Pharmacological strategies for sexual recovery in men undergoing antipsychotic treatment

Pornography and sexual function in the post-pandemic period: a narrative review from psychological, psychiatric, and sexological perspectives

The COVID-19 pandemic and lockdowns had significant impacts on sexual functioning and behavior. Partnered sexual activity decreased overall, while solo sex activities such as masturbation and pornography consumption increased exponentially. Given the ongoing debate about the effects of pornography on sexual function, it was prudent to consider how the increase in porn consumption during the pandemic might have impacted sexual function in the post-pandemic period. Results indicated that despite the increased rates of use during lockdowns, there remains no evidence supporting the relationship between sexual dysfunction and porn use during and following the pandemic period. On the contrary, pornography consumption and solo sex activities offered an alternative to conventional sexual behavior during a highly stressful period and were found to have positive effects of relieving psychosocial stress otherwise induced by the pandemic. Specifically, those who maintained an active sexual life experienced less anxiety and depression, and greater relational health than those who were not sexually active. It is important to consider factors including frequency, context, and type of consumption when analyzing the impact of pornography on sexual function. While excessive use can have negative effects, moderate use can be a natural and healthy part of life.

Managing antipsychotic-related sexual dysfunction in patients with schizophrenia

INTRODUCTION

Schizophrenia is a psychotic disorder and one of the most severe and impactful mental illnesses. Sexual dysfunction is highly prevalent in patients with schizophrenia but remains underdiagnosed and undertreated. Sexual dysfunction is frequently attributed to antipsychotics which may reduce medication adherence, but negative symptoms can also reduce sexual drive.

AREAS COVERED

This review provides an overview of the current knowledge about sexual dysfunction in patients with schizophrenia. The authors first review the literature concerning the mechanisms of sexual dysfunction and explore the impact of antipsychotics on sexual function. Finally, they present the available non-pharmacological and pharmacological treatment strategies for sexual dysfunction in patients with schizophrenia.

EXPERT OPINION

Sexual dysfunction in patients with schizophrenia is still underrated by clinicians despite having a negative impact on the quality of life and therapeutic adherence. Antipsychotic treatment is still perceived as a major cause of sexual impairment. Psychiatrists must be aware of this condition and actively question the patients. A comprehensive approach, addressing pharmacological and non-pharmacological aspects, is fundamental for managing sexual dysfunction in schizophrenia. Pharmacological strategies include (1) Serum-level adjustment of the antipsychotic dose, if possible (2) switching to a well-tolerable antipsychotic (aripiprazole, brexpiprazole) and (3) adding a coadjuvant drug (phosphodiesterase-5 inhibitors).

The effects of non-andrological medications on erectile dysfunction: a large single-center retrospective study

PURPOSE

To evaluate the association among andrological diseases at the first outpatient visit and the medications taken by patients for other comorbidities, as well as the differential impact between specific medication and relative comorbidities.

METHODS

This is a single-center retrospective study based on subjects who referred to the Andrology Unit with a well-defined andrological diagnosis.

RESULTS

A total of 3752 subjects were studied (mean age ± DS 46.2 ± 16.5 years). A total of 19 categories of andrological diseases and 110 type of medications for other comorbidities were identified. ED was the most frequent andrological pathology at the first andrological examination (28.7%), followed by infertility (12.4%). The couple of variables that were statistically significant in the univariate association analysis (p < 0.001) were: ED and (a) antihypertensives; (b) antihyperglycemics; (c) lipids-lowering; (d) psychotropics. The univariate and multivariate regression analyses confirmed the association. All the related comorbidities were also significantly associated with the univariate analysis, and all remained significantly associated with multivariate analysis. A multivariate analysis was also conducted to analyze the association between ED and the following pairs of variables "DM-antihyperglycemics", "dyslipidemia-lipids-lowering", and "hypertension-antihypertensives". In all cases, the pathology, but not the specific treatment, was significantly associated with ED.

CONCLUSION

ED is significantly associated with antihypertensive, antihyperglycemic, lipid-lowering, psychotropic drugs' intake. Anyway, ED appears to be more related to the diseases than to the specific therapies. The definitive cause/effect relationship should be established based on future prospective studies.

Sexual and Reproductive Health in Adolescents and Young Adults With Psychotic Disorders: A Scoping Review

BACKGROUND AND HYPOTHESIS

The sexual and reproductive health (SRH) of young people with psychosis has been largely overlooked. We hypothesised that there are key deficiencies in the existing literature on the SRH of adolescents and young adults with psychotic disorders.

STUDY DESIGN

We conducted a systematic scoping review using Pubmed, Web of Science, Embase, PsycINFO, and CINAHL. We included empirical studies and case reports focused on SRH issues in young people (aged 14-24 years) with psychotic disorders. A qualitative synthesis was completed. Joanna Briggs Institute Critical Appraisal Tools were utilized to assess study quality.

STUDY RESULTS

Seventeen empirical studies and 52 case reports met inclusion criteria. Most focused on sexual dysfunction which was identified as common among this cohort and associated with both psychotic disorders and antipsychotics. The study population was more likely to engage in sexual risk-taking behavior and was at higher risk of sexually transmissible infections than those without psychosis. SRH topics of clinical relevance in older patients with psychosis such as pregnancy, abortion, sexual violence, coercion, sexual identity, and gender were poorly addressed in this younger group. We found empirical studies generally lacked identification and controlling of confounders whilst case reports provided limited description of mental health and SRH outcomes following clinical intervention.

CONCLUSION

Research and clinical practice addressing sexual and reproductive health is needed for young people living with psychosis. To address research gaps future studies should focus on women's health, sexual violence, gender, and sexuality in young people with psychosis.