SEXUALITY
AND PARKINSON’S DISEASE
(Presented
in the International Symposium on Mental and Behavioral
Dysfunction in Movement
Disorders, Oct. 2001 ,Montreal Canada.)
Bronner
Gila
Sex Therapy Clinic, Movement Disorders Unit,
Department of Neurology
Tel-Aviv Souraski Medical Center, 6 Weizman
st. Tel-Aviv, ISRAEL
Tl. 03-6974909 Fx.03-6393515 gilab@netvision.net.il
Patients with Parkinson’s disease
(PD) experience significant sexual disturbances as the disease progresses.
Physiological as well as psychological factors can explain the deterioration
in sexual function among these patients. Sexual interest and activity is
reduced both in male and female patients. Men report about erectile
dysfunction and women have difficulty to achieve orgasm. Motor symptoms
(rigidity, tremor and bradykinesia), mood changes (depression), treatment
with anti parkinsonian medications as well as psycho-social changes
(employment, sex role) can contribute to the development of sexual
difficulties in PD patients.
Since February 2000 the Movement Disorder Unit in Tel-Aviv Medical Center
was offering in house sex therapy and counseling service to patients and
their spouses in order to promote sexual health and contribute to
improvement in their quality of life. A study of 89 PD patients (50 men)
found a significant decrease along the course of the disease in sexual
satisfaction (2/3 of men and 1/3 of women) and in sexual desire
(
4/5 of men and 2/5 of women). Erectile dysfunction was related to H&Y stage
while orgasmic dysfunction in women was not.
In
parallel, the service initiated short training sessions on individual basis
for physicians in the Movement Disorders Unit, in order to increase the
awareness to sexual disturbances and to improve sexual communication with PD
clients.
During this period, thirty six PD patients (two women) received sex
counseling and therapy. Half of the men complained of erectile dysfunction,
third had desire problems and 7% premature ejaculation. The service was
based on a short term intervention using the intercourse- outercourse
approach with referral to specialist according to the specific sexual
dysfunction.
The intercourse- outercourse is a special training based on the concept of
sexual flexibility. It enables a choice of two sexual options for those
couples who cope with sexual dysfunction. They can either have intercourse
with or without medical treatment for their sexual dysfunction or enjoy a
variety of pleasuring sexual activities without penetration (outercourse).
The acquired sexual flexibility enables the PD patients and his/her partner
an increase in sexual satisfaction, intimacy and self-esteem and a decrease
in marital tension.
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