Pharmacopsychiatry 2007; 40(2): 58-63
DOI: 10.1055/s-2007-970143
Original Paper

© Georg Thieme Verlag KG Stuttgart · New York

Sexual Impairment in Psychiatric Inpatients: Focus on Depression

S. Cohen 1 , K-U. Kühn 4 , S. Bender 3 , A. Erfurth 5 , M. Gastpar 3 , A. Murafi 6 , M. Rothermundt 5 , J. Signerski 3 , B. Sträter 4 , L. Teusch 6 , W. Weig 7 , A. Welling 7 , J. Westheide 4 , T. J. Huber 2
  • 1Department of Psychiatry and Psychotherapy, Rheinische Kliniken Duesseldorf, Heinrich-Heine-University Duesseldorf, Bergische Landstrasse 2, Düsseldorf
  • 2Department of Clinical Psychiatry and Psychotherapy, Medical School Hannover, Carl-Neuberg-Strasse 1, Hannover
  • 3Department of Psychiatry and Psychotherapy, University Duisburg-Essen
  • 4Department of Psychiatry and Psychotherapy, University Bonn
  • 5Department of Psychiatry and Psychotherapy, University Muenster
  • 6Department of Psychiatry and Psychotherapy, Ev. Krankenhaus Castrop-Rauxel
  • 7State Hospital for Psychiatry Osnabrueck
Further Information

Publication History

received 25. 09. 06 revised 15. 01. 07

accepted 17. 01. 07

Publication Date:
19 April 2007 (online)


Introduction: Although sexual side effects are a common reason for noncompliance with medication, information on impairment of sexuality in psychiatric inpatients is scarce.

Methods: In the present multi-center study, data on several aspects of sexual functioning were collected in psychiatric inpatients using a previously validated questionnaire.

Results: A high overall prevalence of sexual dysfunction was reported by participants and was highest in depressed subjects. Patients receiving antidepressants suffered from more frequent and more severe impairment of sexuality than did subjects receiving neither antidepressants nor antipsychotics or opioids.

Discussion: Judging from this data, sexual impairment appears to be a frequent and underestimated problem in psychiatric inpatients with a high prevalence across all diagnostic groups, particularly in depressed subjects. Female patients attribute this impairment mainly to their mental illness, whereas male patients tend to assign their impairments primarily to their medication.


