Jemds.

com Original Research Article

Proportion of Sexual Dysfunction among Drug Free Patients

Suffering from Anxiety Disorders
Rakesh Gandhi1, Mahesh Suthar2, Rajkumar3, Prashant Mangla4

1Associate Professor, Department of Psychiatry, Medical College and SSG Hospital, Baroda, Gujarat, India. 2Assistant
Professor, Department of Psychiatry, Medical College and SSG Hospital, Baroda, Gujarat, India. 3Resident, Department
of Psychiatry, Medical College and SSG Hospital, Baroda, Gujarat, India. 4Resident, Department of Psychiatry, Medical
College and SSG Hospital, Baroda, Gujarat, India.

ABSTRACT

BACKGROUND
Normal sexual behaviour is influenced by a number of factors, including mental Corresponding Author:
Dr. Mahesh Suthar,
illness and psychotropic drugs which are used for the management of mental illness.
#201, Vivanta Classic,
Anxiety is one of the most important mental illnesses which affects sexual Behind Soham Bunglow,
functioning. The aim of this study was to compare sexual dysfunction in drug free Vasna Road, Vododara-390016,
patients suffering from anxiety disorders with normal healthy controls. Gujarat, India.
E-mail: [email protected]
METHODS
This was a case control study conducted on subjects coming to Psychiatry OPD in DOI: 10.14260/jemds/2019/574
S.S.G. Hospital, Vadodara. Study tools used were DSM-5 Diagnostic Criteria for
Financial or Other Competing Interests:
anxiety disorders, Hamilton Anxiety Rating Scale and Arizona Sexual Experiencing
None.
Scale.
How to Cite This Article:
RESULTS Gandhi R, Suthar M, Rajkumar, et al.
Sexual dysfunction was reported by 65% of patients with anxiety disorders, with Proportion of sexual dysfunction among
most common complain of low desire in both males and females. With increasing drug free patients suffering from anxiety
severity of anxiety disorder, the rate of sexual dysfunction also increased. disorders. J. Evolution Med. Dent. Sci.
2019;8(33):2639-2643, DOI:
10.14260/jemds/2019/574
CONCLUSIONS
Sexual dysfunction occurs in significant amount in patients with anxiety disorders Submission 10-12-2018,
which must be explored in detail during clinical interview and should be advised Peer Review 16-02-2019,
proper management for better outcome of patients. Acceptance 22-02-2019,
Published 26-08-2019.
KEY WORDS
Sexuality, Drug Free, Impotence, Anxiety

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Jemds.com Original Research Article

BACKGROUND impairment in both interpersonal and sexual relationships(14)

