is 10 times more common in women with previous diagnoses of anxiety disorder. Clinicians often do not routinely inquire about their patients' sexual concerns, particularly in the context of psychotic illness but careful assessment, diagnosis and explanation of their situation is necessary and in keeping with patients' wishes. Evidence-based pharmacological and non-pharmacological interventions are available but poorly researched in the context of psychotic illness.

Keywords: antidepressant/ antipsychotic induced sexual dysfunction; female sexual dysfunction; psychiatric illness.

Figure 1.

Incentive-based model of sexual response. Human sexual response is depicted as a motivation-/incentive-based cycle of overlapping phases of variable order. A sense of desire may or may not be present initially: it can be triggered alongside the sexual arousal resulting from attending to sexual stimuli. Sexual arousal comprises subjective (pleasure/excitement/wanting more of the same), and physical (genital and non-genital responses) components. Psychological and biological factors influence the brain’s appraisal of the sexual stimuli. The sexual and non-sexual outcomes influence present and future sexual motivation. Adapted from Basson.

Figure 2.

Sexual response cycle is potentially weakened by depression at all points in an incentive-based model of sexual response. Depression diminishes sexual incentives: anhedonia lessens the wanting of physical pleasure; depression reduces emotional intimacy—a major sexual incentive for women. There is little effort to secure needed sexual stimuli and sexual context. Sexual information processing in the brain is severely compromised by poor concentration and non-erotic thoughts and emotions leading to minimal arousal and no triggered desire. Neurotransmitters modulating sexual arousal are altered in depression. Outcome is unsatisfactory physically and emotionally and does not motivate further sexual interaction.