The State of Art Education Initiative

Can the onset of psychosis affect sexual function?

Reviewed by the medical professionals of the ISSM’s Communication Committee

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Yes, some people find that they develop sexual issues at the onset of psychosis.

Psychosis occurs when a person becomes disconnected with reality. The person is not able to distinguish between reality and what their own mind is experiencing. They might have delusions (beliefs that something is happening when it is not) or hallucinations (seeing or hearing things that other people do not see or hear).

People with schizophrenia or bipolar disorder might experience psychosis.
But it can also occur in some people with dementia, Parkinson’s disease, brain tumors, and epilepsy. It might also be a side effect of some prescription drugs.
People who use alcohol and illegal drugs can have psychotic episodes, too.

Medications used to treat psychosis often have sexual side effects.
However, the onset of psychosis (before treatment with medications) has been linked to sexual problems as well.

In 2021, the Journal of Sexual Medicine published an analysis of five studies that focused on the sexual function of patients with psychosis who were not yet taking medication.

  • Researchers found that between 17% and 70% of people with untreated psychosis had sexual dysfunction compared to people without psychosis.

Psychotic episodes typically have three phases:

  • The first phase (called the prodromal phase or the ultra-high risk phase) is when symptoms start to appear. Such symptoms might include irritability, trouble focusing, depression, and anxiety.
  • During the second phase (the acute phase), symptoms are most prominent.
  • The third phase (recovery), symptoms start to resolve.

Researchers found that the rate for sexual issues was about 50% for people in the ultra-high risk (prodromal) phase.

The study authors also estimated prevalence rate ranges for certain sexual problems in unmedicated patients with psychosis:

  • Sexual desire difficulties: 14% to 20%
  • Arousal difficulties: 4% to 60%
  • Orgasm difficulties: 1% to 56%

People who had untreated psychosis for a long time tended to have more severe issues, the authors explained.

The researchers recommended that all people with psychosis be screened for sexual problems.

If you have been diagnosed with psychosis and are struggling with sexual issues, don’t hesitate to discuss them with your health care provider.


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