Sexual & Reproductive Health

Sexual Problems in Parkinson’s

As with any subject that makes us the least bit embarrassed, sexual problems often are swept under the rug. The subject is seldom mentioned outside the bedroom (and can feel taboo even inside the bedroom) and may rarely be brought up to (or by) your doctor. Still, sexual changes are a common part of getting older and occur frequently among people with Parkinson’s.

You can continue to have healthy sexual relationships while living with Parkinson's disease (PD), but you may experience new challenges. The symptoms of Parkinson's can create barriers to intimacy, and many people with Parkinson's experience emotions that affect their sexual relationships, such as anxiety, fear and insecurity about physical changes. The stress of caring for a loved one with PD can make you feel tired, anxious or even resentful. Talking with your partner is key to finding solutions that work for both of you. If you can remain open, honest and patient — and remember that physical closeness takes many forms — you and your partner can, together, discover many ways to adapt.

Your doctor is a source of help. Treatments and strategies are available, but people often don't talk to their doctors about sexual matters. Sharing this aspect of your life with PD with your physician can help you maintain a healthy sexual relationship and quality of life.

Parkinson's symptoms and medications can bring changes in sexual health:

• Slowness and stiffness can make sexual activity more challenging.
• Tremor and dyskinesia can cause discomfort or get in the way, especially as these naturally increase with excitement.
• Fatigue and depression, common in PD, can lessen sex drive.
• Parkinson's drugs, such as dopamine agonists, can increase sexual interest and activity. Some antidepressants do the opposite and lower interest in sex.   
• Changes in your body image and appearance and shifting household roles and responsibilities also can affect sexual relationships.

Challenges for Men

Erectile dysfunction (ED) is the most common sexual problem for men with Parkinson's. Medication side effects, progressing disease and non-motor symptoms, such as anxiety or apathy, can decrease sex drive, erections and orgasm.

As depression often occurs with ED, treating depression may help ED. Some antidepressants, though, also can decrease sex drive and cause ED. Ask your doctor about newer medications that are less likely to contribute to ED. Other treatments for ED range from medications, such as Viagra (sildenafil) and Cialis (tadalafil), to physical or talk therapy, to vacuum devices and surgical implants.

Challenges for Women

Women with Parkinson's may experience decreased sex drive and problems with orgasm. Some also have pain with intercourse, often from decreased lubrication. Changes in the hormone estrogen may play a role. (Estrogen also seems to have an impact on Parkinson's, but details of this interaction are not yet known.) Many women also grapple with body image, and the physical changes and sometimes social stigma of PD can affect a woman's perception of her body. Treatment options include adding lubrication, timing sex for periods when Parkinson's symptoms are well controlled and talking to a therapist.

Treatments and Strategies

If your doctor does not ask about sexual problems, you may have to raise the subject yourself. Your doctor needs to be aware of your concerns. That way, you can talk about possible treatment options and work on a plan for you. If you have sexual problems, consider these tips:

• Schedule sexual activity: Consider times when your medication typically is working best.
• Experiment: Find what works best for you and your partner, and look for ways other than sex to express affection.
• Ask your doctor about treatments: Prescription medications are available for specific problems, such as erectile dysfunction or vaginal dryness. Your doctor also may refer you to another specialist, such as a urologist or gynecologist, for help managing your symptoms.
• Be honest about your experience: Don't be embarrassed or afraid to discuss changes in your sex drive or activity with your doctor. This could signal the need to adjust or change medications.
• Talk to your partner: Talk often, openly and honestly about what's going on so that you can find ways around Parkinson's. You also can work with a counselor or sex therapist to guide these conversations.

Pregnancy & Contraception

There is limited data on Parkinson's and pregnancy, but plenty of women with PD have successfully carried healthy babies to term. During pregnancy, some women notice a slight worsening of symptoms. Some say they have fatigue, mild memory problems or sleep changes, many of which are common in pregnancy, regardless of whether you have Parkinson's.

Some women wonder about the safety of taking Parkinson's medications during pregnancy. No thorough study of the effects of Parkinson's drugs on the developing baby has been conducted. When considering taking PD medication during pregnancy, the benefits should be weighed against potential risks. A woman with mild symptoms might be able to forego medication, but a woman with moderate symptoms might require medication in order to work and/or care for other children. Your movement disorder specialist will find the best treatment plan for you and coordinate care with your obstetrician. You also may be offered genetic counseling with an expert who can outline the genetic components of PD and talk to you about genetic testing.

Women with PD seeking to prevent pregnancy or regulate menstrual cycles might use birth control pills (oral contraceptives). These medications boost the effects of certain PD drugs, so dosages may need to be adjusted, especially when starting or stopping oral contraceptives. Some women may prefer alternatives to the pill, such as an intrauterine device (IUD) or a diaphragm.

The medical information contained in this article is for general information purposes only. The Michael J. Fox Foundation for Parkinson's Research has a policy of refraining from advocating, endorsing or promoting any drug therapy, course of treatment, or specific company or institution. It is crucial that care and treatment decisions related to Parkinson's disease and any other medical condition be made in consultation with a physician or other qualified medical professional.