0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Treatment in Psychiatry   |    
Loss of Libido in a Woman With Schizophrenia
Mary V. Seeman, M.D.
Am J Psychiatry 2013;170:471-475. doi:10.1176/appi.ajp.2012.12111475
View Author and Article Information

The author has served as a medical consultant for Clera, Inc.

From the Centre for Addiction and Mental Health, Toronto.

Address correspondence to Dr. Seeman (mary.seeman@utoronto.ca).

Copyright © 2013 by the American Psychiatric Association

Received November 26, 2012; Revised December 14, 2012; Accepted December 20, 2012.

Abstract

Sexual dysfunction is common among women with schizophrenia treated with antipsychotic medication. Multiple factors influence sexual function and reproductive health in this patient population, including the effects of medications on prolactin secretion and the complexities of making contraceptive decisions in the context of a serious mental illness. The author explores the causes and management of loss of libido as illustrated by a case vignette and describes the course and outcome of a clinical intervention that was implemented to alleviate the sexual dysfunction. Possible approaches and potential pitfalls of the intervention are described. Clinicians must be open to discussions regarding sexual concerns, relationships with sexual partners, and reproductive issues with women suffering from schizophrenia. Both patients and clinicians need to be aware of unintended effects of intervention. Opportunities exist for improved education among clinicians to achieve a more proactive approach to sexual health in women receiving antipsychotic medication.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

+

References

Sobecki  JN;  Curlin  FA;  Rasinski  KA;  Lindau  ST:  What we don’t talk about when we don’t talk about sex: results of a national survey of U.S. obstetrician/gynecologists.  J Sex Med 2012; 9:1285–1294
[CrossRef] | [PubMed]
 
Coverdale  JH;  Balon  R;  Roberts  LW:  Teaching sexual history-taking: a systematic review of educational programs.  Acad Med 2011; 86:1590–1595
[CrossRef] | [PubMed]
 
Cannon  BJ;  Kramer  LM:  Delusion content across the 20th century in an American psychiatric hospital.  Int J Soc Psychiatry 2012; 58:323–327
[CrossRef] | [PubMed]
 
Bitzer  J;  Platano  G;  Tschudin  S;  Alder  J:  Sexual counseling for women in the context of physical diseases: a teaching model for physicians.  J Sex Med 2007; 4:29–37
[CrossRef] | [PubMed]
 
Kelly  DL;  Conley  RR:  Sexuality and schizophrenia: a review.  Schizophr Bull 2004; 30:767–779
[CrossRef] | [PubMed]
 
Nunes  LVA;  Moreira  HC;  Razzouk  D;  Nunes  SOV;  Mari  J deJ:  Strategies for the treatment of antipsychotic-induced sexual dysfunction and/or hyperprolactinemia among patients of the schizophrenia spectrum: a review.  J Sex Marital Ther 2012; 38:281–301
[CrossRef] | [PubMed]
 
Marques  TR;  Smith  S;  Bonaccorso  S;  Gaughran  F;  Kolliakou  A;  Dazzan  P;  Mondelli  V;  Taylor  H;  DiForti  M;  McGuire  PK;  Murray  RM;  Howes  OD:  Sexual dysfunction in people with prodromal or first-episode psychosis.  Br J Psychiatry 2012; 201:131–136
[CrossRef] | [PubMed]
 
Derogatis  LR;  Burnett  AL:  The epidemiology of sexual dysfunctions.  J Sex Med 2008; 5:289–300
[CrossRef] | [PubMed]
 
Ambler  DR;  Bieber  EJ;  Diamond  MP:  Sexual function in elderly women: a review of current literature.  Rev Obstet Gynecol 2012; 5:16–27
[PubMed]
 
Macdonald  S;  Halliday  J;  MacEwan  T;  Sharkey  V;  Farrington  S;  Wall  S;  McCreadie  RG:  Nithsdale Schizophrenia Surveys 24: sexual dysfunction: case-control study.  Br J Psychiatry 2003; 182:50–56
[CrossRef] | [PubMed]
 
Giraldi  A;  Kristensen  E:  Sexual dysfunction in women with diabetes mellitus.  J Sex Res 2010; 47:199–211
[CrossRef] | [PubMed]
 
Kolotkin  RL;  Binks  M;  Crosby  RD;  Østbye  T;  Gress  RE;  Adams  TD:  Obesity and sexual quality of life.  Obesity (Silver Spring) 2006; 14:472–479
[CrossRef] | [PubMed]
 
