Parkinson's and sexual dysfunction

How is sexual dysfunction related to Parkinson’s?
Sexual dysfunction occurs in many individuals with Parkinson’s. As a person ages, the sexual function declines but if a person has Parkinson’s, the rate at which the sexual function declines is much faster. In general, there is a decreased sex drive in people with Parkinson’s. For men, the most frequent problem is attaining and maintaining an erection. Women may experience a decrease in libido. A number of factors including autonomic dysfunction, anxiety, depression and urinary dysfunction may be responsible for this.

Some of the symptoms of Parkinson’s such as slowness of movements, fatigue and tremor, directly interfere with sexual activity. Since Parkinson’s affects motor function it becomes difficult to be sexually active. A couple may not be able to sleep on the same bed if the symptoms are severe enough. Sexual dysfunction can also occur as a result of changes in roles in a relationship. As Parkinson’s progresses in a person, their partner may become their primary caregiver. Sometimes, these energy demands and adjustments disrupt relationships.

Other coexisting medical conditions such as diabetes, may affect sexual function. In addition, the drugs used to treat high blood pressure and some other medical conditions may also affect sexual function.

How is sexual dysfunction treated?
Sexual dysfunction is like any other health concern. You need to discuss it with your health care team so that they can take the necessary steps to treat it. However, sometimes it is difficult for people to speak about such problems.

You may be referred to an urologist for further assessment of sexual dysfunction. Urologist may rule out other causes of erectile dysfunction such as prostate problems, diabetes and depression. Urologist will also review all the medications used for other medical conditions such as betablockers and antidepressants which may cause sexual dysfunction. The following are some practical tips,

Non pharmacological Measures:

1. Maintaining regular sexual activity which helps to increase your sexual drive (libido), and can also keep your relationship close. If sexual activity is rare, your interest may wane and your relationship may become uncomfortable.

2. Performing sexual activity in a relaxed environment.

3. Frank discussion with your partner.

4. Psychosexual counseling.


5. Devices such as Vacumes and vibrators may help.

6.  Exploring the methods other than intercourse as the intimacy with your partner does not necessarily mean sexual activity. Simple gestures such as hugs and kisses can go a long way in keeping a relationship strong over time.


Pharamacological Treatments:


1. Medications used to treat Parkinson’s especially dopamine agonists (pramipexole, ropinarole, apomorphine) may help in improving the sexual drive.

 

2. Depression can be a cause of sexual dysfunction, if suspected should be treated. However some of the drugs used to treat depression may cause sexual dysfunction as a side effect.

3. Medications such as Sildenafil or Viagra, Vardenafil, Tedafil, Yohimbine, Alprostadil, surgical implants  such as Semi rigid rods  and  Hydraulic prosthesis are very helpful but should only be used under guidance of your physician. Some of these medications may have serious side effects such as headaches, facial flushing, and upset stomach, blurred vision, increased sensitivity to light and unsafe drop in blood pressure.

If the oral medications don’t help, the medications that can be injected into the penis, and certain devices that can increase the blood flow into the penis can be used. Dopamine agonists in some cases may lead to abnormal behaviors such as compulsive hypersexuality. In such a case, your physician needs to be informed, so the medication can be altered.

What are some suggestions for improving  sexual function?
If you are taking medication for a condition other than Parkinson’s, you should consult with your physician to make sure it does not affect your sexual function as a side effect. Older women may experience issues associated with menopause. These need to be addressed appropriately since they usually reduce sexual function.

This information should not be used as a substitute for the medical care and advice of your physician.

Copyrights  © World Parkinson’s Program