Ask an Expert: Sexuality and Parkinson’s Disease

Sheila Silver, MA, DHS, ACS Dr. Sheila Silver is a board certified clinical sexologist in private practice in Portland, Oregon. She sees individuals and couples for a range of sexological issues including desire discrepancies, orgasm difficulties, pain with intercourse, alternative relationships and maintaining intimacy in the face of chronic illness, with a specific expertise in Parkinson’s disease. She has a Masters degree in Marriage, Family and Child Therapy and a Doctoral degree in Human Sexuality.

What do you do as a sexologist?

As a clinical sexologist, I offer sexual information, counselling and workshops for individuals, couples, therapists, clergy and health care professionals. Often shame, trauma or simply a lack of education prevents people from creating the sex life they want. My intention is to create an environment where people can feel comfortable talking about their beliefs, attitudes, life history and behavior, to see how all of that impacts their struggles. I then offer suggestions of things they can read, think about and do at home, to make small changes that can shift their perspective and experience.

In September 2016, you presented on Creating and Keeping Intimacy in Your Relationships at the World Parkinson Congress in Portland, Oregon. What are some tips you have for people with Parkinson’s disease who want to maintain intimacy with their partners?

The first thing I always recommend is communicating with your partner about how you are feeling about your sexual relationship, and to share ideas you have to create more intimacy. Often couples haven’t needed to communicate about sex prior to a PD diagnosis or health issues that affect their sexuality. Conversations where the couple can be allies toward a common goal can help to eliminate defensiveness and allow for collaboration in creating a sex life where the goals are simply pleasure and connection. I also encourage couples to expand their definition of “sex”. I invite them to view sex as a buffet of many options that feel physically good and promote emotional intimacy. This enables couples to create a new experience every time, choosing different things from the “buffet” based on their energy levels, mood and abilities. Finally, prioritizing physically connecting with your partner, even if it means putting intimacy on the calendar, indicates to each of them that it is important and something they both want. Even if it is simply naked cuddling, or each person receiving 10 minutes of touch that they ask for, these are ways couples can feel close, connected and more than roommates!

What are some common misconceptions about aging and sexuality?

The biggest misconception is that older adults are less interested in sexuality. Although there are changes in sexual drive and sexual response with age, these changes do not mean older people are not sexual. On the contrary, for most adults pleasure and interest don’t diminish with age, but how we choose to express ourselves sexually changes. For example, intercourse may be more difficult or painful due to health issues or menopause, but older adults still enjoy erotic sensual pleasure with an intimate partner, with or without orgasm.

How may Parkinson’s affect genders differently, in terms of sexuality?

The sexual side effects of PD are very similar for both genders. Loss of desire, depression, sleep issues, hypersexuality caused by medications, large and small motor changes, difficulty achieving orgasm and diminished facial animation can all impact a sexual relationship. Men can also often have erectile issues and women may experience pain with intercourse. It is important for patients to report these changes to their doctor, so adjustments can be made and they can be referred to other professionals who can be of help.

Do you have any words of advice for someone considering scheduling an appointment with a sexologist or counsellor who specializes in sexuality, but who may be shy or uncomfortable?

I would suggest sharing your discomfort with the therapist so the two of you discuss this right at the beginning. I always reassure my clients that I understand how hard it can be to discuss the most intimate aspects of their life with someone they don’t know, particularly if they have never done that before with anyone. I assure the client that I have “heard it all” and I am very comfortable with anything they want to share. I often convey my admiration for them for their willingness to ask for help in this area. Their courage and honesty can make a real difference in solving the issues that bring them to my office.

Are there any resources people with Parkinson’s can access from home if they would like to know more?

I can recommend three books that give more context for many of these topics I have discussed here. One is Sexual Intelligence by Marty Klein. Although it is not specifically about PD, it explains in greater detail the need to expand one’s definition of sex as we age and/or face chronic illness. Another good book is Naked At Our Age by Joan Price which gives some sex education for older adults. Finally, Maria De Leon’s book, Parkinson’s Diva: A Woman’s Guide to Parkinson’s Disease is wonderful. She is a medical doctor so she brings a medical perspective, but she is also a woman with PD and writes informatively about the challenges facing women with Parkinson’s.

This content was published in the Winter 2016 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.