Martelli  V;  Valisella  S;  Moscatiello  S;  Matteucci  C;  Lantadilla  C;  Costantino  A;  Pelusi  G;  Marchesini  G;  Meriggiola  MC:  Prevalence of sexual dysfunction among postmenopausal women with and without metabolic syndrome.  J Sex Med 2012; 9:434–441
[CrossRef] | [PubMed]
 
Atlantis  E;  Sullivan  T:  Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis.  J Sex Med 2012; 9:1497–1507
[CrossRef] | [PubMed]
 
Günzler  C;  Berner  MM:  Efficacy of psychosocial interventions in men and women with sexual dysfunctions: a systematic review of controlled clinical trials, part 2: the efficacy of psychosocial interventions for female sexual dysfunction.  J Sex Med 2012; 9:3108–3125
[CrossRef] | [PubMed]
 
Bains  S;  Shah  AA:  Sexual side effects of antipsychotic drugs.  Advances in Pharmacoepidemiology and Drug Safety 2012; 1 (10.4172/2167-1052.1000109)
 
Byerly  MJ;  Nakonezny  PA;  Bettcher  BM;  Carmody  T;  Fisher  R;  Rush  AJ:  Sexual dysfunction associated with second-generation antipsychotics in outpatients with schizophrenia or schizoaffective disorder: an empirical evaluation of olanzapine, risperidone, and quetiapine.  Schizophr Res 2006; 86:244–250
[CrossRef] | [PubMed]
 
Serretti  A;  Chiesa  A:  A meta-analysis of sexual dysfunction in psychiatric patients taking antipsychotics.  Int Clin Psychopharmacol 2011; 26:130–140
[CrossRef] | [PubMed]
 
Malik  P;  Kemmler  G;  Hummer  M;  Riecher-Roessler  A;  Kahn  RS;  Fleischhacker  WW; and the EUFEST Study Group:  Sexual dysfunction in first-episode schizophrenia patients: results from European First Episode Schizophrenia Trial.  J Clin Psychopharmacol 2011; 31:274–280
[CrossRef] | [PubMed]
 
Wang  AT;  Mullan  RJ;  Lane  MA;  Hazem  A;  Prasad  C;  Gathaiya  NW;  Fernández-Balsells  MM;  Bagatto  A;  Coto-Yglesias  F;  Carey  J;  Elraiyah  TA;  Erwin  PJ;  Gandhi  GY;  Montori  VM;  Murad  MH:  Treatment of hyperprolactinemia: a systematic review and meta-analysis.  Syst Rev 2012; 1:33
[CrossRef] | [PubMed]
 
Jayyab  AA:  Taurine implicated in bromocriptine induced hallucination: glycine-glutamic-aspartic implicated in bromocriptine induced schizophrenia.  Am J Pharmacol Toxicol 2010; 5:34–41
[CrossRef]
 
Schmidt  HM;  Hagen  M;  Kriston  L;  Soares-Weiser  K;  Maayan  N;  Berner  MM:  Management of sexual dysfunction due to antipsychotic drug therapy.  Cochrane Database Syst Rev 2012; 11:CD003546
[PubMed]
 
Seeman  MV:  Preventing breast cancer in women with schizophrenia.  Acta Psychiatr Scand 2011; 123:107–117
[CrossRef] | [PubMed]
 
Faupel-Badger  JM;  Sherman  ME;  Garcia-Closas  M;  Gaudet  MM;  Falk  RT;  Andaya  A;  Pfeiffer  RM;  Yang  XR;  Lissowska  J;  Brinton  LA;  Peplonska  B;  Vonderhaar  BK;  Figueroa  JD:  Prolactin serum levels and breast cancer: relationships with risk factors and tumour characteristics among pre- and postmenopausal women in a population-based case-control study from Poland.  Br J Cancer 2010; 103:1097–1102
[CrossRef] | [PubMed]
 
Inder  WJ;  Castle  D:  Antipsychotic-induced hyperprolactinaemia.  Aust N Z J Psychiatry 2011; 45:830–837
[CrossRef] | [PubMed]
 
Byerly  MJ;  Marcus  RN;  Tran  Q-V;  Eudicone  JM;  Whitehead  R;  Baker  RA:  Effects of aripiprazole on prolactin levels in subjects with schizophrenia during cross-titration with risperidone or olanzapine: analysis of a randomized, open-label study.  Schizophr Res 2009; 107:218–222
[CrossRef] | [PubMed]
 
