Prevalence and psychological impact of antidepressant-associated sexual dysfunction: a study from North India

A narrative review on sexual wellbeing and dysfunctions: Research in the past 15 years

Background

Psychosexual health is an important aspect of mental and physical wellbeing. Though Indian culture has a rich history of sexuality, over the years, our population has been reticent in talking about the same. With the advent of technology and new legislations protecting the rights of LGBTQIA population, awareness is also on the rise.

Methods

This review focuses on research published by Indian authors over the past 15 years, with search of databases like PubMed, Scopus, Google Scholar, and Litmaps to include original articles and case reports.

Results

Most studies focus on male sexual dysfunctions. Some emerging research showed promise in female sexual dysfunctions, the elderly, and the LGBTQIA population. The majority of research in sexual health continues to concentrate on dysfunctions, primarily prevalence, associations, or risk factors. Several studies investigated various medical/psychiatric comorbidities associated with sexual dysfunctions. A few studies have explored management strategies as well.

Conclusion

This review highlights the need for a more holistic approach to management to sexual health issues. It further underscores the importance of grassroots-level initiatives working on improving the training of all medical practitioners and postgraduate students, increasing the availability of services for sexual disorders, promoting sexual health research in areas with gaps, and raising awareness in the general population.

Sexual dysfunction, marital relationship, and subjective quality of life among women with schizophrenia: Analytical case-control study

Background

Women with schizophrenia have a high risk of adverse sexual health outcomes. The chronic course of schizophrenia draws attention to assessing the quality of life and marital relationships of patients with schizophrenia. However, there is a crunch of data in the Indian setting. This study aimed to investigate the prevalence of sexual dysfunctions (SDs) and determine the marital relationship and quality of life among women with schizophrenia.

Material and Methods

The study followed an analytical case-control design. The study was conducted at the inpatient psychiatric department of one of the apex tertiary healthcare centers located at the foothills of the Northern Himalayas. The study purposively included 136 participants (68 cases and 68 controls). The control group included healthy women aged 18-45 currently staying with sexual partners. Data were collected using pretested and standardized self-report questionnaires.

Results

The median age of the case group was 36 (interquartile range (IQR), 29-42) years, while that of the control group was 29 (IQR 26-34) years. The prevalence of SD was significantly higher (P = 0.001) in cases (95.3%) than in controls (73.4%). Compared to healthy controls, women with schizophrenia have a significantly higher rate of SD in sexual desire (P = 0.001), getting arousal (P < 0.001), lubrication (P < 0.001), achieving orgasm (P < 0.001), and sexual satisfaction (P < 0.001) (except pain). In addition, the marital relationship was better managed (P < 0.001) in healthy controls compared with cases. The healthy control group significantly expressed a better quality of life in physical (P < 0.001), psychological (P < 0.001), and maintaining social (P < 0.001) relationships (except environment domains). In multivariable logistic regression analysis, employment status significantly predicted SDs (odds ratio (OR), 25.78; 95% confidence interval (CI), 2.09, 318.10; P < 0.05) in participants.

Conclusion

The prevalence of SD is significantly high among female participants. Hence, treating physicians should pay attention to sexual function during the screening and treatment of patients with schizophrenia.

Prevalence of Sexual Dysfunction in Women With Depression: Need for Psychosexual Health Promotion Approach

Introduction:

Depression-associated sexual dysfunction (SD) is a pervasive and ignorant problem among the general population. The antidepressant used to treat depression may further alter the sexual response cycle in one way or another. This study aims to assess the prevalence of SD in females with major depressive disorders and the effects of antidepressant therapy after 4 weeks of follow-ups.

Material and Methods:

In a prospective observational survey, 94 women diagnosed with depression and on antidepressant therapy were purposively enrolled. Female Sexual Functioning Index (FSFI) and Montgomery-Asberg Depression Rating Scale (MADRS) are administered at baseline and 4 weeks of treatment to measure sexual function and depression changes. Relevant descriptive and inferential statistics are applied to compute the results.

Results:

The mean age of the participants was 35.87 (±5.10) years. A total of 95.7% of participants showed SD at baseline assessment. There was a significant difference (31.87 vs 18.51, P < .001) in depression from baselines to 4 weeks after antidepressant therapy. Further, a significant negative correlation was reported between the MADRS scores and the scores of arousals (r = −0.396, P < .001), lubrication (r = −0.453, P < .001), orgasm (r = −0.342, P < .001), satisfaction (r = −0.407, P < .001), pain (r = −0.362, P < .001), and total domains of FSFI (r = −0.412, P < .001) after 4 weeks. Using cut-off scores of different areas, decreased sexual desire was reported in 97.9%, poor vaginal lubrication (100%), a problem with arousal (100%), reduced satisfaction (96.8%), reduced ability to achieve orgasm (100%), and pain during sexual intercourse in 100% of the participants.

