(730) The Impact of Schizophrenia on Sexual Function: A Narrative Review

Abstract Introduction Schizophrenia is a chronic psychiatric disorder affecting around 1% of the global population and among the most disabling worldwide. Beyond cognitive, social, and occupational impairments, sexual health remains a neglected aspect despite its key role in quality of life. Sexual dysfunction is highly prevalent and often the leading cause of antipsychotic discontinuation. While adverse effects such as hyperprolactinemia, dopaminergic blockade, metabolic changes, and extrapyramidal symptoms contribute substantially, factors like the illness’s pathophysiology, comorbidities, stigma, and sociodemographic variables also play major roles. Once wrongly viewed as asexual, patients with schizophrenia are now recognised to have sexual wellbeing closely tied to treatment adherence, functional recovery, and relapse prevention. Objective This study aimed to clarify the relationship between schizophrenia and sexual dysfunction, with a particular emphasis on the multifactorial mechanisms underlying sexual impairment. It sought to explore the contribution of antipsychotic medication, pathophysiological aspects of schizophrenia, sociodemographic variables, and cultural influences, highlighting that antipsychotics, while relevant, are not the sole etiological agents. Methods A narrative review was conducted using articles indexed in PubMed, Google Scholar, and UpToDate between 2017 and 2023, without temporal restriction but with preference for the most recent and methodologically robust evidence. Search terms included “schizophrenia,” “antipsychotics,” “sexual dysfunction,” and “sexual function.” After screening abstracts, studies most relevant to the objectives were selected. Results Evidence consistently demonstrates that antipsychotics exert a deleterious impact on sexual function. Typical antipsychotics are strongly associated with high rates of dysfunction due to potent dopaminergic antagonism, hyperprolactinemia, and extrapyramidal adverse effects. Among atypical antipsychotics, risperidone and paliperidone display a similarly high prevalence of sexual side effects, whereas clozapine, quetiapine, and aripiprazole are less frequently implicated. Aripiprazole, a partial D2 agonist, has shown efficacy both as a first-line treatment and as an adjunctive agent for reversing hyperprolactinemia and improving sexual outcomes. Beyond pharmacological effects, schizophrenia itself contributes to sexual dysfunction through negative symptoms, cognitive impairment, and disease chronicity, with severity of positive and negative symptoms correlating with worse outcomes. Comorbidities such as diabetes, metabolic syndrome, and substance use disorders further exacerbate dysfunction. Stigma, both internalised and societal, limits patients’ ability to pursue intimate relationships, compounding functional disability. Sociodemographic variables also modulate outcomes: women, older patients, and those with longer illness duration report higher prevalence of dysfunction, whereas married individuals generally report better sexual health. Cultural and religious frameworks critically shape how patients experience and disclose their sexual concerns. Conclusions Sexual dysfunction in schizophrenia results from a complex interplay of pharmacological, biological, psychosocial, and cultural factors. Systematic assessment of sexual health is essential, as many patients do not spontaneously report symptoms. Regular monitoring of metabolic status, prolactin levels, extrapyramidal effects, and sexual complaints is recommended. Clinicians should consider dose adjustments, switching to agents with lower sexual side-effect profiles, or adding aripiprazole when appropriate. Addressing sexual dysfunction is a key element of holistic care, as improvement in sexual wellbeing enhances quality of life, treatment adherence, and functional recovery. Future research should develop structured guidelines for the assessment and management of sexual health in this population. Disclosure No