Sexual concerns rank among the most difficult communication issues for couples. Our perceptions of masculinity and femininity and what we expect from our intimate relationships are as unique as our personalities. Self-concept, body image and self-esteem all impact the quality of our sexual relations The physical challenges presented by Parkinson’s can also have specific effects on sexual participation and satisfaction.

Parkinson’s affects the autonomic nervous system and therefore, can impact sexual performance. Decreased agility and flexibility can be a problem. Parkinson medications, as well as many other medications, can negatively impact sexual performance. Depression, which is common in people with Parkinson’s, can also decrease sexual desire and energy.

Some men with Parkinson’s may experience problems with impotence. Medication for erectile dysfunction can help in many cases. It can be used in combination with Parkinson medications and tends to be effective in younger age groups. It may not be appropriate for men with certain heart conditions. If you are experiencing erectile dysfunction, see a urologist to discuss the best medical approach to the problem.

In women, Parkinson’s may affect the desire to have sex rather than performance. Some women may find it easier to get sexually aroused while others may feel a decreased desire. The onset of Parkinson’s during the peri-menopausal years of hormone fluctuations can be particularly challenging. Women should see a gynaecologist and a neurologist to choose how to combine hormone replacement therapy (should they choose that route) and Parkinson medications.

Couples may need to get creative about when and how they have sex. Although penetration provides pleasure and intimacy, other forms of touching, perhaps as yet undiscovered, can also provide sexual satisfaction that will downplay the presence of sexual dysfunction. Foreplay and touching may become more important. Intimacy that once took place at night may be experienced in the morning. Satin sheets, use of lubricants or body oils may help mobility and increase pleasure. A sex therapist can assist the couple in finding options to maintain intimacy.

Changes in sexuality can lead to tension between the couple. Talking about sex and making attempts to find solutions is important to cope with sexual dysfunction imposed by Parkinson’s. Sometimes the first step is speech therapy, as speech is often impaired preventing mutual discussion.

Communication is the key to maintaining a relationship in which respect, partnership, tenderness and love may be freely and warmly expressed.

For more information, contact your regional Parkinson Society.

Source: Parkinson Society Canada, A Manual for People Living with Parkinson’s Disease, section 17.

©2010