Gila Bronner

Sexual dysfunction in Parkinson's disease

Sexual dysfunction is common in Parkinsons disease (PD). We investigated the premorbid and present sexual functioning of 75 people with PD (32 women and 43 men). Women reported difficulties with arousal (87.5%), with reaching orgasm (75.0%), with low sexual desire (46.9%), and wih sexual dissatisfaction (37.5%). Men reported erectile dysfunction (68.4%), sexual dissatisfaction (65.1%), premature ejaculation (40.6%), and difficulties reaching orgasm (39.5%). Premorbid sexual dysfunction may contribute to cessation of sexual activity during the course of the disease (among 23.3% men and 21.9% women). Associated illnesses, use of medications, and advanced stage of PD contributed to sexual dysfunction.

Sexual Dysfunction After Radical Prostatectomy: Treatment Failure or Treatment Delay?

This study defines characteristics of delayed help-seeking in men who fail phosphodiesterase-5 inhibitors (PDE5I) treatment for their post radical retropubic prostatectomy (RRP) erectile dysfunction (ED). Medical charts were reviewed retrospectively. All men were offered second line treatment with vacuum devices or intracavernous injection (ICI) and sex therapy. This study included thirty one patients. Average age at surgery was 60 years (SD = 5.3, range 46–70). Average period for second line help-seeking was 25.9 months (SD = 12.9, range 3–111). All subjects believed that surgery would not affect their sexual function. Twenty men (65%) used ICI as a second line treatment. Eleven men (35%) declined treatment, waiting for spontaneous recovery. In ICI sub-group, 5 men (25%) regained spontaneous erection within 7–10 months after initial treatment (16–19 months post-surgery). Seven men (35%) responded positively to PDE5I 3–5 months after starting ICI. Three men (15%) used vacuum device. None regained spontaneous erection. All 7 men (23%) who met sex therapist with their partner reported improved sexual life, even if ED wasnt resolved. Patients should receive comprehensive information about sexual recovery, to encourage early ED treatment after RRP and to overcome unwanted misconceptions regarding spontaneous recovery.

Sexual problems in Parkinson's disease: The multidimensional nature of the problem and of the intervention

Sexual problems are common in Parkinsons disease and contribute to poor quality of life of patients and partners. Nonmotor and motor disease manifestations can affect sexual function. This article reviews the progressive and multidimensional sexual manifestations and provides practical suggestions for taking sexual history and treating sexual problems, which may enable clinicians to contribute to the sexual wellbeing of patients.

Sexuality in patients with Parkinson's disease, Alzheimer's disease, and other dementias.

Sexual dysfunction (SD) is common among patients with Parkinsons disease (PD), Alzheimers disease (AD), and other dementias. Sexual functioning and well-being of patients with PD and their partners are affected by many factors, including motor disabilities, non-motor symptoms (e.g., autonomic dysfunction, sleep disturbances, mood disorders, cognitive abnormalities, pain, and sensory disorders), medication effects, and relationship issues. The common sexual problems are decreased desire, erectile dysfunction, difficulties in reaching orgasm, and sexual dissatisfaction. Hypersexuality is one of a broad range of impulse control disorders reported in PD, attributed to antiparkinsonian therapy, mainly dopamine agonists. Involvement of a multidisciplinary team may enable a significant management of hypersexuality. Data on SD in demented patients are scarce, mainly reporting reduced frequency of sex and erectile dysfunction. Treatment of SD is advised at an early stage. Behavioral problems, including inappropriate sexual behavior (ISB), are distressing for patients and their caregivers and may reflect the prevailing behavior accompanying dementia (disinhibition or apathy associated with hyposexuality). The neurobiologic basis of ISB is still only vaguely understood but assessment and intervention are recommended as soon as ISB is suspected. Management of ISB in dementia demands a thorough evaluation and understanding of the behavior, and can be treated by non-pharmacologic and pharmacologic interventions.