Conclusions:

There is a high prevalence of SD in women with depression. There is a marked improvement in depression at the end of 4 weeks. However, sexual function status remains unchanged and indicates the need for time to improve, suggesting different study designs.

Human Chorionic Gonadotrophin (hCG) Trigger-Mediated Ovulation Induction in Infertility Management in South Indian Women Undergoing IVF/ICSI Regimens: A Pilot Sexual Medicine Study with Public Health Perspective

Introduction:

Infertility is a global public health problem; cost-effective patient-friendly treatment modalities along with psychosexual intervention strategies are essential for infertility control/prevention/management among ethnically disparate populations.

Objectives:

This study aimed to assess differential in vitro fertilization (IVF) success trends among infertile women of South Indian ethnicity.

Materials and Methods:

Prospective, observational study designed in a hospital-based setting with active enrollment of infertile women undergoing IVF/intracytoplasmic sperm injection (ICSI) at Indira IVF Center, Chennai, Tamil Nadu, India (April-September 2019); inclusion criteria: age >35 years, South Indian ethnicity, married >1 year, absence of full-term clinical pregnancy, endometrial thickness <6 mm/thin endometrium; exclusion criteria: prior ≥2 IVF failures, fibroids/adenomyosis/cervical cancer/endometriosis. IVF success was determined by evaluating total frozen embryos transferred/month, average oocyte yield/donor, oocyte quality, M-II oocytes, biochemical/clinical pregnancy (beta-human chorionic gonadotropin positivity/fetal cardiac activity). Mycobacterium tuberculosis positivity was assessed by GeneXpert polymerase chain reaction-based technology, and psychosexual intervention-incorporated marital relationship counseling sessions/therapy, referrals for psychiatric assessments (cognitive impairment/schizophrenia/depression). Written informed consent of participants was taken and study was approved by Institutional Review Board.

Results:

Mean age and endometrial thickness of study participants were 33.3 years (SD ±1.9) and 8.7 mm (SD ±0.5), respectively; average Body Mass Index (BMI) and anti-müllerian hormone (AMH) levels were 28.4 kg/m2 and 4.7 ng/mL, respectively. Embryos transferred/month: 7 in April/13 in May/24 in June/36 in July/24 in August/30 in September, and pregnancies: 4/8/17/26/20/22 for the months of April, May, June, July, August, and September 2019, respectively. Subgroup stratification demonstrated M-II vs total oocytes retrieved were 76%, 73%, 60%, 71%, 77%, and 77%. Overall IVF success rates were 57% in April/62% in May/71% in June/72% in July/83% in August/73% in September; frozen embryo transfer success was 0 in April-May/67% in June/73% in July/89% in August/100% in September 2019. English/Tamil-speaking infertile women self-reported treatment-related satisfaction rates of 80% to 100%.

Conclusion:

M-II oocytes’ yield, sociodemographics of infertile women, and increasing age/aberrant AMH/BMI profiles/endometrial receptivity/diminished ovarian reserve are promising predictors of IVF/ICSI success in genetically distinct patient population subset(s). Future multicentric gene epidemiology studies with larger sample size and precision-based psychiatric assessments/interventions are warranted for development of predictive biomarkers in infertility management.

Prevalence and Type of Sexual Dysfunction in Female Patients Receiving Antidepressant Medications

Aim: To assess the prevalence and typology of sexual dysfunction in female patients receiving antidepressant medications using the Arizona Sexual Experience Scale (ASEX).

Method: A cross-sectional design was employed. A total of 71 married women with various psychiatric disorders receiving antidepressants for at least 3 months’ were evaluated on ASEX, Brief Adherence Rating Scale, Medication Adherence Questionnaire, and Global Assessment of Functioning (GAF) scale. Subjects with a history of sexual dysfunction prior to psychotropic intake, menopause, severe interpersonal relationship problems with spouse, or chronic medical illness were excluded.