and they tend to perceive themselves as less sensual in
comparison to patients with other anxiety disorders.(12) The
Sexual function is a complex area that includes emotions, results are a poor level of sexual pleasure(14) and a strong
perception, self-esteem, complex behaviour and the ability to dissatisfaction with their sexuality (73%).(11)
initiate and complete sexual activity. Important aspects are Post-traumatic stress disorder (PTSD) affects emotional,
the maintenance of sexual interest, the ability to achieve social, professional, and sexual life.(15,16) It is still unclear
arousal, the ability to achieve orgasm and self-esteem. Many whether such populations have normal levels of sexual
factors influence the reported incidence of sexual desire.(17,18) Certainly, these patients have erectile
dysfunction. These include the method of enquiry,(1) the dysfunction (Prevalence of about 69% in combat veterans
expectations people have of their sexual performance and with PTSD) and problems with orgasm, and thus report a
their willingness to discuss problems varies widely between poor level of sexual satisfaction.(17–19)
different cultures,(2) many terms used to define sexual Impairment in sexual function is frequent and
dysfunction are subjective and dependent on ideas of what is underestimated in patients with mental disorders,
normal; and finally, temporal trends can occur as increased particularly in those with anxiety disorders. They are usually
awareness of sexual matters and availability of medical prescribed antidepressant/antianxiety medications, which
treatments increase the numbers who perceive themselves as are known to cause substantial sexual dysfunction. Simply
suffering from sexual dysfunction.(3) exemplifying the dysfunction caused by medications is
Sexual dysfunctions are highly prevalent, affecting about imperfect unless the dysfunction caused by the disease is
43% of women and 31% of men.(4) Hypoactive sexual desire clearly demarcated. Although it is important to study and
disorder has been reported in approximately 30% of women document the effects of antidepressant medication on sexual
and 15% of men in population- based studies, and is functioning, it is equally important to establish a baseline
associated with a wide variety of medical and psychological level of sexual interest and sexual function in such patients
causes. Sexual arousal disorders, including erectile prior to the initiation of treatment with medication.
dysfunction in men and female sexual arousal disorder in We wanted to compare sexual dysfunction in drug free
women, are found in 10% to 20% of men and women, and is patients suffering from anxiety disorders with normal healthy
strongly age-related in men. Orgasmic disorder is relatively controls.
common in women, affecting about 10% to 15% in
community-based studies. In contrast, premature ejaculation
ME T H O D S
is the most common sexual complaint of men, with a
reporting rate of approximately 30% in most studies. Finally,
sexual pain disorders have been reported in 10% to 15% of This was a time bound case control study in which subjects
women and less than 5% of men. In addition to their who fulfilled the inclusion criteria were enrolled
widespread prevalence, sexual dysfunctions have been found consecutively for a period of six months. Both cases and
to impact significantly on interpersonal functioning and controls were taken from Psychiatry outpatient department
overall quality of life in both men and women.(5) Prevalence at S.S.G. Hospital, Vadodara. Cases were new patients coming
of sexual dysfunction in a study was found to be 75% in to Psychiatry outpatient department for consultation and
patients with panic disorder.(6) This was confirmed in diagnosed as having anxiety disorders and who were not on
another retrospective study which evaluated the sexual any kind of medication. Controls were taken from healthy
function and the sexual history of patients with panic relatives of patients. They were matched for age, sex, and
disorder and social phobia. It was also found that sexual marital status. Subjects were enrolled after getting written
aversion disorder is the most common sexual dysfunction in approval from the Institutional Ethics Committee for Human
patients with panic disorder, and that its prevalence in this Research.
population is greater than in the general population.
Furthermore, they also found that sexual aversion was Inclusion Criteria for Cases
secondary to panic disorder. These results were found in 1. Patients coming to Psychiatry outpatient department for
both men and women and suggest that sexual aversion may consultation and diagnosed as anxiety disorders
be part of the agoraphobic spectrum.(7) according to DSM-5.
Studies on sexuality in patients with social phobia show a 2. Aged ≥18 years.
co-morbidity of about 30%. Arousal disorders and orgasm- 3. Gave written informed consent for study.
ejaculation disorders are most common in males with social 4. Did not have history of or concurrent active major
phobia,(8) while some studies have found a high prevalence of medical illness.
premature ejaculation (47%),(7) whereas others found a link 5. Were antianxiety or antidepressant free for a minimum of
with retarded ejaculation (33%).(9) Pleasure and sexual 2 weeks prior to treatment (5 weeks in the case of
satisfaction are impaired in persons with social phobia.(7–10) Fluoxetine).
Women with social phobia are more likely to have
concomitant desire disorders (46%), pain during sex (42%), Exclusion Criteria for Cases
and less frequency of sexual thoughts and sexual 1. Patients with exposure to any psychotropic medication in
intercourse.(8) Sexual dysfunctions have a prevalence of 39% the previous month.
in females with obsessive compulsive disorder (OCD).(11) 2. Patients suffering from illness such as diabetes, severe
Patients may report sexual disgust, the absence of sexual hepatic disease, hypertension or any other disease that
desire, very low sexual arousal, anorgasmia and high may cause sexual dysfunction.
avoidance of sexual intercourse.(12,13) They show severe 3. Patients on any drugs that affect sexual function.

