Research Explores the Latest in Sex and Psychiatry

Sex – and by extension gender – have been integral to psychiatry even before Sigmund Freud. More than a century later, we’re still struggling to better understand issues such as sexual dysfunction, gender differences, and even desire.

Just this summer:

• A study – appearing in two separate journals – revealed a link between ginger consumption and elevated sexual desire and more frequent sexual behaviors. 
• Another recent paper, appearing in the Journal of Neuroscience, exposed gender variations in molecular mechanisms affecting reward-related behaviors. The results point to implications for treating a variety of disorders while highlighting a gender-specific research gap created by historical biases.
• On the less academic side, Talker Research online survey shows that nearly half of Gen Z viewers confess to bailing on a movie after a sex scene – more than any other generation.

The Primary Care Companion for CNS Disorders has published a wealth of information just this year. This week, we’re presenting summaries of three of the more recent pieces we’ve published – along with links – for further review.

Sexual Dysfunction Study Shows Complex Factors at Play

In a bid to build a “psychobiosocial model” for treating sexual dysfunction (SD) – factoring in psychological, social, and biological aspects – researchers in Lebanon launched a study to explore the association between SD and psychological/behavioral factors and coping skills.

The researchers split participants into three different groups based on eating attitudes, anxiety, depression, and mindfulness. Researchers noted the historical link between SD and older adults, but they added that young adults also face similar risks.

The team found that the Lebanese citizens they surveyed – indicative of the wider population – showed a strong distaste for discussing mental illness and sex. Nevertheless, the authors included more than 360 sexually active university students from various parts of the country.

The results indicated a strong tie between older participants and higher mindfulness and higher sexual arousal. Other findings include:

• Women and anyone with “moderate or negative well-being” showed significantly lower sexual arousal.
• Integrating mindfulness into therapeutic practices can benefit patients with SD.
• Awareness campaigns are crucial to address and destigmatize sexual health issues.

In the end, the study hinted that integrating mindfulness into therapy could benefit patients with SD. The study’s authors also identified cultural factors – such as attitudes toward discussing sexual health – as significant influences on SD.

Finally, the researchers argued that future research should consider varied gender identities and more comprehensive assessments of factors related to SD.

Naltrexone Shows Promise in Treating Compulsive Sexual Behavior in OCD Patients

The ICD-11 classifies compulsive sexual behavior disorder (CSBD) as an impulse control disorder. Notably, it doesn’t fall within the obsessive-compulsive (OCD) spectrum. The DSM-5’s classification of CSBD remains murky.

Studies have shown that the co-occurrence of CSBD with OCD is significant, with an estimated OCD rate in CSBD patients at 5 percent to 14 percent and CSBD rate in OCD patients at around 5 percent to 7 percent.

Research also points to positive outcomes for naltrexone in treating CSBD, though its success in alleviating OCD symptoms is limited. This report, published earlier this year, discusses a unique case involving a 58-year-old man diagnosed with OCD and CSBD, treated with sertraline and naltrexone.

The patient had a history of moderate OCD, characterized by contamination-based obsessions, checking behaviors, and intrusive thoughts. The patient also had a CSBD diagnosis, primarily excessive pornography viewing and masturbation, which hampered his daily life. Initially treated with sertraline 100 mg, his doctor later increased the dosage to 150 mg. His OCD symptoms improved from moderate to mild/subclinical. But his CSBD symptoms persisted.

In July 2020, the patient started taking 50 mg of naltrexone daily, leading to a significant improvement in his CSBD symptoms. The patient reported a reduced compulsive desire and better control over his behaviors. Although he experienced fatigue and temporarily stopped naltrexone, the return of CSBD symptoms led him to resume the medication, which (again) improved his condition.

This case highlights that sertraline effectively treated OCD but not CSBD.

Naltrexone, however, significantly improved CSBD symptoms without affecting his OCD. The patient’s discontinuation and resumption of naltrexone demonstrated the drug’s impact on CSBD, suggesting its potential in treating such disorders.

The case also raises considerations about classifying dysfunctional sexual behaviors, as the patient’s CSBD, unlike typical OCD compulsions, involved some pleasure, was distressing, and responded differently to treatments, aligning more with impulse control or possibly addictive disorders.

SSRI-Induced Sexual Dysfunction Remains a Challenge

SD persists as a common side effect of selective serotonin reuptake inhibitors (SSRIs).

In a letter to PCC,  a reader discusses research that shows – among those taking SSRIs – women are more at risk. Overall it affects anywhere between a quarter to two-thirds of depression patients.

This typically manifests as anorgasmia and can vary widely based on the SSRI, with fluvoxamine and escitalopram causing fewer issues than paroxetine. Researchers attribute the dysfunction to enhanced serotonin neurotransmission in specific brain regions. Genetic factors such as 5-HT receptor polymorphisms could also play a role.

While SSRI-induced SD usually persists during medication use, it can occasionally continue after discontinuation, leading to post-SSRI sexual dysfunction (PSSD) and persistent genital arousal disorder (PGAD).

PSSD includes symptoms like genital anesthesia, weak orgasms, decreased sexual drive, erectile dysfunction in males, and reduced vaginal lubrication and nipple sensitivity in females. Potential mechanisms for PSSD involve epigenetic changes, persistent serotonin receptor downregulation, neurohormonal alterations, serotonin toxicity, and ion channel transduction abnormalities. Treatment options, although limited, include serotonergic antagonists, dopaminomimetics, and low-power laser therapy for penile anesthesia.

PGAD primarily affects women and is characterized by continuous sexual arousal without desire. It’s also marked by symptoms such as genital throbbing, contractions, and pain. Triggers can include physical stimulation and stress.

Potential causes range from mood disorders and pudendal neuropathy to SSRI withdrawal.

Potentially effective treatments include quetiapine and varenicline.

Finally, the reader insists that despite the lack of clear diagnostic criteria or treatment guidelines, clinicians should consider these syndromes when addressing psychotropic-related sexual dysfunctions.