CLINICAL HANDBOOK OF SCHIZOPHRENIA

59. Sexuality 605• Sexual activity of persons with schizophrenia.• Sexual dysfunctions that they experience, including those resulting from side effectsof their long-term use of antipsychotic drugs.• Vulnerability of this population to sexually transmitted diseases.• Psychoeducational programs that have been developed for this population to preventunwanted pregnancies and sexually transmitted diseases.• Development of a Friendship and Intimacy Module designed to teach safe and satisfyingsex to persons with schizophrenia and other mental disabilities.Because mental health professionals have little experience, knowledge, or clinicalcompetence in mounting treatment and education on sex, they are often embarrassed,awkward, and self-conscious when trying to address this topic with their patients in clinicalsettings. Practitioners require special training experiences and self-awareness exercisesif they undertake the important task of teaching individuals with schizophrenia how tomake decisions about sexual relations and to engage in safe and satisfying sex. Therefore,this chapter also contains suggestions about the organization and curriculum for professionaltraining in this area.SEXUAL ACTIVITY OF INDIVIDUALS WITH SCHIZOPHRENIAAlthough limited data are available on sexuality in persons with schizophrenia, a fewstudies have been published in the past decade. For instance, in comparison with representativesamples of non-mentally-ill persons in the United States, men with schizophreniaand mood disorders had approximately the same number of lifetime sexual partners.Both non-mentally-ill and seriously mentally ill males reported three to four times asmany sexual partners as women. In terms of sexual precocity, there were no differencesbetween the mentally ill and non-mentally-ill cohorts. The average age of first reportedsexual intercourse was 16–18 for men and women. It is interesting to note that similarsurveys of physically disabled individuals—such as those with spinal cord injuries—haverevealed a strong interest in sex, sexual activity of various types, and a mature responseto educational programs on sexuality relevant to paraplegics.SEXUAL DYSFUNCTION AFFECTINGPERSONS WITH SCHIZOPHRENIADespite a healthy interest in sex, many people with schizophrenia report a progressive deteriorationof their sexual and sociosexual function beginning in young adulthood,closely paralleling the age of onset of their illness. Indeed, there appears to be a complexyet definite relationship between sexuality and schizophrenia. For example, estrogen, akey hormone for sexual functioning, is lower than normal in females with schizophreniaat the onset of illness. Similarly, lower levels of gonadotropins and testosterone have beenobserved in unmedicated males with schizophrenia. Together these findings suggest thatthese hormonal disturbances contribute to the sexual dysfunction associated with the disorder.Sexual dysfunctions may also result directly or indirectly from symptoms of the disorderand their functional consequences. For example, individuals with schizophreniamay have low self-confidence, few personal relationships, loss of impulse control, andnegative or deficit symptoms, such as lack of interest and loss of pleasure, all of which