There’s no shame in sexual dysfunction

As with any subject that makes us the least bit embarrassed, sexual dysfunction is often swept under the rug. It is seldom mentioned outside the bedroom and rarely, if ever, brought up to (or by) one’s neurologist.  Still, sexual disturbances are a common part of getting older and occur frequently among people with Parkinson’s disease (PD). A candid essay by longtime Foundation friend Marc Jaffe opens the door to conversations surrounding this complex topic.

In Sunday’s Modern Love column in The New York Times, Marc writes about “Finding Equilibrium in Seesawing Libidos.” As a man in a 15-year marriage, he was frustratingly aware of how mismatched the two genders’ sex drives can be and how this dichotomy only seems to grow with time. So, when his wife Karen was diagnosed with Parkinson’s and prescribed medication with a side effect of hypersexuality, you’d imagine it was “problem solved” (with regard to the sexual divide, at least). And it was — temporarily — until the pendulum swung in the opposite direction and Karen’s insatiable appetite drove Marc to stop-gap measures like taking prescription drugs simply to keep up.

Eventually, Karen was able to find another outlet and she now channels the majority of her energy into fundraising and advocating for Parkinson’s research. [In fact, she’s a member of our Patient Council.] Doing so has allowed her and Marc to settle back into a comfortable partnership — one that still has unequal, but no longer incompatible, sexual desires.

The hypersexuality Karen experienced in response to the prescribed dopamine agonist is just one possible form of the sexual disturbances that can be seen in Parkinson’s disease.

Sexual dysfunction is common in Parkinson’s

Parkinson’s contributes to sexual dysfunction through physical, psychological and pharmacological effects.

• Fatigue, bradykinesia and rigidity can make sexual activity more challenging. Tremor and dyskinesia can cause discomfort, especially as these symptoms naturally increase with excitement.
• Depression, often associated with PD, can lessen sex drive. Body image issues, shifting roles and changes in appearance secondary to Parkinson’s are additional mental factors.
• Parkinson’s medications and antidepressants can influence libido. Dopamine agonists are notorious for causing hypersexuality.

Sexual matters are infrequently addressed and are therefore inadequately treated. As a result, symptoms unnecessarily interfere with a healthy sexual relationship and impair quality of life.

Multiple treatment options are available

If your doctor does not routinely inquire about sexual problems, you may have to raise the subject yourself. A myriad of options exists to manage sexual dysfunction, but none of them can be offered if your doctor is unaware of your concerns. Your neurologist will work with you to develop an individualized treatment plan but there are some general guidelines to follow:

• Schedule sexual activity for times when medication is typically working optimally.
• Experiment with other types of foreplay and sexual positions to find what works. Look for ways to express affection in manners aside from sexual intercourse.
• Ask your doctor about prescription medications to manage specific problems like erectile dysfunction or vaginal dryness. Request referral to a urologist or gynecologist if your neurologist is not comfortable managing these symptoms.
• Don’t be embarrassed to discuss hypersexuality with your physician. This may signal the need to decrease the dosage of or discontinue dopamine agonists.
• Maintain an honest and ongoing dialogue with your partner. Together you can scheme up ways around Parkinson’s. If this proves too difficult, consider enlisting the help of a therapist or counselor who can mediate your discussions.

Marc says, “It is understood that when one spouse gets Parkinson’s, the other spouse will be affected by it.” While this is certainly true, the magnitude of Parkinson’s effect on both people can be dampened. As with every aspect of a relationship, open communication is crucial to handling changes in sexual desire or function resulting from Parkinson’s and its treatment. Through trial and error in managing challenging circumstances as they arise, you and your significant other will adapt and find a balance that suits you both.

* NOTE: The medical information contained in this article is for general information purposes only. The Michael J. Fox Foundation has a policy of refraining from advocating, endorsing or promoting any drug therapy, course of treatment, or specific company or institution. It is crucial that care and treatment decisions related to Parkinson’s disease and any other medical condition be made in consultation with a physician or other qualified medical professional.