Men's Sexual Health and Wellbeing in Parkinson's

If you experience sexual difficulties as a result of your Parkinson’s disease (PD), you are far from alone – research shows that approximately 50% of people with PD have similar concerns (Bronner & Vodušek, 2011). Moreover, men with Parkinson’s may face a unique set of challenges because of an interplay of biology and social factors. While many men feel embarrassed to talk about such difficulties, there is a compelling reason to address the proverbial elephant in the bedroom: research conducted on men in the early stages of the disease suggests that those who maintained a healthy sex life were less likely to experience motor disability and depression, and had a higher quality of life overall (Picillo et al., 2019). It is important to note that the definition of a healthy sex life is open to interpretation, and what is considered satisfying differs widely between individuals. Sexual intercourse is just one expression of sexual intimacy, and is by no means the only way to foster an intimate connection with one’s partner.

Types of Sexual Dysfunction Experienced by Men

Below are some of the most common sexual function concerns reported amongst men with Parkinson’s. However, no two people’s Parkinson’s is the same, as the disease varies in both its symptoms and progression. Just because a symptom is common does not mean any one person is guaranteed to experience it.

• Erectile dysfunction (ED): ED occurs in 60% to 80% of men with Parkinson’s (Bronner & Korczyn, 2017). While erectile dysfunction may be a natural consequence of aging, PD can exasperate difficulties with erections, as the disease affects the nervous system.
• Decrease in libido: studies show that people of all genders with Parkinson’s experience a decrease in libido. Interestingly, predominantly experiencing motor symptoms on the left side of the body is correlated with a greater loss of libido (Kummer, et al., 2009).
• Difficulty with orgasms: one study found that men with Parkinson’s who experienced difficulty with orgasms were afraid of not meeting their partner’s expectations; as a result, they were more likely to show avoidance in the relationship, as well as have thoughts of withdrawing from their partner (Bronner & Korczyn, 2017).
• Positioning difficulties: many people with Parkinson’s report that physically positioning their bodies during intimate moments may be challenging due to the motor symptoms of the illness (Hocaloski, 2022). Furthermore, the societal expectation that men should take a more active role in the bedroom can be difficult to live up to for those who experience profound motor symptoms.

Factors Contributing to Sexual Difficulty in Men

There are a number of reasons why a man with Parkinson’s might experience sexual difficulty, including:

• Stress, anxiety, and depression: living with a chronic neurological condition can certainly bring about challenges, as both the person with PD and their partner deal with the day-to-day and plan for the future.
• Hormones: testosterone naturally decreases over one’s lifetime. However, testosterone deficiency, which affects about half of men with PD, can potentially cause apathy, as well as reduced sexual desire (Bronner & Korczyn, 2017). Snoring, sleep apnea, and opiate use can also decrease this important male sex hormone (Hocaloski, 2022).
• Parkinson’s disease symptoms: both the motor and non-motor symptoms associated with PD can pose a challenge to one’s intimate life. Autonomic dysfunction, which may cause symptoms such as bladder and bowel problems, drooling, and excessive sweating, can interfere with sexual expression (Kummer, et al., 2009). Fatigue and pain, two very common non-motor symptoms of PD, also can present challenges.
• Medication side effects: one study found that the use of dopaminergic medications may contribute to erectile dysfunction and low desire (Bronner & Vodušek, 2011). However, levodopa may also cause the opposite effect, resulting in hypersexual and compulsive behavior. If you suspect your medication is causing unwanted sexual side effects, consult your healthcare provider.
• Predetermined expectations: sometimes, the expectation that all sexual advances will lead to intercourse can disrupt the emotional or physical intimacy of relationship. For example, if a man with Parkinson’s experiences ED, he may hesitate to make a flirtatious remark to his partner, for fear of disappointing them later (Hocaloski, 2022).

Tips for Optimizing Male Sexual Health and Wellbeing

Fortunately, there are many things men can do to improve both their attitudes about sex, as well as their sexual function. These include:

• Focusing on responsive versus spontaneous desire: when desire is portrayed in the media, it is frequently that of a spontaneous nature – for example, a person is suddenly struck with passion and yearning for their partner or for sexual activity. This perpetuates the myth that if desire is not spontaneous, it is nonexistent. However, in real life, desire is often a response to something. Don’t feel discouraged if arousal is not instantaneous; it may build with a little bit of patience as the sexual encounter goes on (Hocaloski, 2022).
• Medical treatment options: there are numerous treatments for common concerns, such as erectile dysfunction. PDE5 inhibitors, such as Viagra and Cialis, work by affecting chemicals in the body that relax the muscles of the penis, allowing for easier erections. Because people with Parkinson’s disease experience slower gastrointestinal function as a result of PD, it may take substantially longer than normal for these drugs to work. A more invasive option to treat ED is intracavernosal injections. These injections, which are administered into the penis, are often more affordable than medications for ED, and have the added benefit of not requiring sexual arousal to work, unlike PDE5 inhibitors. Additionally, apomorphine, a dopaminergic drug used for Parkinson’s disease, has shown some positive effect on erections. However, at higher doses, apomorphine can cause nausea and other unwanted side effects (Hocaloski, 2022). Some men find that a combination of therapies is best for treating their erectile dysfunction. Talk to your doctor to explore the options available to you.
• Hormone therapy: if testosterone deficiency is a concern, daily transdermal testosterone gel can quickly improve symptoms, such as loss of libido, apathy, and depression (Bronner & Korczyn, 2017).
• Improving positioning, and planning sexual encounters during medication ‘on’ periods: the use of common household items, like pillows, chairs, and headboards, can help to make positioning more comfortable. Planning sex around when medication is working most effectively is another way to make sure that the experience is as rewarding as possible (Hocaloski, 2022).
• Shedding preconceived expectations: narrowly defining sex as only intercourse excludes a whole world of intimate activity that can be both pleasurable and emotionally fulfilling. Remaining open and challenging yourself to expand your horizons increases the number of opportunities you have to be surprised by an outcome. Even if sexual activity looks different when compared to before a Parkinson’s diagnosis, there are many ways to optimize your potential and adapt to your limitations. Explore what is best for you and your partner (Hocaloski, 2022).
• Seeking the help of a counsellor or sex therapist: the objective perspective of a professional can be invaluable, especially for sensitive topics such as sexual wellbeing. Parkinson Society BC offers free, confidential counselling for people with PD and their loved ones. For more information, visit www.parkinson.bc.ca/counselling.

Sources

Bronner, G., & Korczyn, A. (2017). The role of sex therapy in the management of patients with Parkinson’s disease. Movement Disorders, 5(1), 6-13. doi: 10.1002/mdc3.12561

Hocaloski, S. (2022, September 27). September Symposium Series (2022): Sexual Wellbeing - The Male Experience [Video]. YouTube. https://youtu.be/CxXafoQnCo0

Kummer, A., Francisco, C., & Teixeira, A. L. (2009). Loss of libido in Parkinson’s disease. The Journal of Sexual Medicine, 6(4), 1024-1031. doi: 10.1111/j.1743-6109.2008.01083.x

Picillo, M., Palladino, R., Erro, R., Colosimo, C., Marconi, R., Antonini, A., & Barone, P. (2019). The PRIAMO study: active sexual life is associated with better motor and non-motor outcomes in men with early Parkinson's disease. Eur J Neurol, 26: 1327-1333. https://doi.org/10.1111/ene.13983

This content was published in the Winter 2022 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.