Waldinger Marcel D
Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of BetaSciences, Utrecht University, Utrecht, The Netherlands.
Handb Clin Neurol. 2015;130:469-89. doi: 10.1016/B978-0-444-63247-0.00027-4.
Sexual problems are highly prevalent among patients with psychiatric disorders. They may be caused by the psychopathology of the psychiatric disorder but also by its pharmacotherapy. Both positive symptoms (e.g., psychosis, hallucinations) as well as negative symptoms (e.g., anhedonia) of schizophrenia may negatively interfere with interpersonal and sexual relationships. Atypical antipsychotics have fewer sexual side-effects than the classic antipsychotics. Mood disorders may affect libido, sexual arousal, orgasm, and erectile function. With the exception of bupropion, agomelatine, mirtazapine, vortioxetine, amineptine, and moclobemide, all antidepressants cause sexual side-effects. Selective serotonin reuptake inhibitors (SSRIs) may particularly delay ejaculation and female orgasm, but also can cause decreased libido and erectile difficulties. SSRI-induced sexual side-effects are dose-dependent and reversible. Very rarely, their sexual side-effects persist after SSRI discontinuation. This is often preceded by genital anesthesia. Some personality characteristics are a risk factor for sexual dysfunction. Also patients with eating disorders may suffer from sexual difficulties. So far, research into psychotropic-induced sexual side-effects suffers from substantial methodologic limitations. Patients tend not to talk with their clinician about their sexual life. Psychiatrists and other doctors need to take the initiative to talk about the patient's sexual life in order to become informed about potential medication-induced sexual difficulties.
性功能问题在精神疾病患者中极为普遍。它们可能由精神疾病的精神病理学引起，也可能由其药物治疗导致。精神分裂症的阳性症状（如精神病性症状、幻觉）以及阴性症状（如快感缺失）均可能对人际关系和性关系产生负面影响。非典型抗精神病药物的性副作用比经典抗精神病药物少。心境障碍可能影响性欲、性唤起、性高潮和勃起功能。除安非他酮、阿戈美拉汀、米氮平、伏硫西汀、阿密曲替林和吗氯贝胺外，所有抗抑郁药物都会引起性副作用。选择性5-羟色胺再摄取抑制剂（SSRIs）可能尤其会延迟射精和女性性高潮，还会导致性欲减退和勃起困难。SSRIs引起的性副作用具有剂量依赖性且是可逆的。极少数情况下，在停用SSRIs后其性副作用仍会持续。这种情况通常先出现生殖器麻木。某些人格特征是性功能障碍的危险因素。饮食失调患者也可能存在性方面的困扰。到目前为止，关于精神药物引起的性副作用的研究存在重大方法学局限性。患者往往不愿与临床医生谈论他们的性生活。精神科医生和其他医生需要主动询问患者的性生活情况，以便了解潜在的药物引起的性问题。
