Let's Talk About Sex (and Parkinson's)
Let's Talk About Sex (and Parkinson's)
Gila Brunner and Orna Moore
Posted in Living with Parkinson's
A call to the international Parkinson's community
On April 9, 2015
Sexuality and intimacy are a challenge facing Parkinson's patients and their partners. But as Gila Brunner and Erna Moore explain, they open channels of communication that are essential for a normal quality of life.
Proximity is an important factor in human behavior that includes communication, mental and physical proximity and interpersonal relationships.
Sexuality is the primary manifestation of intimacy. It is a complex process influenced by interrelationships between biological, psychological, economic, political and cultural factors. Sexual dysfunction is a problem that affects both health and mental and physical well-being.
In Parkinson's disease, poor sexual function is common with a connection to movement disorders, and emotional and cognitive difficulties, sleep disorders and side effects of drugs. Each of the symptoms of the disease can create emotional, physical and cognitive difficulties, which can be expressed in changes in the intimate relationship between the patient and his partner.
look at reality
Living with Parkinson's involves dealing with a variety of motor and non-motor symptoms that can affect relationships and sex life, resulting in frustration, sexual dysfunction and sometimes loss of self-esteem. Some couples easily accept the limited intimacy and the cessation of sexual activity, while for others the quality of life will be significantly affected.
"Depression, excitement and self-esteem often contribute to sexual dysfunction and lack of sexual satisfaction"
Movement disorders such as stiffness, tremors, immobility in bed or lack of control over delicate finger movement, which is required for intimate times (hugging, kissing, affectionate touch) and sexual activity. Other disease symptoms, such as excessive sweating, salivation and postural problems make the patients less sexually attractive, and a mask face can be interpreted as a lack of sexual attractiveness. Movement problems can cause patients to be sexually passive while making their partner more sexually active.
In our clinical experience, we have seen that couples often feel rejected when their partner with Parkinson's disease ignores them from intimate and sexual contact. Parkinson's patients avoid intimate contact due to fear of rejection or failure.
How to deal with motor and non-motor symptoms
The manifestation of non-motor symptoms in Parkinson's patients may be more limiting than motor symptoms. They can include lack of bowel movement, drooling and bladder problems, hallucinations, weakness, learning and memory problems, sweating and skin problems. Some of them, such as the lack of sense of smell, constipation, depression and sleep problems during the phase of rapid eye movement (REM) can precede the motor symptoms. Others, especially cognitive symptoms such as hallucinations and dementia, tend to appear in the later stages of onset.
3 out of 4 Parkinson's patients suffer from constipation. Bowel inactivity and constipation can cause discomfort, a feeling of heaviness and pain. It is clear that in this situation it is difficult to create intimacy.
Bladder problems are also common, in fact they happen to one third of Parkinson's patients. The most common problem with the bladder is overactive bladder. Its symptoms include getting up at night to urinate, high frequency of urination and urgency when going to urinate.
These problems, in the urinary bladder including lack of bladder control, may damage the patient's self-esteem, which leads to the feeling that they are not sexually attracted to him.
In addition, depression, excitement and self-esteem often contribute to sexual dysfunction and lack of sexual satisfaction. Again these factors affect about a third of Parkinson's patients. Even the patients suffering from moderate depression lose all desire for sexual activity and it is very difficult to tempt them and stimulate them.
"Some Parkinson's patients are not aware that their sexual dysfunction is related to their health condition and the treatment they receive, and therefore do not raise these issues with their neurologist"
The medication given against depression and excitement has an effect on intimacy and sexual function. While an improvement in mood can improve the ability for intimate communication and return to sexual function, antidepressants can impair erection and make it difficult to reach orgasm.
In addition, sleep disturbances and excess hours of daylight sleep lead to separation of beds for sleeping, thus reducing the possibility of intimate contact and sexual activity. The sexual partners can be irritable, impatient and tired, and their anger and frustration over the sleep disorders can have a severe effect on their relationship. In addition, partners who used to talk and share feelings may find that due to speech problems, the number of opportunities for intimate communication will decrease.
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The contrast between a partner and a therapist
In these difficult circumstances, the caregivers of Parkinson's patients face a contrasting reality. On the one hand, they are partners or partners with feelings and needs for intimacy and sexual activity. And on the other hand, they are required to act as caregivers for patients with chronic diseases. These necessary tasks are often expressed in great frustration, depression, weakness and a sense of loss. A continuous accumulation of unresolved tensions may contribute to the formation of abnormal relationships.
It is important to remember that treatment requires a lot of time, dedication and energy. Which results in the Parkinson's patient and their caregiver spending a lot of time together. Every healthy relationship requires space between the partners, which means that each couple should take care of free time for themselves to do something they like, such as exercising, meeting friends or going to see a movie. These separate activities will enrich the relationship between the couple and create the much desired interval and improve sexual intimacy.
The role of professionals
Parkinson's patients often feel embarrassed about their sexual needs. They may think that their interest in sex is irrelevant especially because they are so sick or so old. Some Parkinson's patients are not aware that their sexual dysfunction stems from their disease and the treatment of their disease, and therefore do not raise this issue with their neurologist.
Therefore, it is necessary for the treating staff to be aware of the sexual changes that occur due to the disease and its treatment, and to inform the patients about the importance of sexuality. If sexual problems are not solved, the self-esteem of Parkinson's patients decreases and creating an adjustment to image and physical function becomes difficult.
"Providing professional support can help couples understand the way in which Parkinson's disease affects the patient's abilities, and allow both to make the right adjustments"
Most Parkinson's patients and their partners welcome the opportunity to talk about sex and intimacy with a professional therapist they trust. But many would welcome the opportunity to receive some guidance on how and when to share their feelings, and would prefer that the attending physician initiate such a conversation. They want to tell what it's like to live with a chronic disease, how it affected them psychologically and physically and how their personal lives were affected as a result.
Talking about sexuality and intimacy allows people to get used to being sick with a chronic disease, which involves physical changes, sensory changes and weakness. Such support allows professional therapists to explain to couples how Parkinson's disease affects the abilities of Parkinson's patients, and allows them to make adjustments.
While all Parkinson's patients should be given the opportunity to discover issues of intimacy and sexuality, raising sexual issues with care professionals should be encouraged and thus be the driving force for better treatment of sexual dysfunction. Such patient-centered treatment can lead to a significant improvement in the quality of life.
Gila Bruner is a certified sex therapist. She manages the sexual therapy service at the Mini Medical Center belonging to the Sheba Medical Center in Israel. You can be contacted at gilab@netvision.net.il
Orna Moore is a specialist nurse for Parkinson's and movement problems. She also manages the memory and attention centers of the neurological department at the Tel Aviv Medical Center. You can be contacted at
