The aim of the present study was to determine the prevalence rate of sexual dysfunctions in male psychiatric patients in comparison with other medical patients. The results of the study were indicative of higher prevalence rate of sexual dysfunction in the psychiatric patients compared to those in the other medical patients. These results were in accord with the results of other studies, which have reported the prevalence rate of these dysfunctions to be higher in psychiatric patients [14].
The higher rate of sexual dysfunction in psychiatric patients is influenced by different factors such as the type of medical and mental illness together with the drugs used, marital and relationship problems between the patients and their spouses, and cultural and social issues [15].
As the causes of sexual dysfunctions are multifactorial and due to using different tools to measure these dysfunctions, the rate of these dysfunctions in various studies has been reported from 17 to 80% [16]. Moreover, other studies exert an increase in the prevalence rate of mental disorders in those patients with sexual dysfunction [17].
In our study, the results revealed that the mean age (in years) of 47.26 ± 7.41 and 45.09 ± 9.22 had the highest rate of sexual dysfunction in psychiatric and other medical patients respectively. This was in accordance with other studies that have reported sexual dysfunction in the patients between 35 and 64 years old to be higher than in the patients between 18 and 34 years old [16]. This was consistent with other Egyptian studies: Habeeb who found that the sexual function is negatively correlated with age [18] and Mohammed who found that sexual function in patients with paranoid schizophrenia is affected negatively by sociodemographic factor (aging) [13].
It is noteworthy to mention that the patients included in our study were selected from the Abbassia Mental Health Hospital and Al-Zahraa University Hospital. Both hospitals offer their services to the patients of low socioeconomic standards on a low price basis; this may reflect the high prevalence of patients with low education and low occupation in this study.
In this study, the results showed that psychiatric and other medical patients with sexual dysfunction had a statistically significant longer duration of illness than psychiatric and other medical patients without sexual dysfunctions (P value < 0.05). This finding is in agreement with Schover who stated that the patients who had chronic and long duration of illness often had difficulties in sexual functioning [17]. Egyptian studies were also supporting this finding: Mohammed found that sexual function in patients with paranoid schizophrenia is affected negatively by long duration of illness [13], and Hashem et al. reported that long duration of schizophrenia may lead to sexual dysfunctions among schizophrenics [19].
In this study, we found that sexual dysfunction was significantly higher in the psychiatric patients (51.2%) than in the other medical patients (21%) (P value < 0.05). This finding is confirmed by other studies, where Bobes et al. reported that the prevalence of sexual dysfunction among psychiatric patients is higher in comparison to non-psychiatric patients and the general population [20]. Also, Van Lankveld and Grotjohann stated that psychiatric patients have significantly more sexual dysfunction than non-psychiatric patients and also more than in the general population [21].
In this work, the results revealed that among the psychiatric patients, those with schizophrenia (75%) had the highest prevalence rate of sexual dysfunctions. The patients with bipolar disorders, depressive disorders, and anxiety disorders had the following rates respectively. This result comes in accordance with the result of the study done by Fanta T et al. who reported that the overall sexual dysfunction among male schizophrenics was 84.5% [22]. Also, Smith et al. reported that 45% of schizophrenics taking conventional antipsychotic medications have sexual dysfunction [12].
These findings are supported with the findings of Macdonald et al. who found that at least one sexual dysfunction was reported by 82% of male schizophrenic patients [23].
The previous studies confirmed that sexual dysfunction is very common in patients with schizophrenia. This reflects another aspect of the poor quality of life led by many people with schizophrenia that should be addressed.
The high prevalence of sexual dysfunctions in patients with schizophrenia was proved by several studies to be the cause of sexual side effects of using antipsychotics in those patients. In this respect, Mccreadie found that depot antipsychotic treatment resulted in sexual dysfunction [23]. Also, Atmaca et al. concluded that sexual dysfunction is an important problem in schizophrenics even with novel antipsychotics [24]. In a study done by Kockott and Pfeiffer to study sexual disorder in non-acute psychiatric patients, they found that schizophrenic patients on neuroleptic medications are most frequently affected, whereas schizophrenic patients not in medications have fewer dysfunctions [25].