  • 1 Angst J. Sexual problems in healthy and depressed persons.  Int Clin Pharmacol. 1998;  13 ((Suppl 6)) S1-S4
  • 2 Baldwin DS, Thomas SC, Birtwistle J. Effects of antidepressant drugs on sexual function.  Int J Psychiatry Clin Pract. 1998;  1 47-58
  • 3 Baldwin DS. Depression and sexual dysfunction.  Br Med Bull. 2001;  57 81-89
  • 4 Balon R, Yeragani VK, Pohl R, Ramesh C. Sexual dysfunction during antidepressant treatment.  J Clin Psychiatry. 1993;  54 209-212
  • 5 Balon R. SSRI-Associated sexual dysfunction.  Am J Psychiatry. 2006;  163 ((9)) 1504-1509
  • 6 Beck AT. Depression. Causes and Treatment. Philadelphia: University of Pennsylvania Press 1967
  • 7 Berner MM, Hagen M, Kriston L. A systematic review of research on strategies for the management of antipsychotic-induced sexual dysfunction: high-level evidence is needed.  J Clin Psychiatry. 2006;  67 ((10)) 1649-1650
  • 8 Bitter I, Basson BR, Dossenbach MR. Antipsychotic treatment and sexual functioning in first-time neuroleptic-treated schizophrenic patients.  Int Clin Psychopharmacol.. 2005;  20 ((1)) 19-21
  • 9 Bonierbale M, Lançon C, Tignol J. The ELIXIR study: evaluation of sexual dysfunction in 4557 depressed patients in France.  Curr Med Res Opin. 2003;  19 ((2)) 114-124
  • 10 Byerly MJ, Nakonezny PA, Bettcher BM, Carmody T, Fisher R, Rush AJ. Sexual dysfunction associated with second-generation antipsychotics in outpatients with schizophrenia or schizoaffective disorder: an empirical evaluation of olanzapine, risperidone, and quetiapine.  Schizophr Res. 2006;  86 ((1-3)) 244-250
  • 11 Clayton A, Pradko JF, Croft HA, Montano CB, Leadbetter RA, Bolden-Watson C, Bass KI, Donahue RM, Jamerson BD, Metz A. Prevalence of sexual dysfunction among newer antidepressants.  J Clin Psychiatry. 2002;  63 357-366
  • 12 Clayton A. Recognition and assessment of sexual dysfunction associated with depression.  J Clin Psychiatry. 2001;  62 ((Suppl. 3)) 5-9
  • 13 Cohen S, Huber TJ. Stichtagserhebung zu Störungen der Sexualität bei stationär behandelten, psychisch kranken Menschen.  Nervenarzt. 2006;  77 ((Suppl. 3)) S326-327
  • 14 Cohen S, Scholz P. Sexualstörungen in der Behandlung depressiver Erkrankungen - Eine Herausforderung für die behandelnden Ärzte.  Psychoneuro. 2004;  30 ((3)) 164-168
  • 15 Cyranowski JM, Frank E, Cherry C, Houck P, Kupfer DJ. Prospective assessment of sexual function in women treated for recurrent major depression.  J Psychiatr Res. 2004;  38 ((3)) 267-273
  • 16 Farah A. Relief of SSRI-induced sexual dysfunction with mirtazapine treatment [letter].  J Clin Psychiatry. 1999;  4 260-261
  • 17 Ferguson JM. The effect of antidepressants on sexual functioning in depressed patients: a review.  J Clin Psychiatry. 2001;  62 ((Suppl. 3)) 22-34
  • 18 Gastpar M, Singer A, Zeller K. Comparative efficacy and safety of a once-daily dosage of Hypericum extract STW3-VI and Citalopram in patients with moderate depression: a double-blind, randomised, multicentre, placebo-controlled study.  Pharmacopsychiatry. 2006;  39 66-75
  • 19 Gelenberg AJ, Laukes C, McGahuey C. et al . Mirtazapine substitution in SSRI-induced sexual dysfunction.  J Clin Psychiatry. 2000;  61 356-360
  • 20 Gregorian RS, Golden KA, Bahce A, Goodman C, Kwong WJ, Khan ZM. Antidepressant-induced sexual dysfunction.  Annals of Pharmacotherapy. 2002;  36 ((10)) 1577-1589
  • 21 Grasmäder K, Verwohlt PL, Kühn KU, Frahnert C, Hiemke C, Dragicevic A, von Widdern O, Zobel A, Maier W, Rao ML. Relationship between Mirtazapine dose, plasma concentration, response and side effects in clinical practice.  Pharmacopsychiatry. 2005;  38 113-117
  • 22 Herthoft P. Klinische Sexologie. Deutscher Ärzte-Verlag 1989: 85-89
  • 23 Hirschfeld R. Management of sexual side effects of antidepressant therapy.  J Clin Psychiatry. 1999;  60 ((Suppl 14)) 27-30
  • 24 Kennedy SH, Dickens SE, Eisfeld BS. et al . Sexual dysfunction before antidepressant therapy in major depression.  J Affect Disorder. 1999;  56 201-208
  • 25 Knegtering H, Boks M, Blijd C, Castelein S, van den Bosch RJ, Wiersma D. A randomized open-label comparison of the impact of olanzapine versus risperidone on sexual functioning.  J Sex Marital Ther. 2006;  32 ((4)) 315-326
  • 26 Kühn KU, Westheide J. Pharmakoinduzierte Sexualstörungen. In: Linden M, Walter W. Rehabilitationspsychopharmakotherapie. Köln: Deutscher Ärzte Verlag 2005: 337-354
  • 27 Kühn KU, Sträter B. Depression als komorbide Störung bei somatischen und anderen neuropsychiatrischen Erkrankungen - Störungen der Sexualfunktion am Beispiel der erektilen Dysfunktion. In: Müller W, Volz H. Depression als komorbide Störung. Neu-Isenburg: LinguaMed 2005
  • 28 Landen M, Högberg P, Thase E. Incidence of sexual side effects in refractory depression during treatment with citalopram or paroxetin.  J Clin Psychopharmacology. 2005;  66 100-106
  • 29 Linka T, Dittmann-Balcar A, Grohmann R, Bender S. Assessment of sexual dysfunctions in schizophrenic inpatients with the AMSP drug safety program.  Schizophrenia Research. 2003;  , (Suppl 1) 361-362
  • 30 Mathew RJ, Weinman ML. Sexual dysfunctions in depression.  Archives of Sexual Behavior. 1982;  11 ((4)) 323-328
  • 31 Montejo AL, Llorca GL, Izquierdo JA, Rico-Villadermos F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective muliticenter study of 1022 outpatients.  J Clin Psychiatry. 2001;  62 ((Suppl. 3)) 10-21
  • 32 Montejo Gonzalez AL, Rico-Villademoros F, Tafalla M, Majadas S. Spanish working group for the study of psychotropic-related sexual dysfunction. A 6-month prospective observational study on the effects of quetiapine on sexual functioning.  J Clin Psychopharmacol.. 2005;  25 ((6)) 533-538
  • 33 Patterson WM. Fluoxetine-induced sexual dysfunction.  J Clin Psychiatry. 1993;  54 71
  • 34 Robinson DS, Roberts DL, Smith JM. et al . The safety profile of nefazodone.  J Clin Psychiatry. 1996;  57 ((Suppl 2)) 31-38
  • 35 Shen WW, Hsu JH. Female sexual side effects associated with selective serotonin reuptake inhibitors: a descriptive clinical study of 33 patients.  Int J Psychiatry Med. 1995;  25 239-248
  • 36 Stimmel GL, Gutierrez MA. Pharmacologic treatment strategies for sexual dysfunction in patients with epilepsy and depression.  CNS Spectr. 2006;  11 ((8 Suppl 9)) 31-37
  • 37 Teusch L, Scherbaum N, Böhme H, Bender S, Eschmann-Mehl G, Gastpar M. Different patterns of sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment - results of an investigation with a semi-structured interview with schizophrenic and neurotic patients and methadone-substituted opiate addicts.  Pharmacopsychiatry. 1995;  28 84-92
  • 38 Thase ME, Clayton AH, Haight BR, Thompson AH, Modell JG, Johnston JA. A double-blind comparison between Bupropion XL and Venlafaxine XR: sexual functioning, antidepressant efficacy and tolerability.  J Clin Psychopharmacol. 2006;  26 ((05)) 482-488
  • 39 Taylor MJ. Strategies for managing antidepressant-induced sexual dysfunction: a review.  Curr Psychiatry Rep. 2006;  8 ((6)) 431-436
  • 40 Taylor MJ, Rudkin L, Hawton K. Strategies for managing antidepressant-induced sexual dysfunction: systematic review of randomised controlled trials.  J Affect Disord.. 2005;  88 ((3)) 241-254
  • 41 Waldinger MD, Zwindermann A, Olivier B. Antidepressants and ejaculation: a double-blind, randomized, fixed-dose study with mirtazapine and paroxetine.  J Clin Psychopharmacol. 2003;  23 467-470
  • 42 Weig W. Die Rolle von Psychiatrie und Psychotherapie in der Sexualmedizin nach der Markteinführung von Viagra®.  Nervenarzt. 2000;  71 218-221
  • 43 Weig W. Sexuelle Funktionsstörungen aus nervenärztlicher Perspektive.  Nervenarzt. 2006;  77 101-109
  • 44 Werneke U, Northey S, Bhugra D. Antidepressants and sexual dysfunction.  Acta Psychiatr Scand. 2006;  114 ((6)) 384-397
  • 45 Williams VS, Baldwin DS, Hogue SL, Fehnel SE, Hollis KA, Edin HM. Estimating the prevalence and impact of antidepressant-induced sexual dysfunction in 2 European countries: a cross-sectional patient survey.  J Clin Psychiatry. 2006;  67 ((2)) 204-210
  • 46 Wolfsberger M, Greil W. Galactorrhea during treatment with Trimipramine.  Pharmacopsychiatry. 2005;  38 326-327
  • 47 Zajecka J. Strategies for treatment of antidepressant-related sexual dysfunction.  J Clin Psychiatry. 2001;  62 ((Suppl. 3)) 35-43


