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Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial

Thana, Lavanya J.; O�Connell, Lesley; Carne-Watson, Alexandra; Shastri, Abhishek; Saravanamuthu, Arunan; Budhwani, Natasha; Jayacodi, Sandra; Leeson, Verity C.; Munjiza, Jasna; Pappa, Sofia; Hughes, Elizabeth; Reilly, Joe; Crawford, Mike J.


Lavanya J. Thana

Lesley O�Connell

Alexandra Carne-Watson

Abhishek Shastri

Arunan Saravanamuthu

Natasha Budhwani

Sandra Jayacodi

Verity C. Leeson

Jasna Munjiza

Sofia Pappa

Elizabeth Hughes

Joe Reilly

Mike J. Crawford


Background: More than half of people who use antipsychotic medication for psychosis report having sexual dysfunction. The REMEDY trial aimed to find out if switching antipsychotic medication provides an effective way to reduce sexual dysfunction among people with psychosis. We set out to recruit 216 participants over a two-year period, but recruitment was stopped after an extended 12-month pilot phase, during which we recruited only 10 participants. As part of a nested process evaluation, we conducted qualitative interviews with front-line clinicians to examine barriers to recruitment to the trial. Methods: We developed a semi-structured interview schedule to explore staff views on factors that influenced whether they referred potential participants to the study. We interviewed a purposive sample of 51 staff from four National Health Service (NHS) Trusts in England, ensuring a range of different backgrounds, seniority, and levels of involvement in the trial. Audio recordings of interviews were transcribed for verbatim, and data were analysed using an inductive approach to thematic analysis. Results: Nine interconnected themes were generated. Six themes concerned barriers to recruitment; including; prioritising patients’ mental stability, mutual discomfort and embarrassment about discussing a “taboo” subject, and concerns about unintended consequences of asking people with psychosis about their sexual functioning. Three themes, including the quality of treatment relationships and strategies for opening dialogue suggested ways to improve recognition of these “hidden” side effects. Conclusion: The identification and management of sexual dysfunction among people with psychosis are not priorities for mental health services in England at this time. Many staff working in front-line services feel unprepared and uncomfortable asking people with psychosis about these problems. While greater use of screening tools may improve the identification of sexual dysfunction among people with psychosis, the evaluation and implementation of interventions to manage them will continue to be challenging unless NHS leaders and senior clinicians demonstrate greater commitment to changing current clinical practice. Trial registration: Current Controlled Trials ISRCTN12307891.

Journal Article Type Article
Acceptance Date Jul 29, 2022
Online Publication Date Aug 12, 2022
Publication Date 2022
Deposit Date Aug 15, 2022
Publicly Available Date Aug 15, 2022
Journal BMC Psychiatry
Publisher BMC
Peer Reviewed Peer Reviewed
Volume 22
Issue 1
Article Number 545
Keywords Psychotic disorders, Antipsychotic medication, Sexual dysfunction
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Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial (927 Kb)

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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