Results: The study sample had the mean age of 37.35 (SD: 6.82) years. More than four-fifth (80.2%) of patients had sexual dysfunction as per the ASEX. Using a cutoff score of 4 or more to define sexual dysfunction in various domains, decreased desire was seen in 81.7%, reduced arousal was seen in 80.3%, poor vaginal lubrication was seen in 76.1%, reduced satisfaction was seen in 57.7%, and reduced ability to reach orgasm was seen in 50.7%. Despite this, few patients (13.3%) discussed their sexual dysfunction with their treating psychiatrist. Sexual dysfunction did not influence the medication adherence.

Conclusions: Sexual dysfunction is quite prevalent in female patients receiving antidepressant medications; however, this is not adequately discussed by the patient or the treating psychiatrist.

Sexual Disorders: Progress Made and Way Ahead

Although sexuality has a long history in the Indian literature, it is not discussed openly due to various reasons. Although sexual medicine has seen a reasonable growth in the last 70 years, somehow, psychological factors associated with the development of various sexual dysfunctions have not received due importance. Cultural factors which contribute to development and persistence of sexual disorders have not been evaluated properly. In terms of training, there is a wide variation across different centers in this country. There are very few indigenously designed instruments for the assessment of sexual disorders and there is limited data on well-evaluated indigenously designed interventions for the management of various sexual disorders. There is a need to homogenize the training and liaise with other specialists working in this area. Centers with well-developed services for sexual disorders need to start observerships and postdoctoral fellowship programs to train the interested clinicians. There is a need for multicentric studies to generate national-level data.

A comparative study evaluating the marital and sexual functioning in patients with schizophrenia and depressive disorders

AIM

To assess marital functioning, quality of marriage, marital forgiveness, sexual dysfunction and sexual satisfaction among patients with schizophrenia and their spouses and compare the same with patients with depressive disorder and their spouses.

METHODOLOGY

76 married patients with schizophrenia and 58 married patients with depressive disorders were assessed on Dyadic Adjustment Scale (DAS), Quality Marriage Index (QMI), Marital Forgiveness Scale (MOFS), Arizona Sexual Experience Questionnaire (ASEX) and New Sexual Satisfaction Scale (NSSS).

RESULTS

Compared to patients with depressive disorder, patients with schizophrenia reported poor marital adjustment (in the consensus and satisfaction domains of DAS) and poor quality of marriage. Compared to patients with depressive disorder, patients with schizophrenia reported significantly lower sexual satisfaction. There was no difference in the prevalence of sexual dysfunction between the groups. Poor marital adjustment in patients with schizophrenia was associated with lower sexual satisfaction but not with sexual dysfunction.

CONCLUSION

Present study suggests that marital adjustment and sexual satisfaction is more impaired in schizophrenia, when compared with depressive disorders.

Evaluation of sexual dysfunction and quality of life in patients with severe mental illness: A cross-sectional study from a tertiary care center in Chhattisgarh

BACKGROUND

Sexual dysfunctions (SDs) are common and lead to psychological distress and impair quality of life (QOL). However, little attention has been paid to explore SD in severe mental illnesses (SMIs). Hence, this study aimed to evaluate the occurrence of SD and its impact on the QOL in persons suffering from schizophrenia, bipolar disorder, and depression and compare it with healthy controls.

MATERIALS AND METHODS

In this cross-sectional study, 79 clinically stable patients and 50 healthy controls underwent evaluation for SD on the Arizona Sexual Experience Scale, and their QOL was measured using the WHO QOL-BREF scale. Chi-square test was used for the categorical variables, whereas comparison of continuous variables was done by t-test with post hoc corrections.

RESULTS

Compared to healthy controls, patients with depression had significantly higher rates of SD in the domain of obtaining penile erection (P = 0.019), ability to reach orgasm (P = 0.03), and satisfaction from orgasm (P = 0.01). Patients with schizophrenia had higher rates of problems in achieving arousal (P < 0.01), penile erection (P = 0.03), and satisfaction from orgasm (P = 0.03), whereas those with bipolar disorder only differed significantly on the domain of ability to reach orgasm (P = 0.03). However, patients fared better than the controls on various domains of QOL (except social domain).

CONCLUSION

A significant number of patients with SMI suffer from SD. Hence, it should be made a routine practice to evaluate and address the problem of SDs in patients with SMI.

Enhancing the Relationship Adjustment of South Asian Canadian Couples Using a Systemic-Constructivist Approach to Couple Therapy

The effectiveness of systemic-constructivist couple therapy (SCCT) in improving the relationship adjustment of South Asian Canadian couples in ways that attend to their culture was evaluated. The SCCT interventions engage partners in reflexive processing of both their own and their partner's ways of construing, and the reciprocity between these two. A core change mechanism of SCCT, couple identity ("we-ness"), that connotes the ability for thinking and experiencing relationally, was coded from verbatim transcripts of partners' within-session dialogue. As predicted, South Asian partners' relationship adjustment improved significantly from the first to final session of SCCT, and concurrent increases in each partner's couple identity mediated such improvements. The implications for considering culture and couple identity in couple therapy are discussed. Video Abstract is found in the online version of the article.