The results of our study revealed that 60% of patients with schizophrenia had sexual desire dysfunction. This was consistent with the study done by [22] who reported that 62%of male chronic schizophrenics have reduced libido. The “disease-related” sexual desire reduction might be induced by an unknown underlying process, the patients’ psychotic symptoms, or as part of the general loss of initiative and activity level (i.e., negative symptoms) [26].
Regarding the ejaculatory function, we found that 75% of patients with schizophrenia had ejaculatory dysfunction. This was consistent with the study of [22] who reported that 86% of male chronic schizophrenics had ejaculatory dysfunction. This emphasizes that direct questioning about sexual functioning including sexual side effects is necessary to avoid underestimating their frequency among the psychiatric patients.
In the present study, we found that 45% of patients with depressive disorders had sexual dysfunctions. This was in agreement with the study done by [27] who reported that 54% of depressed male patients have sexual dysfunction. Our results showed that 40% of patients with depressive disorders have sexual desire dysfunction. In this respect [27], reported that 37.03% of depressed male patients have lack of sexual desire. Also, the results of our study revealed that 30% of patients with depressive disorders had erectile dysfunction. This was consistent with the study done by [27] who reported that 22.22% of depressed male patients have lack of erection. This may lead us to advice the psychiatrists to bear this in mind, and they should ask about the sexual power before starting treatment and during follow-up and to reassure the patients if there is any problem.
In the present study, we found that 55% of patients with bipolar disorders had sexual dysfunctions. This comes in accordance with [28], who reported that the co-administration of benzodiazepines and lithium resulted in significantly higher rates of sexual dysfunction (49%) in bipolar patients. Additionally, in our study, the results showed that 30% of patients with anxiety disorders had ejaculatory dysfunctions. In this respect, [29] concluded that anxiety or fear of failing to meet a partner’s expectations is one of the most common causes of premature ejaculation.
In the present study, we found that among the other medical patients, those with the cardiac diseases (35%) had the highest prevalence rate of sexual dysfunctions. The patients with hepatic diseases, diabetes, urologic diseases, and respiratory diseases had the following rates respectively. This was confirmed by Ahmadzadeh and Shahin who concluded that cardiac patients (37.1%) had the highest prevalence rate of sexual dysfunction among the patients in non-psychiatric wards [30].
Our study revealed that 35% of patients with cardiac diseases had erectile dysfunction. Consistently, data from several studies involving patients with cardiac disease have shown a high prevalence, 42–75%, of erectile dysfunction in this patient population [31]. Also, the results showed that 20% of diabetic patients had erectile dysfunction. This was in accordance with [32] who stated that the prevalence of erectile dysfunction among diabetic patients is 20–65%. Moreover, our results showed that 25% of patients with hepatic diseases had sexual dysfunctions. In this respect, we should mention that liver has a major role in sex hormone metabolism. In the present study, we found that 15% of patients with urologic diseases had sexual dysfunctions. This comes in accordance with the study done by [33] who stated that a common problem that remains difficult to diagnose and treat in patients with chronic renal failure is sexual dysfunction. Our study showed that 10% of patients with respiratory diseases had sexual dysfunction. Also, [34] found that 21% of men with COPD had erectile dysfunction. In fact, any chronic illness may be associated with sexual dysfunction.
In the present study, the results revealed that psychiatric patients with sexual dysfunction had statistically significant higher prolactin level than psychiatric patients without sexual dysfunction. Also, we found that patients with schizophrenia (higher rate of sexual dysfunction) had statistically significant higher prolactin level than other psychiatric patients. These findings can prove that elevated prolactin level may cause sexual dysfunction. This is consistent with the study done by Bruno who reported that hyperprolactinemic patients reported significant degree of sexual dysfunction [35].Hyperprolactinemic patients reported significant degree of sexual desire dysfunction, orgasm dysfunction, sexual satisfaction dysfunction, and low frequency of sexual intercourses which is supported with that hyperprolactinemia caused hypogonadism with suppressed LH and FSH levels and low testosterone levels.
In this study, we found no significant difference between psychiatric and other medical patients and between patients with and without sexual dysfunction as regards total testosterone level. This is contrary to [36] who reported that a component of the increased risk conferred by erectile dysfunction could be testosterone deficiency.