The Role of Sex Therapy in the Management of Patients with Parkinson's Disease

Abstract

Background: Patients with Parkinson disease (PD) and their partners report deterioration in their sexual life. Sexual dysfunction (SD), an important and often ignored aspect, is common in PD. Motor and nonmotor symptoms are involved in limiting pleasure and disturbing function. Sexual dissatisfaction is more common in men that in women. Frequently, both patients and partners have SD associated with PD, and both need suitable treatment. These issues need to be evaluated by neurologists or PD nurses and by specialized sex therapists. The objectives of this study were to describe the complexity and multidimensional nature of sexual problems in PD, enable practitioners to assess and treat sexual difficulties of their patients, and increase awareness of the role of sex therapy in the therapeutic process of PD. Methods: Based on clinical experience of over 30 years in movement disorder clinics and a review of the literature, the authors suggest practical approaches, including an "Open Sexual Communication" module, prescribing medications, and/or referring to specialists. Results and Discussion: The longitudinal nature of treating neurologic patients puts physicians in an important position to introduce sexual issues and to assess and plan the interventions and follow-up needed to ensure that sexual difficulties are resolved. The management of hypersexuality requires a thoughtful distinction between lack of opportunities for sexual expression, limited ability to perform, and true hypersexuality. Sex therapists have a major role in the assessment and treatment of the multiple factors that may underlie sexual dissatisfaction in PD, differentiating between hypersexual behaviors and other sexual preoccupation behaviors, and training the professional team.Parkinson's disease (PD) is an age-related, chronic, multisystem, progressive disorder with motor symptoms (bradykinesia, rigidity, tremor, and postural instability) 1 and highly prevalent and diverse nonmotor symptoms (NMS), which can precede the motor symptoms and may have a significant, adverse impact on quality of life (QoL). 2 NMS also contribute to caregiver strain and depression even more than motor symptoms. 3 NMS can be divided into 4 domains: (1) neuropsychiatric (e.g., depression, anxiety, apathy, dementia), (2) autonomic (e.g., constipation, orthostatic hypotension, urinary disturbances, and erectile dysfunction [ED]), (3) sleep-related (e.g., insomnia, excessive daytime sleepiness, restless-legs syndrome), and (4) sensory dysfunction (e.g., pain and changes in smell, vision, and olfaction). 2 The motor symptoms and NMS progress over time with growing physical disability and may contribute to sexual dysfunction (SD). 4 Sexual functioning is a multifaceted process that requires coordinated functioning of the person's mental, autonomic, sensory, and motor systems and depends on proper function of the neurologic, vascular, and endocrine systems, allowing sufficient blood supply to and from genital organs, a balanced hormonal system, and a healthy emotion...

Sexual dysfunction in male patients with Parkinson’s disease: related factors and impact on quality of life

“…This is consistent with previous studies that proved a strong association between PD and erectile dysfunction [6-9, 11-13, 18, 19]. Similar to previous studies [6,9,18,19], our study showed that sexual satisfaction was impaired among men with PD. Several mechanisms of erectile dysfunction in PD were reported, independent of disease severity, including autonomic dysfunction, central dopaminergic deficiency, psychosocial factors, medication side effects, as well as testosterone deficiency [8,20].…”

The PRIAMO study: active sexual life is associated with better motor and non‐motor outcomes in men with early Parkinson's disease

“…Specific gender differences exist in motor symptoms and NMS in early PD [13][14][15]. Then, women are less prone to talk about sexual and genital issues due to societal attitudes [5]. Finally, women were much less represented in our cohort (33% vs. 67%).…”

“…Chronic diseases are associated with a profound change in sexual activity and sexual dysfunction is one of the commonest NMS in PD [8]. The goal of treatment of sexual function in PD should not be limited to maintaining full genital functions but, rather, to achieving pleasure and satisfaction, reducing anxiety and concerns, increasing intimate couple communication and reducing relationship tension [1,5]. Our data confirm these theories and should prompt clinicians to broadly address sexual issues not limited to sexual dysfunction in PD patients.…”

“…Likewise, the most commonly used tools to evaluate non‐motor symptoms (NMS) as well as health‐related quality of life (HR‐QoL) in PD contain either a few or no items related to sexual function. Yet, as effective pharmacological and behavioural therapies for sexual problems are available, sex life should be proactively investigated .…”

Multidisciplinary care for people with Parkinson’s disease: the new kids on the block!

“…Hypersexuality is very vexing for patients who have a limited ability to perform. Adjustment of dopaminergic medication can be helpful, but we often refer many of our patients to a sex therapist who can offer counseling and address alternative approaches to intimacy [78].…”