Sex and Schizophrenia
Many males with schizophrenia can tell you that the "swinging life of a bachelor" is not all it's cracked up to be. I have one friend about age 40 who had never had a girlfriend until a few years ago. He developed schizophrenia in high school, and never had the opportunity to catch up with his peers. He's 40 years old and still a virgin. Males with schizophrenia don't often get married, although I've never seen any analysis as to why not. Even when all the barriers are considered, poverty, social isolation, continuing negative and cognitive symptoms, non-employment, etc. you would still expect some marriage. Sexuality per se was never considered of any significance in psychosocial rehabilitation, never discussed at conferences, never discussed in psychiatrist offices, until quite recently. The only interest taken in patients' sexuality has been when it was socially inappropriate, criminal, or resulted in victimization of the patient.
There was no doubt conventional medications were having a major impact on people's sexuality. One prominent side effect of many medications is prolactin level increases. Prolactin elevation has a variety of sexual impacts in both male and females, none of them very desirable, although some women might not mind losing their menstrual periods. Sexual side effects just weren't considered important compared to the need to control psychotic symptoms.
With the introduction of atypical medication researchers are only now starting to investigate sexuality and it's importance to patients. Some researchers are finding that sexual side effects are a major reason for noncompliance. People would rather be psychotic than impotent. These researchers are finding that psychiatrists almost never initiate discussion of sexuality with patients, and patients are often too embarrassed to raise the subject themselves. Patients become noncompliant, relapse, and are rehospitalized, and the psychiatrist has no idea why. If anything the tendency would be to raise the dose of the medication in belief that an adjustment is needed.
There is an interesting debate going on now between Janssen which produces Risperidone and Eli Lilly which produces Olanzapine. Risperidone has a tendency to raise prolactin levels which causes considerable sexual side effects. Olanzapine has a tendency to cause weight gain sometimes quite a lot of weight. Each company is hoping that psychiatrists will see their rival's side effect as the greater evil. Which would you rather lose?
Although there is a beginning interest in sexuality as a component of patient satisfaction, it is only just beginning, and it is not entirely pure in intent. On the new atypicals, women are ovulating again and having unwanted pregnancies because no one is discussing birth control with them. The vast majority of men with schizophrenia do not have a satisfying sex life. The women are generally luckier because schizophrenia usually develops later in women and many are already married by then, although divorce is not uncommon in that population.
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