Changes in sexuality after a first psychotic episode

People with psychotic disorders may experience a variety of sexual changes and problems, which may be caused by the symptoms of the disorder, by the medication used to treat it, or by emotional and relational factors associated with the situation.

Some sexual problems or changes related to sexuality include:

• Decreased sexual interest. A decrease and loss of interest in sex, known as sexual anhedonia, can be a symptom of psychotic disorders. It can also be related to the depression, anxiety, or stress that often accompany these disorders. Psychological therapy and cognitive behavioral therapy can help address these emotional issues.
• Sexual dysfunction can include difficulty achieving or maintaining an erection in men (erectile dysfunction) or difficulty with arousal and orgasm in both men and women. Some medications can have side effects that affect sexual function. In these cases, it is important to talk to a psychiatrist to discuss treatment options or adjust medication, if necessary. Additionally, some people with psychotic disorders may turn to substance abuse as a form of self-regulation or to cope with symptoms, and this abuse can negatively impact sexual function. In these cases, it is important to seek treatment for substance abuse.
• Self-image and self-esteem issues : Psychotic disorders can affect self-perception and self-esteem. This can impact sexual intimacy and trust in relationships. Individual or couples therapy can be beneficial in addressing these concerns.
• Difficulties in sexual communication : Open and honest communication about sexual needs and desires is fundamental in any relationship. Psychotic symptoms, such as disorganized thinking or hallucinations, can affect communication and the expression of sexual desires. Couples therapy or sex therapy can help improve communication in the relationship.

Types of sexual dysfunctions

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It is important to note that each person may experience these changes differently. It is essential that people with psychosis receive comprehensive support, including medical care, psychotherapy, and social support. Open communication with mental health and medical professionals is key to addressing sexual issues effectively. Furthermore, it is crucial that individual desires and boundaries in sexual relationships are respected and that sexual health is promoted in a safe and consensual environment.

How can sexual problems and disorders be treated?

We know that talking about sexual problems or disorders isn't easy, as it remains a taboo subject in our society. Furthermore, because it's often considered a minor issue within a broader mental health condition, it doesn't receive the attention it deserves. Even so, it's important to bring up the topic if it's significant for the individual or disrupts their daily life.

The treatment of sexual problems and disorders in people with a psychotic disorder should be comprehensive and tailored to individual needs. Some general guidelines for addressing these problems are:

• Proper evaluation and diagnosis. Before addressing any sexual problem, a thorough medical and psychological evaluation is essential. This includes discussing specific sexual symptoms, reviewing medical and psychiatric history, and considering any medications being taken and their side effects. An accurate diagnosis is crucial to determining the underlying cause of sexual problems.
• Medical treatment and medication adjustments. If sexual problems are related to antipsychotic or other medication, a dosage adjustment, a change in medication type, or the addition of a medication to counteract side effects may be necessary. This should be discussed and monitored by healthcare professionals.
• Psychological therapy. Psychological therapy can be beneficial for addressing sexual problems related to emotional, self-image, or interpersonal factors. Cognitive behavioral therapy (CBT) and sex therapy are common approaches that can help people develop skills to overcome sexual obstacles.
• Couples therapy. If the sexual problem is affecting a couple's relationship, couples therapy can be helpful in improving communication, addressing concerns, and finding solutions together. This can be especially important if the couple is also experiencing stress or difficulties related to the psychotic disorder.
• Sex education. Appropriate sex education can help people with psychotic disorders better understand their sexuality and develop realistic expectations about sexual intimacy. Therapists and healthcare professionals can provide information on anatomy, sexual physiology, and techniques to improve sexual satisfaction.
• Social support. The support of friends and family is essential. People with psychotic disorders can benefit from a supportive environment that understands their challenges and needs.
• Comprehensive treatment. It is important that the treatment of sexual problems be part of a comprehensive approach to medical and mental health care for the person with a psychotic disorder. This may include treatment for psychotic symptoms, stress management, social support, and general health care.

Each person is unique and may have individual needs and concerns regarding their sexuality. Therefore, treatment should be tailored to those specific needs, and it is important to have a supportive and understanding environment.