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4. History of other psychiatric illness. No. of Patients with No. of Control
5. Patient who were pregnant or within 2 months of Demographic Variable Anxiety Disorders Subjects (N=180),
(N=180), n (%) n (%)
postpartum period. Age Groups (in Years)
6. Patients having psychotic symptoms. 18-38 105(58.3) 108(60)
39-59 48(26.7) 50(27.7)
≥60 27(15) 22(12.2)
Inclusion Criteria for Controls Age (Median) 35 27
Gender
1. Healthy relatives of patients coming to Psychiatry Male 96(53.3) 100(55.6)
outpatient department. Female 84(46.7) 80(44.4)
Level of Education
2. Aged ≥18 years. Illiterate 12(6.7) 6(3.3)
3. Gave written informed consent for study. Secondary 123(68.3) 124(68.9)
Higher Secondary 33(18.3) 40(22.2)
4. Did not have history of or concurrent active major Graduation 12(6.7) 10(5.6)
medical illness or psychiatric illness. Marital Status
Unmarried 45(25) 44(24.4)
Married 114(63.3) 122(67.8)
Divorced/Separated 15(8.3) 11(6.1)
Exclusion Criteria for Controls Widow 6(3.3) 3(1.7)
1. Those suffering from illness such as diabetes, severe Area
Urban 108(60) 107(59.4)
hepatic disease, hypertension or any other disease that Rural 72(40) 73(40.6)
may cause sexual dysfunction. Table 1. Age, Sex, Education Level, Marital Status and
2. Those suffering from or having history of psychiatric Area-Wise Distribution of the Study Population
illness.
3. Those who were pregnant or within 2 months of Patients with Control
p
Anxiety Disorders N=180
postpartum period. Value
(N=180), n (%) n (%)
Overall sexual dysfunction (ASEX item≥18) 117(65) 35(19.4) 0.0001
Study Tools Sexual dysfunction in males (ASEX item≥18) 51(53.1) 16(16) 0.0001
Sexual dysfunction in females (ASEX item≥18) 66(78.5) 19(23.7) 0.0001
1. DSM-5 Diagnostic Criteria(20): For diagnosis of anxiety
Table 2. Comparison of Sexual Dysfunction between
disorders. Controls and Patients with Anxiety Disorders
2. Hamilton Anxiety Rating Scale (HAM-A)(21): For
assessment of the severity of anxiety disorders. Anxiety disorder(N=180)
p
3. Arizona Sexual Experiencing Scale (ASEX)(22): For ASEX Item Mild Moderate Severe
Value
n (%) n (%) n (%)
assessment of severity of sexual dysfunction. All Subjects 87 84 9
Sexual dysfunction (Total score ≥18) 36(41.3) 72(85.7) 9(100) 0.0001
Statistical Analysis Male Subjects 60 36 00
Sexual dysfunction (Total score ≥18) 24(40) 27(75) 00 0.0018
Data collected was entered in Excel sheet master chart and Female Subjects 27 48 9
was analyzed using MedCalc – version 11.1.0.0. Appropriate Sexual dysfunction(Total score ≥18) 12(44.4) 45(93.7) 9(100) 0.0001
Table 3. Comparison of Sexual Dysfunction based on
statistical tests i.e., frequency, percentage, median, chi-square
Severity of Anxiety Disorder
and Mann-Whitney U tests were performed.
Patients with
Sexual
Demographic Anxiety Chi-Square
Dysfunction p Value
Variable Disorders Value
RESULTS n (%)
(N=180)
Area
Rural 72 45(62.5)
0.172 0.6784
Demographic Characteristics Urban 108 72(66.6)
Marital Status
Age wise distribution: 58.3% patients from study group were Married
114 81(71.1)
of 18-38 age group and 60% of control group were 18-38 Unmarried/widow/
66 36(54.5) 4.307 0.0379
Separated
years old. Median age of patients with anxiety disorders was Gender
35 years and median age of control group was 27 years. In Male 96 51(53.1)
11.657 0.0006
Female 84 66(78.5)
patients with anxiety disorders 53.3% were male and 46.7% Table 4. Comparison of Sexual Dysfunction in Patients with Anxiety
were female. Similarly, in control group 55.6% were male and Disorder Based on Area, Marital Status and Gender
44.4% were female. In the study group, 6.7% of the subjects
were illiterate, 68.3% were educated up to secondary level, Patients ASEX total
Mann-
18.3% were educated up to higher secondary level and, 6.7% with Score
Demographic Whitney U p
Anxiety Median
were graduates; whereas in the control group 3.3% of the Variable (Test Value
Disorders (Interquartile
Statistic Z)
subjects were illiterate, 68.9% were educated up to (N=180) Range)
Area
secondary level, 22.2% were educated up to higher Rural 72 21.5(15.5-24.5) 0.9895
secondary level and 5.6% were graduates. In the study group, Urban 108 21(16-24) 3883.5(0.0132)
Marital status
63.3% of the subjects were married and 33.3% of were Married
114 22(17-25) 0.0030
unmarried, divorced/separated and widow; whereas in the Unmarried/widow/
66 19(14-23)
2767.5(2.967)
Separated
control group 67.8% subjects were married and 30.5% were Gender
unmarried, divorced/separated and widow. In the study Male 96 19(14.5-22)
1750.5(6.575)
0.0001
Female 84 24(21-25)
group 60% were urban and 40% were from rural area and in
Table 5. Area, Marital Status, and Gender Wise Comparison of Median
the control group 59.4% were from urban and 40.6% were ASEX Total Score of Patients with Anxiety Disorders
from rural area.

