Sexual Health

Sex is a natural part of the human experience. People living with Parkinson’s disease (PD) may face concerns about its impact on their ability to have and enjoy sex. Understanding PD-specific sexual challenges for men and women is the first step in finding the right therapies and treatments to work through them.

How does Parkinson’s affect sexual health?

Sexual dysfunction in Parkinson's is common, affecting men more often than women. It may arise as a primary PD symptom. However, the impact of sexual dysfunction is often underappreciated as people who live with Parkinson's, their partners and healthcare providers may not be comfortable with a frank discussion of sex.

• Many factors contribute to good sexual health. Aging, the physical impacts of Parkinson's and other medical conditions can undermine sexual interest and performance.
• Physical immobility in bed, sleep disturbances, depression and changes in thinking can also impact sexual desire in men and women.
• PD itself may cause sexual dysfunction due to the loss of dopamine, the principal brain chemical behind feelings of reward and pleasure.
• Various medications, including antihistamines, antidepressants, benzodiazepines, drugs for high blood pressure and excessive alcohol or tobacco use, can also contribute to sexual dysfunction.
• Most PD medications are not associated with impotency or loss of libido, with the exception of the anticholinergics.

However, PD dopamine agonists are linked to impulse control disorders such as:

• Uncontrolled gambling
• Uncontrolled shopping
• Uncontrolled eating
• Obsessive compulsive tendencies, such as cleaning and organizing
• Hypersexuality

People living with PD who are taking dopamine agonists and have developed hypersexuality should discuss it with their neurologist. Usually decreasing the dose or complete discontinuation of dopamine agonists resolves impulse control problems.

Impact of Sexual Problems in Parkinson's

It is important to remember that sexual functioning is only one dimension of sexuality and intimacy. Sexuality and intimacy can be a time of gentle relaxation for people, when sharing and touching can improve their sense of well-being.

While some couples easily accept limitations or cessation of sexual activity due to chronic illness, for others alteration of sexual functioning can cause a significant emotional crisis. Sexual challenges in PD can include:

• Feelings of frustration and sexual inadequacy in intimate relationships or a more pervasive loss of self-esteem.
• Depression can be a critical contributing factor in sexual dissatisfaction. Similarly, sexually dissatisfied people are usually found to be more depressed than sexually satisfied people, especially men.

Treating Sexual Dysfunction

There are many ways to address Parkinson’s-related sexual dysfunction.

Sex therapy, couples therapy and behavioral therapy tips:

• Increase open sexual communication between sexual partners.
• Plan the setting of sexual activity (including time, location, position and roles).
• Practice comfortable positions.
• Adapt new sexual roles according to the couple’s abilities.
• Find new solutions for physical limitations (such as touch, arousal and orgasm).
• Perform erotic tasks.
• Practice sensate focus — a process of re-learning body sensations.
• Practice growing intimacy and satisfaction through sexual stimulation without intercourse, then begin to add it back in, known as the intercourse-outercourse approach.
• Work with medical staff to reduce the effects of medications on sexual function.

Page reviewed by Dr. Tracy Tholanikunnel, Assistant Professor of Movement Disorders at the University of Florida, a Parkinson’s Foundation Center of Excellence.