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Stigma negatively affects the well-being of individuals with severe mental disorders (SMD). However, its specific impact on romantic and sexual intimacy remains fragmented in the literature. This study aimed to identify which aspects of intimate life are affected by stigma and the factors mediating this relationship.

A systematic review following PRISMA-P guidelines was conducted using Scopus, Web of Science, PubMed, EBSCOhost, VHL, and SciELO without date restrictions. Due to high methodological heterogeneity among the 26 included studies, a narrative synthesis was utilized to integrate findings.

Findings involving participants with Schizophrenia Spectrum, Bipolar, and Major Depressive Disorders reveal distinct stigma mechanisms. Medication side effects (e.g., sexual dysfunction, weight gain) act as catalysts for internalized stigma, transforming physical symptoms into barriers for romantic desirability. Gender norms exacerbate exclusion: women face intense scrutiny regarding parenting capacity and are vulnerable to intimate partner violence to avoid isolation, while men perceive functional impairment as a failure of masculine identity. Additionally, professional silence regarding sexuality reinforces the 'asexual' stereotype, leaving relational needs unsupported.

The results underscore that stigma permeates the intimate lives of individuals with SMD through biological, social, and professional pathways. Clinical practice must urgently integrate sexual health assessments and relational support into routine care. Future interventions should focus on reducing professional bias and supporting the sexual and reproductive rights of this population.