This content was reviewed by Rachel Dolhun, MD, a movement disorder specialist and vice president of medical communications at The Michael J. Fox Foundation.
Sexual dysfunction is a common complaint of many people living with Parkinson's disease (PD). Some studies suggest as many as 70 to 80 percent of those with PD experience sexual dysfunction.
In men with Parkinson's, common sexual problems are erectile dysfunction, decreased libido (sex drive), premature or delayed ejaculation, and inability to orgasm. Women with PD may experience decreased libido, lack of sexual arousal, inability to orgasm, and decreased lubrication and/or pain with intercourse.
A combination of factors, including the underlying disease itself, side effects and psychological issues may all contribute to sexual dysfunction in PD. However, there are many strategies and therapies that may help. Open communication is important to ensuring any treatment works -- talk to your partner about what you're experiencing and feeling, and ask him or her to do the same.
The motor symptoms of Parkinson's disease can create some practical barriers to sexual activity. Bradykinesia (slowness) and rigidity (stiffness) mean that something as simple as rolling over in bed can become a challenge. Try using satin sheets, wearing silky sleepwear for easier mobility or abandon the bed altogether. Tremor or dyskinesia might also interfere with sex, especially as these symptoms naturally increase with excitement.
Non-motor symptoms, such as fatigue, depression, anxiety or sleep disturbances, could also be factors in sexual dysfunction. Several treatments may be available but some antidepressants might, unfortunately, have a side effect of sexual dysfunction. Other ideas might be to schedule sexual activity for a time of day when your medication typically works best or look for ways to experience sexual pleasure that don't necessarily involve intercourse.
Certain Parkinson's disease medications -- particularly dopamine agonists -- can bring about impulse control disorders, such as hypersexuality (including sex addiction), pathological gambling and compulsive shopping. If you notice these patterns emerging, consult your physician. Changing medication and seeking counseling may mitigate these issues. Researchers are working to understand how and why impulse control disorders occur and to test treatments specifically for them.
Erectile dysfunction (ED) is the most common sexual problem for men with Parkinson's. Medication side effects, disease progression and non-motor symptoms (e.g., anxiety, apathy, sleep problems) can individually or in combination diminish sex drive, the ability to achieve or maintain erections, and the potential to reach orgasm.
ED and depression, a common non-motor symptom of Parkinson's, often coexist. In this case, treating depression may improve ED. The symptoms of depression, their impact on body image and confidence, and even some antidepressants may inhibit desire and impact performance. (Newer antidepressants may have less effect in this regard.)
Treatments for ED range from medications (including Viagra, Cialis and their generic counterparts) to physical or psychological therapy, vacuum devices and surgical implants.
Women with PD face unique issues because of their hormonal makeup. Estrogen seems to have an impact on Parkinson's, but details of this interaction have yet to be determined. Many women also grapple with body image issues, which can be amplified by physical changes and social stigma brought about by PD.
Other sexual problems for women with Parkinson's could include lack of sex drive or arousal, inability to orgasm and discomfort with intercourse, frequently due to decreased lubrication (particularly for post-menopausal women). Treatment options include adding lubrication, timing sex for periods when Parkinson's symptoms are well controlled, and/or talking to a therapist.
Women with Parkinson's may be concerned about pregnancy. There is limited data on Parkinson's and pregnancy, but plenty of women with PD have successfully carried healthy babies to term.
During pregnancy, some women report a slight worsening of motor and non-motor symptoms. The latter might include fatigue, mild memory problems, or sleep disturbances, and may be consistent with what a lot of pregnant women (even without PD) experience.
Questions can also arise around taking PD medication during pregnancy. No thorough study of the effects of Parkinson's drugs on the fetus has been conducted, and there is no clear consensus on the relative risks. When considering taking PD medication during pregnancy, the benefits should be weighed against potential risks. A woman with early PD and mild symptoms might not take medication, while a woman with moderate symptoms might require medication in order to continue working and caring for other children. The decision depends on each woman's symptoms and situation. Among Parkinson's drugs, levodopa is the most commonly prescribed medication during pregnancy. Your movement disorders specialist will work closely to coordinate care with your obstetrician and you may be offered genetic counseling with a specialist who can outline the genetic components of PD and potential medication effects during pregnancy.
Women with PD seeking to prevent pregnancy (or regulate menstrual cycles), might use oral contraceptives. Taking birth control pills doesn't prevent taking any Parkinson's medications but, since oral contraceptives boost the effects of certain PD drugs, the dosages may need to be adjusted. This is especially pertinent when oral contraceptives are started or discontinued. Alternatives to the pill -- non-medication and/or non-hormonal forms of contraception, such as an intrauterine device or a diaphragm -- may be a consideration for some women.
Navigating sexual relationships while living with PD is challenging, but talking through what you experience with your partner is key to finding solutions that work for both of you. Parkinson's can create emotional issues -- anger, anxiety, fear, and insecurity about any physical changes -- for the person diagnosed, but partners can experience their own emotional struggles as well. Exhaustion, resentment and loss of attraction are common reactions. If you can remain open, honest and patient -- and remember that physical closeness takes many forms -- you may together discover many ways to adapt.