Gender-specific associations between sleep quality, chronotype, and sexual function in psychiatric outpatients

Introduction: Circadian rhythms are fundamental biological mechanisms that regulate the temporal organization of physiological processes. Disruptions in these rhythms have been associated with both physical and psychiatric disorders and may negatively impact quality of life. Chronotype, reflecting an individual’s circadian preference, is a key determinant of sleep patterns and overall sleep quality. Although the relationship between sleep and sexual functioning has been previously demonstrated [1, 2], gender-specific differences in this association remain insufficiently explored.

Aim:

This study aimed to investigate the relationship between sleep quality, chronotype, psychological symptom levels, and sexual functioning in psychiatric outpatients, with a particular focus on gender differences.

Methods:

This cross-sectional study included 119 participants (68 women, 51 men; mean age 32.36±9.27 years) attending a psychiatry outpatient clinic. Psychotropic medication use was recorded for all participants. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), psychological symptoms were evaluated with the Hospital Anxiety and Depression Scale (HADS), and sexual functioning was measured using gender-specific instruments: the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men. Chronotype was determined using the Morningness–Eveningness Questionnaire. Statistical analyses included independent samples t-tests, Mann–Whitney U tests, and chi-square tests. A p-value of <0.05 was considered statistically significant.

Results:

Poor sleep quality (PSQI >5) was identified in 67.2% of participants. Women had significantly higher PSQI scores than men (p=0.044). Among men with poor sleep quality, both anxiety and depression scores were significantly higher, whereas in women, only depression scores were significantly elevated (p<0.001, p=0.037, and p=0.012, respectively). Erectile function scores did not differ significantly by sleep quality in men; however, men with poor sleep quality reported significantly lower sexual satisfaction and overall satisfaction scores (p=0.006 and p=0.004, respectively). In women, total FSFI scores did not differ significantly between groups, but the pain/discomfort subdomain scores were significantly lower in those with poor sleep quality (p=0.047). An evening chronotype was significantly associated with poor sleep quality in both men (p<0.001) and women (p=0.008).

Conclusions:

In men, a notable dissociation was observed between objective erectile function, which appeared to remain preserved despite poor sleep quality, and subjective sexual satisfaction, which was significantly reduced. This dissociation suggests that poor sleep may impair the experiential and hedonic dimensions of sexual functioning even when physiological capacity is intact. The selective impairment of sexual pain/discomfort in women, alongside preserved overall sexual function, mirrors this male pattern of dissociation between erectile capacity and satisfaction. These convergent findings suggest that poor sleep quality disrupts specific dimensions of sexual functioning rather than global sexual response, with the affected domain differing by gender. Additionally, an evening chronotype emerges as a significant risk factor for poor sleep quality in both genders. These findings highlight the importance of incorporating assessments of sleep quality, chronotype, and specific dimensions of sexual functioning (particularly satisfaction and pain) into routine psychiatric evaluations.

References

1. Dilixiati D, Kadier K, Laihaiti D, et al (2023) The relationship between sleep disorders, quality, and duration and sexual dysfunction: a systematic review and meta-analysis. J Sex Med 20:766–780. https://doi.org/10.1093/jsxmed/qdad054
2. Andersen ML, Tufik S (2025) Sleep disorders and sexual function in women. Maturitas 199:108625. https://doi.org/10.1016/j.maturitas.2025.108625