Sexual dysfunction and antipsychotics

The adverse side-effects of antipsychotic medication, including sexual dysfunction, are believed to be one of the main reasons for non-compliance (Smith et al, 2002). However, it is the broader issue of sexual behaviour in psychiatry that we need to focus on. Sexuality is important to most patients, as the drive to procreate is strong.

Psychiatric professionals tend not to be interested in discussing sexual behaviour, for reasons such as that they feel it is not important enough, or that it is something private. Apart from embarrassment, worries also arise because of the sensitivity of this issue in the litigation-ridden atmosphere of current practice. Patients' sexual behaviour is usually considered when it is perceived as deviant or when others are felt to be at risk (e.g. in the context of sexual abuse or harassment).

Buckley and colleagues, having emphasised the importance of sexuality to in-patients, have conducted surveys on psychiatric in-patient units. These have shown a ‘wide variety of differing management approaches’ (Buckley & Robben, 2000) to in-patient sexual behaviour. Also, most mental health facilities perceive sexual behaviour as an ‘infrequent problem’ (Buckley & Weichers, 1999).

Healthy expression of sexuality is frowned upon and pornographic material is discouraged on most general adult psychiatric wards. This is justified, as it would not be appropriate. Little consideration is given to the idea that freer expression of sexuality may be therapeutic.

Psychiatric in-patients are vulnerable, yet inhibition of sexual behaviour may increase distress, which can be detrimental to mental health. In the era of holistic medicine such an important facet of patient care has to be catered for. We should offer patients ways by which they can express themselves sexually in a safe and private environment. The way forward is to design in-patient wards, and write management policies, that are more ‘person-friendly’.