Exploring sexuality, sexual well-being and intimacy in schizophrenia spectrum disorders: systematic review and meta-synthesis of qualitative studies

INTRODUCTION: Sexuality and intimacy are central dimensions of identity, emotional well-being, social connectedness, and quality of life. In individuals with schizophrenia spectrum disorders (SSDs), these domains may be profoundly affected by illness-related, psychological, interpersonal, social, institutional, and treatment-related factors. Although antipsychotic-induced sexual dysfunction is clinically relevant, a broader understanding of patients' subjective experiences is needed to capture the meaning of sexuality, intimacy, and relational well-being in this population. METHODS: A systematic review was conducted in accordance with the ENTREQ framework. PubMed, Scopus, and PsycINFO were searched to identify qualitative and mixed-methods studies exploring patients' subjective experiences of sexuality, sexual well-being, intimate relationships, and antipsychotic-induced sexual dysfunction in SSDs. RESULTS: Fifteen reports from 14 studies met the inclusion criteria. Thematic synthesis identified six overarching descriptive themes: (1) illness-related challenges to sexual well-being, (2) abuse and traumatic experiences, (3) beliefs about sexuality, (4) the role of the healthcare system, (5) barriers and facilitators of sexual well-being, and (6) antipsychotic-induced sexual side effects. Patients' accounts showed that sexuality was not limited to sexual functioning, but was closely connected to self-image, stigma, emotional closeness, relational opportunities, trauma, institutional restrictions, and communication with clinicians. The analytical synthesis indicated that these factors interacted through their effects on self-image, relational confidence, opportunities for intimacy, and sexual agency, potentially reinforcing vulnerability or supporting well-being and personal recovery. CONCLUSIONS: Sexual well-being in individuals with SSDs is shaped by medication-related, relational, psychological, and healthcare-related factors. These findings support the integration of sexuality into patient-centred psychiatric care.