Relationships, Sex and Initmacy

01/20/2011

Living with Parkinson’s can affect you and your relationships in both positive and negative ways.

Parkinson’s can introduce you to new relationships; people that bond through common experiences and share common goals (see related article about support groups.) Parkinson’s can also bring periods of adjustment. This includes adjustment to symptoms, changes in relationships and intimacy.

Intimacy and sex are hard topics to talk about. The first step is to understanding why you are feeling a certain way, how Parkinson’s can affect sexual function and intimacy. With this you will have the information you need to talk about these issues rather than avoiding the problem.

Changes in sexual function include loss of libido or desire for sex, erectile dysfunction or inability to maintain an erection, and difficulty achieving orgasm in women.

Many times people are hesitant or embarrassed to talk about these problems. Often movement problems and medications become the focus during medical visits and intimacy and sexual function become a lower priority. In addition, some medical providers may be reluctant to discuss problems associated with intimacy and patients may feel there is little time left during their appointment and feel too rushed to engage their provider about their changing sexual function. However, sexual function and the importance of intimacy in one’s life is one of the more important priorities for many patients at all stages of PD.

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. Medical problems, medications, psychological factors, relationship changes can affect sexual health. Identifying and understanding what can impact your sexual life is the first step to combat changes and maximize intimacy in your relationship.

Parkinson’s motor symptoms affecting sexual health

Trouble with movement- tremor, stiffness, slowness, dyskinesia, dystonia

Stamina

Pain

Other medical problems that can affect sexual health

Depression Anxiety Impulsivity Control Heart disease Thyroid disease

Hypertension Constipation Obesity Arthritis Insomnia

Fatigue Restless Legs Prostate disease Bladder Control Diabetes

Psychological factors that can affect sexual health

Self esteem Loss of control Anger/resentment Negative body image

Changing role with loved one Fear

Issues for the partner and couple
Fatigue Change to caregiver role Fatigue Anger/resentment

Fear Depression Anxiety Stress Loss of interest

Focus on disease Loss of communication

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 carry a high risk for increasing sexual drive. An increased or decreased libido, impulsivity, or sexual dysfunction can all put a strain on the relationship.

[See related article on hypersexuality and impulsivity control)

There are other possible causes of changes in sexual function and desire and include 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 problems that can cause declines in sexual function. The primary care physician may investigate hormonal changes that can influence sexual function such as 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. Your primary care physician may refer you to a gynecologist or urologist for diagnostic testing to help determine all possible contributing factors when there is a change in sexual function. As with Parkinson’s care in general, a team approach is needed to optimize sexual health. Other team members may be a physical therapist skilled in treating bladder disorders, occupational therapist to focus on bed comfort and mobility or behavioral health counselors.

[See related article reviewing medical therapy for sexual dysfunction.]

Intimacy

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 PD. 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.

[See Relationship and Intimacy Worksheet for tips to keep relationships strong.]

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 psychologists 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. Take a moment to review the worksheet, Relationships and Intimacy, for ideas and discussion points that can help you and your loved one.

Learn more and Print the Relationship and Intimacy Worksheet.

Author: Sierra Farris, PA-C, CES

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