Balon R (ed): Sexual Dysfunction. Adv Psychosom Med. Basel, Karger, 2008, vol 29, pp 89–106 The Impact of Mental Illness on Sexual Dysfunction Zvi Zemishlany  Abraham Weizman Geha Mental Health Center, Petah-Tikva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel Abstract Sexual dysfunction is prevalent among psychiatric patients and may be related to both the psy- chopathology and the pharmacotherapy. The negative symptoms of schizophrenia limit the capability for interpersonal and sexual relationships. The first-generation antipsychotics cause further deterioration in erectile and orgasmic function. Due to their weak antagonistic activity at D2 receptors, second-gener- ation antipsychotics are associated with fewer sexual side effects, and thus may provide an option for schizophrenia patients with sexual dysfunction. Depression and anxiety are a cause for sexual dysfunc- tion that may be aggravated by antidepressants, especially selective serotonin reuptake inhibitors (SSRIs). SSRI-induced sexual dysfunction may be overcome by lowering doses, switching to an antidepressant with low propensity to cause sexual dysfunction (bupropion, mirtazapine, nefazodone, reboxetine), addi- tion of 5HT2 antagonists (mirtazapine, mianserin) or coadministration of 5-phosphodiesterase inhibitors. Eating disorders and personality disorders, mainly borderline personality disorder, are also associated with sexual dysfunction. Sexual dysfunction in these cases stems from impaired interpersonal relation- ships and may respond to adequate psychosexual therapy. It is mandatory to identify the specific sexual dysfunction and to treat the patients according to his/her individual psychopathology, current pharma- cotherapy and interpersonal relationships. Copyright © 2008 S. Karger AG, Basel Proper sexual functioning is one of the most important components of quality of life and of maintaining a satisfying intimate relationship. Sexual dysfunction is a com- mon phenomenon in the general population, affecting an estimated 43% of women and 31% of men in the US [1]. The most common dysfunction amongst women is decrease in sexual desire reported by approximately a third of the women. The most common dysfunctions amongst men are erectile dysfunction (ED; mainly in older age) and premature ejaculation. Despite the importance and high prevalence of sex- ual dysfunction, most sufferers do not seek help either due to feeling of embarrass- ment or because they do not view it as a medical problem [1, 2]. AIP29089.qxd 22/02/08 6:59 PM Page 89