Psychiatric Patients Report Widespread Sexual Dysfunction, Yet Clinicians Rarely Ask

Sexual health is widely recognized as a cornerstone of overall well-being, yet a new pilot study from two German academic psychiatric centers suggests it remains one of the most neglected topics in mental health care. In a cross-sectional anonymous online survey conducted between February and July 2025, researchers at Ludwig-Maximilian-University of Munich and the University of Augsburg found that nearly every psychiatric patient surveyed screened positive for at least one indicator of impaired sexual functioning, while only a small minority reported that a clinician had ever raised the subject during treatment. The findings, published in the Community Mental Health Journal, expose a striking communication gap between patients and mental health professionals and point to insufficient training as a central barrier.

The study recruited 231 patients receiving inpatient or outpatient psychiatric care and 194 mental health professionals, including specialist psychiatrists, residents, psychologists, psychotherapists, psychiatric nurses, and allied therapists. Patients completed validated measures of sexual functioning, psychological well-being, and communication about sexuality, while clinicians answered questions about their attitudes, clinical practice, and professional training. The patient sample was predominantly middle-aged, with affective disorders, somatoform conditions, attention-deficit/hyperactivity disorder, sleep disorders, and post-traumatic stress disorder among the most common diagnoses. Nearly nine in ten patients were taking psychotropic medication, primarily antidepressants and antipsychotics, both of which are well documented to interfere with desire, arousal, orgasm, and satisfaction.

The scale of sexual dysfunction reported by patients was remarkable. Using the German version of the Sexual Behaviour Questionnaire, which assesses desire, arousal, orgasm, and satisfaction over the preceding three months, 100 percent of women and 97 percent of men screened positive for at least one indicator of impaired sexual functioning. Yet only 18.7 percent of patients described themselves as sexually satisfied. Almost half reported no sexual activity at all during the previous three months, and 87 percent scored below the clinical cut-off on the WHO-5 Well-Being Index, indicating reduced psychological well-being. The authors caution that the instrument uses a low threshold and may capture mild or transient impairments, and that self-selection effects may have inflated the figures, but they argue the pattern is consistent with prior research showing markedly elevated rates of sexual dysfunction in psychiatric populations compared with the general population.

The epidemiological backdrop makes the findings more consequential. In the representative German GeSiD study, about a third of men and nearly half of women reported at least one sexual problem in the past year, and roughly 13 percent of men and 17 percent of women met ICD-11 criteria for a distressing sexual dysfunction. Among people with psychiatric disorders, prevalence estimates climb dramatically, ranging from 45 to 93 percent in depressive disorders, 33 to 75 percent in anxiety disorders, around 60 percent in schizophrenia, and 25 to 81 percent in obsessive-compulsive disorder. Psychotropic drugs compound the problem: selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and antipsychotics are all associated with decreased libido, erectile dysfunction, delayed orgasm, and anorgasmia, effects that can undermine treatment adherence, mood, and relationship satisfaction.

Against this clinical backdrop, the survey’s communication data are sobering. Although 62 percent of patients considered sexuality an important topic in psychiatric treatment and 44 percent wanted clinicians to initiate such discussions, only 12.5 percent reported that a clinician had addressed it, and just 19.6 percent had raised the topic themselves. Clinicians, by contrast, reported addressing sexuality far more often: 62.1 percent of specialist psychiatrists and 44 percent of psychotherapists said they actively discussed sexual health, compared with only about a quarter of residents and roughly 10 percent of nursing staff and allied professionals. This mismatch between what clinicians believe they do and what patients report experiencing echoes earlier international research and constitutes what the authors describe as a clinically and ethically relevant communication gap.

Statistical analysis revealed what drives clinicians to engage with the topic. Across all occupational groups, perceived importance of sexual health, confidence in discussing it, viewing sexuality as part of one’s professional role, and years of professional experience all significantly predicted whether clinicians actively addressed sexuality. Among physicians specifically, a multiple regression showed that greater confidence and more years of experience were the significant predictors of actively discussing sexual issues with patients. Notably, perceived adequacy of training did not predict communication behavior, suggesting that formal education is failing to translate into practice and that clinicians rely heavily on experiential learning rather than structured instruction.

The training deficit was perhaps the study’s most consistent finding. More than 80 percent of clinicians reported that sexual health had been insufficiently covered during their education, and fewer than half felt adequately trained or confident in addressing sexual issues. Only a small proportion of physicians recommended pharmacological treatment for sexual dysfunction, with 5.9 percent of residents compared with 55.6 percent of specialists doing so. The authors argue that targeted training emphasizing experiential and communication-based approaches, including role-play, simulated encounters, and supervised practice, could strengthen clinicians’ confidence where curricular content alone has not.

The study also highlights structural and interpersonal dynamics that keep sexuality out of psychiatric consultations. Patients often perceive sexual concerns as sensitive or shameful and expect clinicians to signal openness first, while clinicians cite time constraints, personal discomfort, fear of offending patients, and unclear role boundaries within multidisciplinary teams. The researchers suggest practical remedies: standardized screening items, dedicated documentation fields, supervision that addresses sexual health, and coordinated intake approaches in which designated team members are responsible for specific assessment domains. They also emphasize that clinician-initiated enquiry should be paired with an explicit statement that patients may decline to answer, preserving agency and reducing pressure.

As an exploratory pilot, the study has limitations that the authors acknowledge candidly. The sample was regionally restricted and modest in size, self-selection may have overrepresented patients concerned about sexual issues, and the cross-sectional design precludes causal inference. The Sexual Behaviour Questionnaire, though validated, was primarily evaluated in patients with schizophrenia and offers only binary male and female versions, which may introduce bias for non-binary and intersex individuals. The predominantly female patient sample and the high proportion of patients on antidepressants and antipsychotics likely inflated observed dysfunction prevalence. The authors stress that all findings should be treated as hypothesis-generating rather than confirmatory.

Nevertheless, the central message is clear. Both patients and clinicians regard sexual health as important, yet conversations about it remain rare, largely because clinicians lack confidence and formal preparation. The authors call for future research on the effectiveness of educational programs and their impact on patient engagement, adherence, and therapeutic outcomes, as well as on interpersonal factors such as clinician and patient gender and age. Until then, the study stands as evidence that integrating sexual health into routine psychiatric assessment, through training, screening, and institutional support, is an essential step toward genuinely holistic, patient-centred mental health care.

Subject of Research: Communication about sexual health between psychiatric patients and mental health clinicians, and the training needed to close the gap

Article Title: Sexual Health in Psychiatry: Bridging the Communication Gap and Training Needs between Patients and Clinicians – A Cross-Sectional Exploratory Pilot Study

Article References: Sexual Health in Psychiatry: Bridging the Communication Gap and Training Needs between Patients and Clinicians – A Cross-Sectional Exploratory Pilot Study. (n.d.). https://doi.org/10.1007/s10597-026-01716-4

Image Credits: AI Generated

DOI: 10.1007/s10597-026-01716-4

Keywords: sexual health, psychiatry, sexual dysfunction, patient-clinician communication, mental health care, psychotropic medication, clinician training, medical education, survey study, well-being, antidepressants, stigma