How Parkinson's Disease Affects Sexual Function

Causes includes medications, emotions, nerve dysfunction

Depressed Man
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Many people with Parkinson’s disease have experienced problems with sexual function. In fact, some studies have suggested that nearly seven out of 10 people with parkinsonism have experienced some form of sexual dysfunction ranging from impaired performance to decreased sexual desire.

But it's not always about decreased sexual dysfunction. In some cases, the opposite pattern can emerge when Parkinson's medication are taken in excess, leading to behavioral disinhibition and extreme risk taking.

Causes of Sexual Dysfunction in People With Parkinson's Disease

Sexual dysfunction can be caused by several factors in people living with Parkinson's, including older age, low dopamine levels, impaired mobility, treatment side effects, depression and anxiety, and autonomic nervous system (ANS) disorders that can hinder sexual function.

Loss of dopamine in the brain is often the primary cause of decreased libido. Because dopamine acts as a "pleasure molecule," any reduction can make it harder for men and women to experience sexual pleasure or achieve orgasm. Lower testosterone levels, commonly seen in men with parkinsonism, can also contribute.

Parkinson's disease may also affect your ability to move easily in and out of bed. Self-consciousness associated with impaired mobility can create greater stress when engaging in sex, reinforcing any doubts one might have about sexual performance.

Changes in the Autonomic Nervous System

Autonomic nervous system (ANS) dysfunction is common in people with Parkinson's disease.

The ANS controls many of the bodily functions that happen automatically or beyond our voluntary control. These includes the heartbeat, blood pressure, respiratory rate, and blood flow changes in response to increased or decreased physical activity.

The ANS supports several facets of sexual performance, as well, including erections in men and vaginal secretions in women.

Nerves of the ANS are directly involved in the stimulation of the genitals and the process of sexual arousal. If the ANS is not working properly, aspects of sexual activity can be profoundly impaired.

Abnormal Increases in Sexual Desire

By contrast, persons with Parkinson's can sometimes experience a dramatic increase in sexual arousal due to their medications. This can be the case when the dosages are too high, leading to a condition called impulse control disorder.

The response can vary from person to person but is often characterized by unnecessary risk-taking, lavish spending, gambling, sexual disinhibition, and a general recklessness. Some people describe the response as being similar to the manic phase of bipolar disorder.

Treating Sexual Dysfunction in People With Parkinson's 

Dose adjustment can rectify many of these problems. If you're having mobility problems, you can ask your doctor to add a night dose if you're already taking one at morning and another in the afternoon. A continuous-release formulation may also help sustain drug levels, leading to fewer fluctuations and changes in mobility.

On the other hand, if you're experiencing impulse control issues, decreasing your daily dose or switching medications can usually rectify the problem.

For those experiencing depression, antidepressant medications such as citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline are known to decrease libido. This is true even if you're taking erectile dysfunction drugs like Viagra and Cialis. If possible, ask your doctor about antidepressants that may have less impact on your sexual function. Exercise, a healthy diet, and plenty of rest can also help.

Testosterone replacement therapy may sometimes be prescribed for men who have abnormally low levels for their age.

Source:

Bronner, G. and Vodusek, D. "Management of sexual dysfunction in Parkinson’s disease." Ther Adv Neurol Disord. 2011; 4(6): 375–383.

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