(Informative) translation of the

“Essener Fragebogen zu Sexualstörungen”


Have you noticed any changes concerning your sexuality? yes/no

If you did, was it more an improvement/or an impairment?

When did you become aware of these changes?

not applicable/recently/a few weeks ago/a few months ago /a few years ago

In which situations did you become aware of these sexual changes?

not applicable/during sexual intercourse/during masturbation/during sexual fantasies

Libido (sexual interest and desire)

Have you noticed a decrease in or loss of your sexual desire (libido)? yes/no

Scale of changes: unimportant=1-2-3-4-5-6=very important

Physiological arousal

Have you noticed an impairment of your physical sexual arousal?

Questionnaire for men: e.g., of the erection of your penis? yes/no

Questionnaire for women: e.g., of the lubrication of your vagina? yes/no

Scale of changes: unimportant=1-2-3-4-5-6=very important

Physical Orgasm

Have you noticed an impairment of your physical reactions at orgasm?

Questionnaire for men: e.g., of the ejaculation? yes/no

Questionnaire for women: e.g., of rhythmic, pelvic contractions? yes/no

Scale of changes: unimportant=1-2-3-4-5-6=very important


Have you noticed an impairment or loss of your emotional satisfaction during orgasm? yes/no

Scale of changes: unimportant=1-2-3-4-5-6=very important

Alterations of your body

Did you observe an alteration of your genitals? yes/no

Did you feel pain during sexual activities? yes/no

Are you suffering from galactorrhea (milk secretions/flow from your breast)? yes/no

Do you assume a causal connection between some of the following items and the changes of your sexuality?

Relationship conflicts? yes/no

Physical disease? yes/no

Stress? yes/no

Lack of a partner? yes/no

Mental illness? yes/no

Age? yes/no

Finally two questions for statistical information:

Age ___ years

Sex male/female

Following are items to be answered by the responsible physician:
Psychiatric diagnoses according to ICD10:
Somatic diagnoses according to ICD10:
Medication (agent and dosage):


S. Cohen

Department of Psychiatry and Psychotherapy

Rheinische Kliniken Duesseldorf

Heinrich-Heine-University Duesseldorf

Bergische Landstrasse 2

40629 Düsseldorf


T. J. Huber

Department of Clinical

Psychiatry and Psychotherapy

Medical School Hannover

Carl-Neuberg-Strasse 1

30625 Hannover