Validation of sexual functioning questionnaire in Indian patients

OBJECTIVE

To establish norms for sexual functioning questionnaire (SFQ) in Indian population.

MATERIALS AND METHODS

100 male subjects, diagnosed with depressive disorder and currently in a state of clinical remission for a period of at least 4 weeks were evaluated on SFQ and Arizona Sexual Experience Questionnaire (ASEX).

RESULT

By using receiver operating characteristics (ROC) curves a score of 14 was considered to be a cutoff for sexual dysfunction as per SFQ. This cutoff yielded a sensitivity of 91.7% and specificity of 86.4% for the detection of sexual dysfunction. The PPV of the instrument at this cutoff was 87%.

CONCLUSION

A cutoff of 14 should be used to define sexual dysfunction as per SFQ.

Sexual dysfunction in clinically stable patients with bipolar disorder receiving lithium

There is limited data on the prevalence of sexual dysfunction in patients with bipolar disorder receiving lithium. This study aimed to evaluate the prevalence of sexual dysfunction in patients with bipolar disorder receiving lithium and to study the correlates of sexual dysfunction. One hundred clinically stable patients with bipolar disorder (Global Assessment for Functioning score of >70, Hamilton Depression Rating Scale score of ≤7 and Young Mania Rating Scale score of ≤7, and no change in medications at least in the last 3 months) receiving lithium were evaluated on Arizona Sexual Experience Scale and Brief Adherence Rating Scale. The mean age of study sample was 44.3 years. The mean Hamilton Depression Rating Scale score was 1.06 (SD, 1.7) and the mean Young Mania Rating Scale score was 0.1 (SD, 0.5) and the mean Global Assessment for Functioning scale score was 84 (SD, 6.0). The mean duration of lithium use was approximately 119.62 (SD, 99.6) months, and the mean dose of lithium was 799.5 (SD, 251.4) mg/d. Of the 100 patients, approximately one third of the patients (n = 37) were found to have sexual dysfunction as per Arizona Sexual Experience Scale. Compared with those without sexual dysfunction, those with sexual dysfunction were older (t value = 3; P = 0.003). Those with sexual dysfunction had lower level of functioning (Global level of functioning score of 81.7 vs 85.5; t value = 3.2; P = 0.002), higher number of other adverse effects with lithium (total number of other adverse effects, 2.9 vs 1.4; t value = 4.2; P < 0.001), and poor medication compliance. To conclude, the present study suggests that approximately one third of the patients receiving lithium experience sexual dysfunction, and it is associated with poor medication adherence.

Prevalence and pattern of sexual dysfunction in married females receiving antidepressants: An exploratory study

Objective:

To study the prevalence and patterns of sexual dysfunctions in female patients receiving antidepressants.

Materials and Methods:

Eighty married female patients with a diagnosis of depressive disorder, currently in remission, and receiving a single antidepressant at least for 3 months, were assessed for sexual dysfunction on female sexual function index (FSFI) scale.

Results:

Thirty four patients (42.5%) receiving antidepressants had FSFI score less than 26.55 and were considered to have sexual dysfunction. When only the domain cutoff scores were used for the whole study sample (n=80), it was found that 95% had decreased desire, 60% had decreased arousal, 37.5% had decreased lubrication, 63.8 had decreased orgasm, 55% had decreased satisfaction and 25% had pain during sexual activity.

Conclusions:

To conclude, our study suggests that sexual dysfunction is quite prevalent in married female patients receiving antidepressants and all the domains of sexual functioning are impaired by antidepressants.

Marital adjustment and depressive symptoms in Korean Americans

The purpose of this study was to explore the relationship between the quality of marital adjustment and depressive symptoms in Korean American couples. Fifty-three wives and 19 husbands reported on the Dyadic Adjustment Scale and the Center for Epidemiologic Studies for Depression Scale. Results from linear regression indicated a negative relationship between marital adjustment and depressive symptoms at a significant level for wives and near significant for husbands. The model explained 15% of the variance in wives' depressive symptoms. The negative impact of marital adjustment on depressive symptoms indicates that Korean American couples' marital adjustments need to be addressed.