Sexual dysfunction in anxiety disorders

Background. Anxiety disorders, being one of the widespread mental illnesses, are often accompanied by sexual dysfunctions. In turn, pharmacotherapy used in the treatment of affective disorders can lead to adverse sexual disorders. Only a small proportion of patients report having problems in the intimate sphere when seeking psychiatric help. However, untimely detection of sexual dysfunctions can reduce adherence and effectiveness of therapy.

Materials and methods. The article is devoted to a review based on 21 sources, of which 9 are systematic reviews, as well as other studies. The data was searched by names, annotations and keywords: sexual dysfunction, anxiety and stress disorder (sexual dysfunction, anxiety and stress disorder) in the databases Elibrary and PubMed.

Results. In anxiety disorders, sexual dysfunctions are observed in both men and women and are manifested by violations of all phases of sexual reactions. The relationship of sexual dysfunction with anxiety disorders is explained by three models: the first, which includes causal relationships, suggests that the correlation between sexual dysfunction and anxiety disorders is often bidirectional, and the symptoms of sexual and anxiety disorders can manifest simultaneously; The second model assumes the presence of a common underlying factor, or hidden predisposition, causing the development of both mental and sexual disorders over time; the third model conceptualizes sexual dysfunctions as disorders unrelated to anxiety disorders.

Conclusion. Based on the conducted research, the authors recommended the following algorithm for the supervision of patients suffering from anxiety disorders and sexual disorders: at the stage of seeking psychiatric help, along with standard diagnostic methods to determine the severity of mental pathology, it is advisable to use questionnaires to assess sexual function. In addition, the possible negative effect of pharmacotherapy on sexual function should be taken into account and evaluated at all stages of treatment in order to carry out timely correction. If sexual disorders are detected in patients with anxiety disorders, taking into account the clinical situation, psychotropic drugs with no or minimal negative effect on sexual function are prescribed, if possible. In cases where it is impossible to use such drugs, after achieving correction of anxiety symptoms, the doses of psychotropic drugs used may be reduced, interruptions in their intake, mainly 1-2 days before the alleged sexual contact. If sexual disorders persist, an antidepressant with no effect on sexual function is added to the treatment regimen as an antidote, or drugs for correcting sexual disorders – type 5 phosphodiesterase inhibitors. Psychotherapeutic measures, including sex therapy, are an integral part of the treatment of sexual dysfunctions in patients with anxiety disorders.

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