The present study examined sexual functioning among first-time treated schizophrenia patients at the time that they initiated antipsychotic treatment, and again 3 and 6 months later. These first-time treated patients comprise a subgroup of 570 schizophrenia patients who were part of a cohort of 7655 patients enrolled in the Intercontinental Schizophrenia Outpatient-Health Outcomes observational study (IC-SOHO). As part of a brief clinical assessment conducted at entry to the study, and after 3 and 6 months of antipsychotic medication, patients were asked to rate their sexual functioning, and the investigator was asked to rate the extent to which the patient had neuroleptic-related loss of libido and sexual dysfunction. After being treated, patients treated with olanzapine showed the lowest prevalence of neuroleptic-induced sexual difficulties. At 3 months, there were significant differences between the treatment groups on neuroleptic-related loss of libido, neuroleptic-related sexual dysfunction and change in patient-rated sexual dysfunction. At 6 months, the difference between the groups on neuroleptic-related loss of libido was statistically significant. There were no significant differences between males and females. Many recent onset patients appear to suffer from problems of sexual functioning. Olanzapine may offer an advantage in this area.