Do we adequately address sexuality in patients with psychotic disorders? Barriers and needs in clinical practice.

INTRODUCTION

Sexuality is a key component of quality of life in psychosis, yet it is rarely addressed in routine clinical practice. Sexual side effects of antipsychotic medication are a common cause of treatment discontinuation, with significant implications for adherence and prognosis.

OBJECTIVES

To explore mental health professionals' experiences in addressing sexuality in psychosis, the difficulties they encounter, and the needs identified to improve clinical care.

METHODS

A mixed-methods design was used. An ad hoc survey was administered to 49 clinicians (psychologists and psychiatrists) from 11 specialized psychosis services across Spain, and a focus group was conducted with five of them. Quantitative data were analyzed using descriptive statistics and group comparison tests, and qualitative data were examined using thematic analysis in Atlas.ti.

RESULTS

A total of 72.7% of clinicians reported receiving no specific training, and 70.5% felt their knowledge was insufficient. Although 93% acknowledged the relevance of sexuality, 87.7% addressed it rarely or never, and 61% did so only if the patient initiated the conversation. Gender, age, cultural and relational biases were identified. The focus group revealed avoidance strategies, the negative impact of clinical silence on the therapeutic relationship, and a lack of resources for comprehensive care.

CONCLUSIONS

There is a clear discrepancy between the perceived relevance of sexuality and its clinical consideration. Lack of training and professional biases limit comprehensive care. Implementing training programs and specific clinical protocols may improve adherence, reduce relapse risk, and enhance quality of life in people with psychosis.