The Importance of Sexual Health in People with Schizophrenia

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Sexuality is often neglected in patient care for people with schizophrenia. Cultural myth leads us to believe that basic human needs like love, romance, sex, or long-term partnership disappear simply because we appear psychotic or “crazy.”

My aunt spoke of her desire to have sex, get married, and have children well into her sixties despite being diagnosed with severe schizophrenia when she was 14 years old. She spent most of her life in a desolate environment deprived of the natural social connection that non-mentally ill people receive naturally due to the stigma of association with “crazy” people.

After being diagnosed with a schizoaffective disorder myself, I also fought very hard against this internalized stigma. I realized the sexuality of people with schizophrenia is very important for human connection and chose to make it a priority. An argument could be raised that there needs to be more attention paid to the facets of human pleasure for schizophrenia patients.

The science indicates that people with schizophrenia may need more attention anyway. In a qualitative study published just this year, 69 people with schizophrenia were interviewed about their sexual habits. Only 78 percent of the sample had been sexually active ever in their lifetimes. Of that number, 65 percent of them did not use a condom during recent intercourse. More than 57 percent of that group also had never been tested for a sexually transmitted infection (STI), while those that did get tested were found at 19 percent to have an STI (Brown et al., 2022). Only 16 percent of the normal population experiences an STI in their lifetime in Australia, where this study was conducted (Willis, 2019).

What’s worse, childhood sexual abuse may contribute to the development of psychosis. In another study, 2,759 people were interviewed in Australia about their childhood sexual abuse that occurred before the age of 16. More than 3 percent of individuals developed psychosis after specifically having penetrative sexual abuse, while 2 percent developed schizophrenia. Abuse that was not penetrative was not associated with psychotic disorders (Cutujar et al., 2010).

The most severe association was for those individuals whose abuse occurred after 12 years old, involved more than one perpetrator, and was also penetrative, with rates of approximately 9 percent for psychosis and 17 percent for people with schizophrenia (Cutujar et al., 2010).

People who develop the disorder are prone to a lack of sexual fulfillment, and sexual dysfunction is also common in people with schizophrenia. Even treating schizophrenia can make sexual dysfunction worse. Antipsychotics that raise levels of prolactin affect women’s libido, and it has been found that non-treated patients with schizophrenia have fewer sexual dysfunctions than those who are treated (Seeman, 2013).

I can’t help but think of Ron Power’s book, No One Cares About Crazy People, as I read these statistics. The efforts put into helping people with schizophrenia are so few and far between that it’s not even a topic people even think of when considering our well-being.

Start with the self, and advocate for it in your medical care. The more patients speak up for their own needs, the more clinicians will need to recognize them.