Dickson  RA;  Seeman  MV;  Corenblum  B.  Hormonal side effects in women: typical versus atypical antipsychotic treatment.  J Clin Psychiatry 2000; 61(suppl 3):10–15
[PubMed]
 
Riecher-Rössler  A;  Schmid  C;  Bleuer  S;  Birkhäuser  M:  [Antipsychotics and hyperpolactinaemia: pathophysiology, clinical relevance, diagnosis and therapy].  Neuropsychiatr 2009; 23:71–83 (German)
[PubMed]
 
Vigod  SN;  Seeman  MV;  Ray  JG;  Anderson  GM;  Dennis  CL;  Grigoriadis  S;  Gruneir  A;  Kurdyak  PA;  Rochon  PA:  Temporal trends in general and age-specific fertility rates among women with schizophrenia (1996–2009): a population-based study in Ontario, Canada.  Schizophr Res 2012; 139:169–175
[CrossRef] | [PubMed]
 
Seeman  MV:  Antipsychotic-induced amenorrhea.  J Ment Health 2011; 20:484–491
[CrossRef] | [PubMed]
 
Coverdale  JH;  Bayer  TL;  McCullough  LB;  Chervenak  FA:  Respecting the autonomy of chronic mentally ill women in decisions about contraception.  Hosp Community Psychiatry 1993; 44:671–674
[PubMed]
 
Greydanus  DE;  Pratt  HD;  Patel  DR:  Concepts of contraception for adolescent and young adult women with chronic illness and disability.  Dis Mon 2012; 58:258–320
[CrossRef] | [PubMed]
 
Seeman  MV;  Ross  R:  Prescribing contraceptives for women with schizophrenia.  J Psychiatr Pract 2011; 17:258–269
[CrossRef] | [PubMed]
 
Trussell  J:  Contraceptive failure in the United States.  Contraception 2011; 83:397–404
[CrossRef] | [PubMed]
 
Lee  M;  Morgan  M;  Rapkin  A:  Clitoral and vulvar vestibular sensation in women taking 20 mcg ethinyl estradiol combined oral contraceptives: a preliminary study.  J Sex Med 2011; 8:213–218
[CrossRef] | [PubMed]
 
Gearing  RE;  Alonzo  D;  Marinelli  C:  Maternal schizophrenia: psychosocial treatment for mothers and their children.  Clin Schizophr Relat Psychoses 2012; 6:27–33
[CrossRef] | [PubMed]
 
Gentile  S:  Antipsychotic therapy during early and late pregnancy: a systematic review.  Schizophr Bull 2010; 36:518–544
[CrossRef] | [PubMed]
 
Gentile  S:  Neurodevelopmental effects of prenatal exposure to psychotropic medications.  Depress Anxiety 2010; 27:675–686
[CrossRef] | [PubMed]
 
Nicholson  J;  Hinden  BR;  Biebel  K;  Henry  AD;  Katz-Leavy  J:  A qualitative study of programs for parents with serious mental illness and their children: building practice-based evidence.  J Behav Health Serv Res 2007; 34:395–413
[CrossRef] | [PubMed]
 
Seeman  MV:  Clinical interventions for women with schizophrenia: pregnancy.  Acta Psychiatr Scand 2013; 127:12–22
 
Seeman  MV:  Parenting issues in mothers with schizophrenia.  Curr Womens Health Rev 2010; 6:51–57
[CrossRef]
 
Lagan  M;  Knights  K;  Barton  J;  Boyce  PM:  Advocacy for mothers with psychiatric illness: a clinical perspective.  Int J Ment Health Nurs 2009; 18:53–61
[CrossRef] | [PubMed]
 
Seeman  MV:  Intervention to prevent child custody loss in mothers with schizophrenia.  Schizophr Res Treatment  2012; 2012:796763
 
McCullough  LB;  Coverdale  JH;  Chervenak  FA:  Ethical challenges of decision making with pregnant patients who have schizophrenia.  Am J Obstet Gynecol 2002; 187:696–702
[CrossRef] | [PubMed]
 
Miller  LJ:  Ethical issues in perinatal mental health.  Psychiatr Clin North Am 2009; 32:259–270
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 20.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 17.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 26.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 12.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 46.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles
Management of sexual dysfunction due to antipsychotic drug therapy. Cochrane Database Syst Rev 2012;11():CD003546.
Loss of libido in a woman with schizophrenia. Am J Psychiatry 2013;170(5):471-5.