Sexual functioning has received little attention as an important aspect of patient care for those suffering from severe mental disorders such as schizophrenia. Yet, it has been implicated as one of the major factors contributing to noncompliance with antipsychotic medications and is documented by people with schizophrenia to be one of the areas of treatment with the most unmet needs. A stronger focus on sexuality and preventing sexual dysfunction in schizophrenia would likely be a major benefit for improving treatment. This review will describe possible mechanisms for sexual dysfunction, describe sexual disturbances that have been documented in the literature of people who have schizophrenia, and summarize and discuss assessment measures available. Moreover, a focus on second-generation antipsychotics (SGA) and their association with sexual functioning is described. Each SGA (clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole) will be described for its prolactin effects, documented sexual disturbances associated with use, and product labeling regarding sexual function. Treatment options and psychosocial issues pertaining to sexuality also are presented.