Relationships and Intimacy

Living and coping with Parkinson’s and the evolving role of the partner as caregiver can impact your relationship in both positive and negative ways. Understanding how Parkinson’s affects intimacy, sexual function and desire as well as relationships is the first step in discussing the complicated and many times avoided subject of sexual function and intimacy.

Changes in sexual function and desire can occur even before PD is diagnosed. The reason for these changes can be complex and vary from one individual to the next. Some individuals experience anxiety, depression, insomnia, fatigue, restless legs, bladder problems, constipation,
and personality changes. All of these symptoms can impact intimacy and relationships. Identifying and understanding how symptoms of PD can impact your sexual life is the first step to combat changes and maximize intimacy in your relationship.

Parkinson’s disease can cause changes in the body and brain that lead to erectile dysfunction, decreased libido and difficulty reaching orgasm. On the
other hand, medications used to treat PD can cause an elevated libido or sex drive. Dopamine modulates sexual desire and satisfaction and can contribute to impulse control problems including hypersexuality which can be very disruptive in a couple’s life. Dopamine agonists (ropinirole and pramipexole) are a type of PD medication that carries a high risk for increasing sexual drive. An increased or decreased libido, impulsivity, or sexual dysfunction can all put a strain on the relationship.

There are other possible causes of changes in sexual function and desire including other medical problems, stress, depressed mood, apathy, pain, or inability to participate due to movement problems. Heart disease, respiratory disease and the complications of diabetes are other common medical conditions that can cause declines in sexual function. For some, changes in hormonal levels can affect desire and sexual performance. Your PCP can evaluate this with simple blood tests that measure levels of testosterone, estrogen and androgens.

Some medications are known to interfere with sexual function including narcotic pain medications, antipsychotics, allergy and blood pressure medications. Serotonin reuptake inhibitor anti-depressant medications are associated with decreased libido, erectile difficulty, delayed ejaculation and difficulty with orgasm.

As with Parkinson’s care in general, a team approach is needed to optimize sexual health. Your neurologist can review your motor symptoms to help improve movement and comfort throughout day and night. Insomnia, restless legs, bladder problems, constipation, fatigue, and pain can affect your sex life. Your PCP can review these concerns, your medicines, medical conditions and hormonal changes that affect sexual function. A gynecologist or urologist may be needed for special testing or treatment. Medications such as Viagra and Cialis can help certain types of sexual dysfunction in men. However, psychological or relationship counseling should be considered an important part of treatment to help with anxiety, depression, loss of confidence or self esteem, personality changes, change in relationship or the role one plays in a relationship.

Intimacy can be more complicated to discuss than the mechanics of sexual function. Intimacy is a very dynamic exchange between partners ranging from feeling of closeness to physical pleasure and may fluctuate over the course of Parkinson’s. Intimacy also takes many forms from the caring and empathy from a close friend or the emotional and physical connection you share with your partner or spouse. The impact of PD on relationships is as important for quality of life as mobility, communication, mood or cognition. The loss of intimacy endured by the partner or spouse may go unrecognized by the patient and partner. Simple touch can be a very powerful source of intimacy but can slip away for both the patient and partner as the PD progresses. Speech problems and masked face alter communication and can add to the challenges a couple can experience over time. Added to this challenge is the fatigue experienced by both the patient and partner with little energy left to cultivate the relationship.

There will be changes over time in the roles of both the person living with PD and their partner or spouse. At times more help will be needed and the caregiver status may take the forefront. This should be discussed by the couple to negotiate how to manage the roles associated with caregiver and intimate partner. The loss of intimacy is a loss that can be avoided.

Identifying strengths in a relationship help build the foundation for the best possible experience for a couple living with PD. Revisiting the memories that all couples share keeps both invested in creating new memories over their life together. Positive steps are an important focus for couples and include being open and honestly sharing feelings. Problems with intimacy can be very emotional and leave each individual feeling vulnerable. Talking about what is working, what is missing and what is needed in the relationship can be guided by Neuropsychologists and counselors who are trained to help with coping strategies to maximize sexual health and can bridge the gap with medical providers. Primary care physicians also play an important role to optimize your general health for sexual activity. Communication is the key for emotional health, including intimacy and sexual relationships.

Think about the following discussion points. It might be helpful to sit down with your loved one and discuss these issues together. It is important to be open, honest and respectful. What has changed in our relationship that we are reluctant to discuss?

What could I do to make the relationship stronger?
Could we find some quality time each week where we sit, talk and listen and truly hear what the other has to say?
What am I doing that is causing un-necessary stress on the relationship?
What is working well and what needs more attention?
Should we meet with a counselor for guidance?

Author: Sierra Farris, PA-C, Physician assistant and DBS Specialist

Copyright 2011 Northwest Parkinson's Foundation Wellness Center
www.nwpf.org/wellness

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