Sexual function concerns and attitudes toward discussing them with psychiatrists among psychiatric outpatients in Japan: a cross-sectional study

Sexual dysfunction, defined as persistent difficulties in sexual desire, arousal, or orgasm, affects treatment adherence to psychotropic medication and quality of life in people with mental disorders, yet patients rarely disclose such concerns to clinicians. Understanding patient-perceived barriers to disclosure is critical for improving care, but empirical data from psychiatric outpatient settings remain limited, particularly in Japan where cultural norms around sexual health may further inhibit communication. We conducted an anonymous cross-sectional online survey of psychiatric outpatients ( N = 264) at 9 Japanese institutions between July and September 2024. Participants reported sexual function concerns, self-attributed main contributors, and attitudes toward discussing these concerns with their psychiatrist, classified as Active, Passive, or No-intention/other. Multivariable multinomial logistic regression examined factors associated with these attitudes ( N = 223), adjusting for sex, age, depressive symptoms, and socioeconomic factors. Current sexual function concerns were reported by 22.3% of respondents, with lifetime concerns reaching 33.3%. Among those with current concerns, one-third attributed their concerns primarily to medication. Only 30% held an Active attitude toward consulting their psychiatrist about sexual function. In the combined analytic sample spanning current and hypothetical response contexts, women had 2.4-fold higher adjusted odds of a No-intention/other attitude versus an Active attitude (aOR = 2.42, 95% CI 1.07–5.46, p = 0.033) after adjustment for age, depressive symptoms, and socioeconomic factors. Most psychiatric outpatients with sexual function concerns held passive or non-disclosing attitudes toward discussing them with their psychiatrist. In the combined analysis of current and hypothetical response contexts, women had higher adjusted odds of a No-intention/other rather than an Active attitude. Given that many patients attribute their concerns to medication, routine clinician-initiated screening and patient-centered communication may help identify modifiable contributors and thereby support adherence to psychiatric treatment. Not applicable.