Stigma and Addiction Severity Tied to Sexual Dysfunction in Men Recovering from Opioid Use Disorder

Sexual dysfunction is one of the least discussed consequences of opioid addiction, yet it may shape recovery in profound ways. A new cross-sectional study published in BMC Psychiatry by Shukrullah Niazi and colleagues examined how stigma, self-esteem, and addiction severity relate to sexual functioning in men with opioid use disorder (OUD) who had achieved at least three months of remission while receiving buprenorphine–naloxone treatment. The findings paint a nuanced picture: stigma and addiction severity were consistently linked to worse sexual outcomes, but the researchers’ hypothesized role of self-esteem as a protective mediator did not hold up under statistical scrutiny.

The research team recruited 104 male patients who met DSM-5 criteria for opioid use disorder and were in sustained remission on medication. Each participant completed a battery of validated instruments: the Addiction Profile Index (API) to measure addiction severity, the Rosenberg Self-Esteem Scale (RSES) to assess global self-worth, the Substance Use Stigma Mechanism Scale (SU-SMS) to capture both anticipated and internalized stigma, the Arizona Sexual Experiences Scale (ASEX) as a screening tool, and the Golombok–Rust Sexual Satisfaction Inventory (GRISS) for a detailed multidimensional profile of sexual function and satisfaction. Sexual dysfunction was defined using established ASEX cut-off scores, giving the study a clear, clinically anchored endpoint rather than relying solely on continuous scores.

The headline number is striking: 36.5 percent of the men—38 out of 104—met criteria for sexual dysfunction. That is a substantial burden in a group that was, by definition, clinically stable and in remission, suggesting that sexual health problems persist well beyond acute withdrawal and may be an underrecognized feature of long-term recovery from opioid dependence. Opioids are well known to suppress the hypothalamic–pituitary–gonadal axis, lowering testosterone and dampening libido, but this study shifts attention toward psychological and social mechanisms that operate alongside these biological effects.

When the researchers compared patients with and without sexual dysfunction, most expected differences failed to materialize. Sociodemographic variables showed no significant associations except for income level, where patients with dysfunction differed from those without (p = .025). Perhaps more surprising, scores on the Addiction Profile Index and the Rosenberg Self-Esteem Scale did not differ significantly between the two groups when compared directly. This pattern hinted that sexual dysfunction in this population is not simply a marker of more severe, more visible illness, but something that cuts across the clinical picture in subtler ways.

Correlation analyses told a richer story. Higher API scores—indicating greater addiction severity—were positively associated with the GRISS total score and with subscales measuring difficulties with touching, avoidance, and satisfaction. In other words, men whose addiction was more severe reported more avoidance of intimacy, less satisfaction, and greater overall sexual difficulty. Anticipated stigma, the fear of being judged or discriminated against because of one’s substance use history, and internalized stigma, the shame a person absorbs and turns inward, were both positively correlated with several GRISS subscales and with ASEX scores. The direction of these associations is intuitive but clinically important: the more a man expects rejection or carries internalized shame about his addiction, the more his sexual functioning suffers.

To test whether these correlations reflected independent effects, the team ran multiple linear regression models. The model predicting the GRISS total score was statistically significant as a whole, although no individual predictor reached significance on its own—a signal that stigma, addiction severity, and related variables likely contribute jointly rather than in isolation. The picture sharpened for the satisfaction subscale: that model was significant, and the API total score emerged as an independent predictor of sexual satisfaction. Addiction severity, in other words, left its clearest fingerprint on how satisfied men felt with their sexual lives, even after accounting for stigma and self-esteem.

The most theoretically ambitious part of the study was its mediation analysis. The authors hypothesized that internalized stigma might erode self-esteem, and that damaged self-esteem might in turn drive sexual dysfunction—a plausible psychological cascade that has support in other stigmatized health conditions. The data did not support it. Self-esteem did not mediate the relationship between internalized stigma and sexual dysfunction in this sample. However, within that same model, addiction severity remained significantly associated with the GRISS total score, reinforcing the idea that the burden of addiction itself, rather than its psychological downstream effects on self-worth, is the more robust correlate of sexual problems in men recovering from OUD.

Why might self-esteem fail as the explanatory bridge? One possibility is measurement and range: the Rosenberg scale captures global self-worth, whereas the mechanisms linking stigma to sexual function may be more specific—performance anxiety, fear of intimacy, relational insecurity, or hypogonadism-related physiological changes that stigma merely amplifies. Another possibility is that in a remitted, medicated sample, self-esteem has partially rebounded while stigma and the neuroendocrine legacy of opioid exposure persist. Cross-sectional designs also cannot establish directionality: sexual dysfunction may itself fuel shame and perceived stigma, reversing the presumed causal arrow. The authors are appropriately cautious, noting that the independent predictive effects they observed were modest.

The clinical implications are nonetheless concrete. Men receiving medication for opioid use disorder are rarely asked about sexual health in routine psychiatric care, yet more than a third of this sample reported clinically significant dysfunction. Because sexual difficulties can undermine intimate relationships, self-image, and treatment retention, the authors argue that routine assessment of sexual functioning, addiction severity, and stigma should be integrated into OUD care. Validated tools such as the ASEX and GRISS make such screening feasible in busy clinics, and identifying stigma as a modifiable psychosocial factor opens the door to targeted interventions, from stigma-reduction psychotherapy to couple-based approaches that address avoidance and dissatisfaction directly.

The study also carries a broader message for how addiction is understood. Stigma is often framed as a barrier to seeking treatment; this work suggests it may also permeate life during treatment, shaping intimacy and satisfaction long after opioid use stops. Anticipated and internalized stigma correlated with sexual difficulties even in men stabilized on buprenorphine–naloxone, implying that recovery programs that address only abstinence and craving may be leaving a significant dimension of quality of life unaddressed. As the authors conclude, greater addiction severity and stigma are linked to more severe sexual dysfunction in men with opioid use disorder, and attending to sexual health, severity, and stigma together may be clinically relevant to durable recovery. For a population already carrying heavy social burdens, that reframing could matter as much as any single statistic.

Subject of Research: The relationship between stigma, self-esteem, addiction severity, and sexual dysfunction in men with opioid use disorder in remission on buprenorphine–naloxone treatment.

Article Title: Examining the relationship between stigma, self-esteem, and sexual dysfunction in patients with opioid use disorder

Article References: Niazi, S., Yazici, A. B., Bardakçı, M. R., Akbulut, K., & Yazici, E. (2026). Examining the relationship between stigma, self-esteem, and sexual dysfunction in patients with opioid use disorder. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08616-7

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08616-7

Keywords: opioid use disorder, sexual dysfunction, stigma, self-esteem, addiction severity, buprenorphine-naloxone, remission, ASEX, GRISS, medication-assisted treatment, psychiatry, men's health