Sexual functioning and its consequences should be a clinically important concern for practitioners and programs serving the needs of persons with schizophrenia. Unfortunately, sexuality is rarely on the radar screen of the vast majority of mental health professionals. By default, the normal and natural sexual interests, needs, and abilities of persons with schizophrenia are sadly neglected in this area of human experience. For the silent chorus of psychiatrists, psychologists, social workers, and allied mental health workers, it is as though persons with schizophrenia are asexual. Awareness and concern by mental health professionals about sexuality in schizophrenia emerge only in the context of its inappropriate occurrence in hospitals or when sexually transmitted diseases or unwanted pregnancies arise as consequences of uninformed sexual activity. As long as the sex lives of individuals with schizophrenia lie deeply buried beneath other clinical priorities of mental health professionals, a vital and normalizing life aspect is suppressed, thereby disenfranchising thousands of individuals with schizophrenia from the potentialities of recovery.

The lack of substantive and systematic interest in the sexuality of their patients should not be surprising given the stigma and prevailing views of schizophrenia as a disorder of despair, deficit syndrome, neurodevelopmental abnormalities, and enduring cognitive impairments. For most providers of mental health services, the sex lives of those with schizophrenia are preferably out of sight and out of mind. Being blind and silent to the sexual needs, desires, and capacities of men and women with schizophrenia perpetuates the myth that schizophrenia is a monolithic, lifelong disorder that separates its victims from the rest of “normal” humanity. One might obtain some interesting responses from mental health practitioners if one were to ask, “Is there sex after schizophrenia?”

But under the ashes, some embers still burn.

With the voices of the seriously mentally ill consumers increasingly being heard, there may be an awakening to the sexuality of persons with schizophrenia, with its attendant pleasures and problems. In this article, we summarize what is known about the following:

•   Sexual activity of persons with schizophrenia.
•   Sexual dysfunctions that they experience, including those resulting from side effects of their long-term use of antipsychotic drugs.
•   Vulnerability of this population to sexually transmitted diseases.
•   Psychoeducational programs that have been developed for this population to prevent unwanted pregnancies and sexually transmitted diseases.
•   Development of a Friendship and Intimacy Module designed to teach safe and satisfying sex to persons with schizophrenia and other mental disabilities.

Because mental health professionals have little experience, knowledge, or clinical competence in mounting treatment and education on sex, they are often embarrassed, awkward, and self-conscious when trying to address this topic with their patients in clinical settings. Practitioners require special training experiences and self-awareness exercises if they undertake the important task of teaching individuals with schizophrenia how to make decisions about sexual relations and to engage in safe and satisfying sex. Therefore, this section also contains suggestions about the organization and curriculum for professional training in this area.

Sexual activity of individuals with schizophrenia
Although limited data are available on sexuality in persons with schizophrenia, a few studies have been published in the past decade. For instance, in comparison with representative samples of non-mentally-ill persons in the United States, men with schizophrenia and mood disorders had approximately the same number of lifetime sexual partners.

Both non-mentally-ill and seriously mentally ill males reported three to four times as many sexual partners as women. In terms of sexual precocity, there were no differences between the mentally ill and non-mentally-ill cohorts. The average age of first reported sexual intercourse was 16–18 for men and women. It is interesting to note that similar surveys of physically disabled individuals-such as those with spinal cord injuries-have revealed a strong interest in sex, sexual activity of various types, and a mature response to educational programs on sexuality relevant to paraplegics.

###

Alex Kopelowicz, M.D.^a
Robert Paul Liberman^b
Donald Stolar, PhD^c

^a Associate Professor of Psychiatry, David Geffen School of Medicine at UCLA
^bProfessor of psychiatry at the University of California at Los Angeles
^cDepartment of Psychiatry, University of California, Los Angeles,. Los Angeles, California

###

REFERENCES

1. Assalian, P., Fraser, R. R., Tempier, R., & Cohen, D. (2000). Sexuality and quality of life of patients with schizophrenia. International Journal of Psychiatry in Clinical Practice, 4, 29–33.
2. Coverdale, J. H., & Turbott, S. H. (2000). Risk behaviors for sexually transmitted infections among men with mental disorders. Psychiatric Services, 51, 234–238.
3. Crenshaw, T. L., & Goldberg, J. P. (1996). Sexual pharmacology: Drugs that affect sexual functioning. New York: Norton.
4. Friedman, S., & Harrison, G. (1984). Sexual histories, attitudes and behavior of schizophrenic and “normal” women. Archives of Sexual Behavior, 13, 555–567.
5. Goisman, R. (2001). Choices: An educational program for AIDS prevention. Boston: MMH Reseach Corporation.

Full References  »