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Among healthy individuals, sexual dysfunction was desire or absence of desire, arousal problems and orgasmic
reported by 19.4% of subjects (16% of males and 23.7% of problems.(6-18) Thus, findings in the present study were in line
females). Most female controls reported difficulty in vaginal with the previously conducted studies. The advantage of the
lubrication (23.7%), followed by low orgasm satisfaction present study over the above studies is that it is a case
(15%), and difficulty in achieving orgasm (13.7%); and while control study comparing sexual dysfunction between patients
among male controls maximally reported complaint was of anxiety disorders and healthy individuals. The limitations
difficulty in penile erection (21%). Difficulty in attaining in of this study include its cross-sectional nature which limits
sexual excitement was the least prevalent sexual dysfunction our possibility to explore the cause and effect relationship
among healthy subjects. Among patients with anxiety between anxiety disorders and sexual dysfunction and since
disorders sexual dysfunction was reported by 65% of data were collected from specific population, the degree to
subjects (53.1% of males and 78.5% of females). Most
which they represent the general population cannot be
common reported sexual dysfunction was low desire (55%)
commented on.
followed by difficulty in penile erection (43.8%). Male
patients with anxiety disorders had maximal complaints of
low desire (43.7%). Similarly, in female patients with anxiety
disorder low desire (67.8%) was most frequently reported, CONCLUSIONS
followed by around similar frequency in other phases of
sexual dysfunction. When compared with controls, sexual Healthy subjects reported considerable sexual dysfunction
dysfunction was more in patients with anxiety disorder in all despite being physically and psychiatrically well. Anxiety
phases of sexual response cycle. On applying chi-square test, disorders affect all the phases of sexual functioning. Patients
p value <0.05 was obtained, which indicates the difference in with anxiety disorders have more sexual dysfunction than
sexual dysfunction between patients suffering from anxiety controls in all phases of sexual functioning cycle, across both
disorder and control group, was statistically significant in genders. Patients suffering from moderate to severe anxiety
almost all items of ASEX across both gender except penile disorder had greater frequency of sexual dysfunction
erection and orgasm. Findings of the present study were in
compared to mild anxiety disorder.
line with the findings of some of the previously conducted
studies.(6–10)
In this study 48.3% were having mild anxiety disorder,
46.6% had moderate anxiety disorder and 5% had severe A C K N O W L E D GE M E N T
anxiety disorder. With increasing severity of anxiety disorder,
the rate of sexual dysfunction also increased. Patients with
The authors would like to acknowledge the support of Dean,
moderate to severe anxiety disorder reported more sexual
Medical College. Baroda and Superintendent, SSG Hospital
dysfunction, in both genders, compared to patients having
Baroda for allowing us to conduct this study.
mild anxiety disorder. On applying chi square test for trend,
the difference in sexual dysfunction was found to be
statistically difference in all items of ASEX.
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