Interest in sexuality and the sexual functions of both men and women start to decline from the age of 50. Parkinson’s disease can cause certain psychological and physical disorders, resulting in sexual dysfunction that contributes to a decline in sexual activity.
Sexual dysfunctions reported by men and women differ. They can be embarrassing or frustrating and can affect marital relationships.
Sexual dysfunctions include:
Several causes can explain the different sexual dysfunctions related to Parkinson’s disease:
1. Degeneration of neurons in certain parts of the brain can lead to erectile dysfunction and loss of libido.
2. Decreased dopamine levels can lead to decreased sexual interest.
3. Motor symptoms of Parkinson’s disease, such as loss of coordination, slow movement and difficulty producing movement, can make relationships more difficult.
4. Some non-motor symptoms, such as depression, anxiety or fatigue, can negatively influence sexual appetite and the ability to have an orgasm. Bladder problems can also cause anxiety about the possibility of being incontinent during sex.
5. Some medication may have adverse effects on sexual function.
Lifestyle habits and mental state are key determinants of libido.
A few strategies can help you face these different problems:
Talk to your doctor if you are experiencing sexual dysfunction. They will ask you about your habits and concerns. They will be able to make a clear diagnosis and guide you towards the right way to manage it. You can also consult a sex therapist who will guide you.
Erectile dysfunction is also common in men, whether they have Parkinson’s or not. This function is at its peak during adolescence and the next few years. With age, erectile dysfunction becomes more and more frequent and must be accepted in the same way as the age-related decline in reading vision.
An erection is an automatic and unconscious phenomenon. You cannot decide to have an erection. On the other hand, you can put yourself in an unfavourable position. The most common is anxiety related to past impotence.
Stress, anxiety and depression unrelated to your relationship with your partner can decrease sexual arousal. This leads to a decrease in desire and therefore, erectile difficulties. These psychological states are very common in Parkinson’s disease and therefore need to be considered first and foremost as the cause of the difficulties.
Parkinson’s disease also predisposes men to impotence by affecting the nervous system that regulates blood flow in the penis.
Levodopa does not affect libido. However, its positive effect on mobility leads to increased sexual appetite and activity. The optimization of your antiparkinsonian treatment is therefore often the first solution.
On the other hand, try to plan your intimate moments to the times in the day when your medication is most effective.
Drugs such as sildenafil (ViagraⓇ), vardenafil (LevitraⓇ) and tadalafil (CialisⓇ) do not affect sexual drive. They work by increasing the flow of blood to the penis, thereby achieving and maintaining an erection. To be effective, these drugs require sexual arousal.
These supplements should usually be taken about 30 minutes before intercourse, with or without a meal. Fatty foods delay their absorption and therefore their action.
These drugs tend to reduce blood pressure, even more so when combined with the low blood pressure that people with Parkinson’s disease usually have and levodopa’s effect. This low pressure can not only cause dizziness and falls, but can also interfere with your sexual relationship.
Other more invasive drugs exist and may be prescribed to you by a urologist if this class of drugs is not suitable for you.
The effects of Parkinson’s disease on women’s sexuality are not well understood because women tend to share fewer of these symptoms with their neurologists, who are mostly men.
Women often mention experiencing a loss of desire, lack of orgasm, pain during intercourse, and vaginal dryness. These symptoms are also associated with age.
Sexual arousal can be at its peak when all stressors, distractions and pain are removed. Optimizing treatment and taking into account variations in the effectiveness of antiparkinsonian drugs are the first factors to address.
On the other hand, psychological factors and depression also need to be treated effectively to help with sexual desire.
Vaginal discomfort and dryness can be alleviated by using lubricants during intercourse. Estrogen-based creams applied daily can also soften the vagina and increase its lubrication.
Right before menstruation, women’s estrogen levels decrease, which can sometimes reduce levodopa’s efficacy in some women. This loss of efficacy may result in an increase in the onset of effect from the moment of intake or a decrease in the duration of action of levodopa.
In both cases, if you notice that this occurs monthly, talk to your neurologist about adjusting your medication dose for this short period of time.
Open communication is crucial in this case. Your roles in your sexual relationships will continue to change as your roles in life do. Your role as a caregiver does not exclude the role of sexual partner.
Have sexual activity when your partner’s motor symptoms are less prominent or when their medication is fully effective.
Sexual dysfunction is common and increases with age. In some cases, these are characteristics of age rather than dysfunctions. When these dysfunctions are well taken care of medically and properly addressed between partners, it is possible to have a fulfilling sex life.
