Sexual difficulties between people with Parkinson’s and their partners are common — surveys report them in 42.6% to 79% of men and 36% to 87.5% of women. Despite that, it is a hard subject to raise first in the exam room, so it often goes unaddressed. Simply knowing how common it is takes some of the weight off the “is it just me?” feeling.
There is rarely one single cause
Changes in sexual function usually come from several things overlapping. The autonomic effects of Parkinson’s itself can cause erectile dysfunction in men and reduced arousal and lubrication in women, and low mood, fatigue, pain and difficulty moving all affect sexual interest and satisfaction. Among medications, anticholinergics are known to lower libido, while most Parkinson’s medications have no direct effect on sexual function. Dopamine agonists can do the opposite and drive libido too high, as part of an impulse control disorderBeing unable to stop a behavior that is harmful, or could become harmful. A characteristic feature is a feeling of relief from anxiety or tension when the behavior is carried out.Learn more — so if you notice a change in either direction, it is worth checking whether medication is involved.
Men and women tend to run into different things
For men, erectile dysfunction is most often the form it takes. For women, surveys more often find reduced desire and difficulty reaching orgasm. The reported severity of the problems doesn’t differ much by sex, though several studies find that men feel the overall impact more strongly. Either way, the first step is knowing this is a common symptom rather than something strange.
Start with a conversation
Talking honestly with your spouse or partner about what you’re finding difficult is the most important first step. Your care team often won’t ask about it, so even if it’s uncomfortable, raise it yourself during an appointment. If having the conversation alone is hard, couples counseling that covers sexual difficulties, or a sex therapist, is another route.
Try adjusting the timing and the approach
Plan for the times of day when your medication is working best, and work out together which positions and approaches your body finds comfortable. Rather than straining to keep doing things exactly as before, finding a new approach that suits your body now does more to keep the relationship going.
Erectile dysfunction has treatment options
Lifestyle changes and oral medication (the PDE5 inhibitorA class of oral medication used for erectile dysfunction (sildenafil is the best-known). If you also take blood-pressure medication your blood pressure could drop too far, so tell your care team everything you are taking before starting one.Learn more class) help in many cases. Less often, injections or surgery are considered. If you also take blood-pressure medication the interaction needs checking, so always talk it through with your care team before starting.
For women, lubricant and pelvic floor work help
Discomfort from vaginal dryness can be reduced considerably with a water-based lubricant, and if orgasm has become difficult, pelvic floor physical therapy sometimes helps. A gynecology visit to check whether something else is contributing is also worth doing.
If bladder problems come with it, plan around them
When bladder control is unreliable, the prospect of intimacy itself can feel worrying. Going to the bathroom beforehand, and using an absorbent pad if you need one, are practical steps. It is common for this worry to lead to avoiding intimacy altogether — but bladder problems are a symptom that can be treated and managed in their own right, so raise them with your care team at the same time.
If a dopamine agonist has pushed libido too high
A change like that can be a side effect of medication rather than a matter of willpower. Instead of blaming yourself, tell your care team and ask whether the drug or the dose can be adjusted.
What you can do now
Sexual difficulties are a common symptom, and a lot of it can be treated or adjusted. If raising it at your next appointment feels hard, write a note beforehand and get through even a short version of the conversation.
This article is not a substitute for medical diagnosis or treatment. Check specific symptoms and treatments with your care team.
