Examining the relationship between stigma, self-esteem, and sexual dysfunction in patients with opioid use disorder

Opioid Use Disorder (OUD) is a prevalent psychiatric condition in which stigma, self-esteem and sexual functioning may play a critical role in the course of illness and treatment outcomes. This cross-sectional study included 104 male patients who met DSM-5 criteria for OUD and had been in remission for at least three months while receiving buprenorphine–naloxone treatment. Participants completed a sociodemographic form, the Addiction Profile Index (API), Rosenberg Self-Esteem Scale (RSES), Substance Use Stigma Mechanism Scale (SU-SMS), Arizona Sexual Experiences Scale (ASEX) and Golombok–Rust Sexual Satisfaction Inventory (GRISS). Sexual Dysfunction (SD) was defined according to ASEX cut-off scores. Overall, 38 patients (36.5%) met the criteria for SD. Patients with and without SD differed only in income level ( p = .025); no significant differences were found in other sociodemographic variables or in API and RSES scores (all p > .05). Correlation analyses showed that higher API scores were positively associated with GRISS total, Touching, Avoidance and Satisfaction subscale scores, while anticipated and internalized stigma were positively correlated with several GRISS subscales and ASEX scores. In multiple linear regression analyses, the model predicting GRISS total score was statistically significant, although no individual predictor reached statistical significance. The model predicting the GRISS satisfaction subscale was significant, with API total score emerging as an independent predictor. Mediation analysis did not support self-esteem as a mediator between internalized stigma and sexual dysfunction; however, addiction severity was significantly associated with GRISS total score in this model. These findings suggest that greater addiction severity and stigma are linked to more severe sexual dysfunction in men with OUD, although the independent predictive effects were modest. Routine assessment of sexual health, addiction severity, and stigma may be clinically relevant in this population. Not applicable. Clinical trial number: not applicable.