Psychiatric disorders, psychopharmacology and sexual dysfunction from the fifth international consultation on sexual medicine (ICSM 2024).

Abstract

Introduction: The World Health Organization estimates that one in eight people around the world is living with a psychiatric disorder. An under-recognized consequence of psychiatric disorders is the detrimental impact they may have on sexuality. Psychotropic medications to treat psychiatric disorders can also have a significant, negative effect on sexual functioning.

Objective: This review is a consensus International Consultation on Sexual Medicine (ICSM) report developed to outline and describe these impacts.

Methods: The committee members first discussed the structure of the manuscript. Literature searches were conducted for each section, seeking key words related to sexual dysfunction and each specific psychiatric condition and for psychiatric medications and classes of drugs. A modified Delfi approach was used when making decisions on content and recommendations. The content and recommendations were presented at ICSM where experts across the field of sexual medicine provided feedback. These comments were reviewed by the co-chairs of the 24 committees for discussion and feedback.

Results: In relation to psychiatric disorders and sexual dysfunction, there are two primary themes evident in the literature, (1) there are significant methodological weaknesses, and (2) the prevalence of sexual dysfunction across all psychiatric disorders is generally high and elevated compared to controls (when available). Additionally, sexual dysfunction associated with psychotropic medications is a frequent treatment-emergent side effect, for antidepressants ranging from 25% to 80% and for antipsychotics ranging from 16% to 60% depending on the underlying mechanism of action of a particular medication. Sexual dysfunction is also associated with many of the co-morbid conditions related to a psychiatric diagnosis.

Conclusion: The committee outlined three recommendations which highlight the importance of assessing for sexual dysfunction in those who report psychiatric disorders, evaluating sexual dysfunction across treatment while treating these disorders with psychotropic medication, and recognizing that the causes of sexual dysfunction are often multi-factorial.