Social anxiety disorder and sexual dysfunctions: A systematic review of a bidirectional relationship

While recent studies have highlighted sexual dysfunctions as a common comorbidity of several psychiatric disorders very few have focused on social anxiety disorder. However, its shared impact with sexual dysfunctions on interpersonal relationships and self-esteem suggested a potential bidirectional relationship worth investigating.

To provide an overview of the available literature on the relationship between social anxiety disorder and sexual dysfunctions, particularly by exploring the frequency and nature of sexual dysfunctions in patients with social anxiety disorder, and the prevalence of social anxiety disorder in sexual dysfunctions populations.

We conducted the first systematic review (according to PRISMA guidelines) to explore this association. Using three databases (MEDLINE, Google Scholar and Science Direct), we included studies reporting quantitative outcomes of sexual dysfunctions among participants with social anxiety disorder or quantitative outcomes of social anxiety among participants with sexual dysfunctions.

Five studies reported data on sexual dysfunctions among 241 subjects with social anxiety disorder, with overall prevalence rates ranging from 33.3% to 36.3%. Premature ejaculation emerged as the most frequently reported condition in men, with prevalence ranging from 33% to 47.4%. Among women, genito-pelvic pain disorders were the most prevalent, with rates reaching up to 42%. Nine studies reported data on social anxiety among 1807 subjects with sexual dysfunctions. Social anxiety disorder prevalence was highest among individuals with PE (9.7-47%), followed by vaginismus (9-9.7%) and dyspareunia (12.5%). Comorbidities and psychosocial factors, such as depression and a history of childhood abuse, appeared to contribute to these associations, although further research is needed to clarify their role. Results for other sexual dysfunctions were mixed, not allowing conclusions.

This systematic review in a neglected area suggests a potential association between social anxiety disorder and specific sexual dysfunctions, particularly premature ejaculation and genito-pelvic pain disorders. These preliminary findings call for routine bidirectional screening, integration of sexual health into psychiatric care, combined therapeutic approaches, and adapted pharmacological strategies.