SEXUAL FUNCTIONING IN SCHIZOPHRENIC AND BIPOLAR FEMALE PATIENTS

Abstract

Introduction: The issue of sexuality is seldom investigated by psychiatrists in psychotic psychiatric patients, partly due to the frontline distressing psychiatric and behavioural symptoms but also due to hesitancy, haste, reluctance. Even though, the aspects of intimacy, sexual functioning are important and bothering, especially for young patients. These sexual impairments might be attributed to the disease itself but also to the medication. Material and Methods: Two separate studies aim to investigate sexual disorders in female inpatient patients diagnosed with schizophrenia and in different phases of bipolar disorder (depression, manic) in comparison to controls. Therefore, treatment emergent sexual side effects (UKU scale), their relation to psychopathology (PANSS, GAF), quality of life (WHO-QOL Bref), misbelieves (Sexual Dysfunctional beliefs Questionnaire) were explored in chronic female schizophrenic patients and compared to matched controls. For the bipolar group, the depressed, manic women and controls were assessed regarding frequency of sexual intercourse, fantasies, desire, and lubrication orgasm by the Sexual Disorders Interview, Female Sexual Index and psychopathology by BDI, respectively YMRS. Both studies were cross-sectional and collected various demographical and therapeutical data. Results: Schizophrenic patients rendered long histories of the disease and treatments, cumulating also disturbing side effects such as weight gain, amenorrhea, less marital and sexual partners. Low sexual interest, modest initiative, involvement, absent orgasm and sexual conservatorism were common and constant during exacerbations but also in chronicity being in connection rather to negative symptoms and modest functioning. Regarding bipolar women, sexual problems were detected in over 75% of the cases, with less implication and satisfaction during depression, pain, often blaming antidepressants as probable source of dissatisfaction. On the other hand, manic patients display more vivid sexual fantasies and interest, with higher arousal and lubrication, attending sexual satisfaction but being disturbed subjectively by some of these aspects. Although a wide range of sexual disorders might arise after treatment with antipsychotics, antidepressants, mood stabilizers, there could not be clearly ascertained a specific disorder. Discussions: Hyposexuality seems to be a hallmark of schizophrenics even in treatment naïve patients, being more obvious after treatment, in chronicity. The issue of sexuality in bipolar women is rather difficult to assess and compare partly to the heterogeneity of the disorder. Conclusions: Sexual disorders are a special and frequent issue in schizophrenia and bipolar women, displaying a wide range from low frequency, interest, dissatisfaction or even pain and a temporary phase limited exacerbation of sexuality during manic episodes.