Correlates of quality of sexual life in male and female patients with Parkinson disease and their partners

INTRODUCTIONnPatients with Parkinson disease (PD) and their partners may experience a worsening of their sexual life.nnnAIMnTo assess quality of sexual life (QoSL) in male and female PD patients and their partners.nnnMATERIALS AND METHODSnMedical, demographic and clinical data was collected regarding consecutive PD patients, including depression, and motor symptom rating. Partners data included the short form-12 health questionnaire (SF-12). All patients and partners filled the 5-item QoSL questionnaire.nnnRESULTSnData from 89 PD patients (66 men) and 69 spouses (52 women) was analyzed. Male patients rejected sex significantly less than female patients and their sexual desire was higher, but female patients reported higher sexual satisfaction. Patients and partners similarly perceived their relationship which was averagely good. Analysis within couples demonstrated that better QoSL of patients could be predicted by gender (male), better QoSL of their partners and, motor severity, but not the patients depression, age or use of l-dopa. The partners QoSL was explained by younger age, and better motor scores of their parkinsonian partner. Treatment of the PD patient with l-dopa or dopamine agonist was associated with worse partners QoSL.nnnCONCLUSIONnDifferences in QoSL of male and female PD patients and within couples were found. These findings suggest that focusing on partners needs may improve QoSL of patients and partners troubled by PD.

Unusual Masturbatory Practice as an Etiological Factor in the Diagnosis and Treatment of Sexual Dysfunction in Young Men

INTRODUCTIONnMasturbation is a common sexual activity among people of all ages throughout life. It has been traditionally prohibited and judged as immoral and sinful by several religions. Although it is no longer perceived as a negative behavior, masturbation is often omitted in the diagnostic inquiry of patients with sexual problems.nnnAIMSnThe aims of this study are to increase the awareness of clinicians to the importance of including questions regarding masturbatory habits in the process of sexual history taking, to analyze cases of male sexual dysfunction (SD) associated with unusual masturbatory practices, and to propose a practical tool for clinicians to diagnose and manage such problems.nnnMETHODSnA clinical study of four cases that include a range of unusual masturbatory practices by young males who applied for sex therapy is described. An intervention plan involving specific questions in case history taking was devised. It was based on detailed understanding of each patients masturbatory practice and its manifestation in his SD.nnnMAIN OUTCOME MEASURESnEffects of identifying and altering masturbatory practices on sexual function.nnnRESULTSnThe four men described unusual and awkward masturbatory practices, each of which was associated with different kinds of SD. The unlearning of the masturbatory practices contributed notably to improvement of their sexual function.nnnCONCLUSIONSnThe four cases in this study indicate that the detailed questioning of masturbatory habits is crucial for a thorough assessment and adequate treatment of sexual problems in men. We propose specific questions on masturbatory behavior as well as a diagnostic and therapeutic flowchart for physicians and sex therapists to address those problems.

Practical strategies for the management of sexual problems in Parkinson's disease

INTRODUCTIONnPatients with Parkinsons disease (PD) report frequent sexual dissatisfaction, desire, arousal and orgasmic problems. Motor and non-motor symptoms contribute to further manifestations of sexual dysfunction (SD). Studies have indicated that the need for intimacy and sexual expression are important dimensions of quality of life for PD patients. Inquiry about sexual functioning may be overlooked by neurologists due to time constraints, confusion about sexual conversation, and lack of proper training.nnnMETHODSnPractical strategies will be presented. Open Sexual Communication (OSEC) module will be used to overcome barriers for sexual discussion. Suggestion for further assessment and analysis of cases will enable understanding of specific sexual interventions adapted for PD patients.nnnRESULTSnPhysicians will be empowered to address sexual problems of PD patients and encounter a range of practical interventions.nnnCONCLUSIONSnThe physical and emotional changes in PD and treatment of the disease have a major effect on SD of patients and their partners. All patients may experience impairment of sexual function and quality of life. Health care providers can proactively address sexual health issues by providing information, by recognizing and treating the sexual needs of PD patients and by referring them to specialists.

Exploring hypersexual behavior in men with Parkinson's disease: is it compulsive sexual behavior?

BACKGROUNDnA range of impulse control disorders has been described in Parkinsons disease, including compulsive sexual behavior. Excessive sexual demands of parkinsonian men can lead to considerable tension within the couple. Thorough sexual interviews reveal that these cases may reflect various types of sexual dysfunctions that present as hypersexuality.nnnOBJECTIVEnThis study aims to analyze cases of presumed and true compulsive male sexual behavior, and to propose a practical tool for clinicians, assisting them with the diagnosis and management of compulsive sexual behavior and other sexual dysfunctions in parkinsonian patients.nnnMETHODSnWe describe four male patients with Parkinsons disease from the movement disorders clinic, which were referred to the sex therapist as suspected hypersexuality.nnnRESULTSnThe sexual assessment revealed that only one of the cases involved true hypersexuality due to compulsive sexual behavior. The other three presented with erectile dysfunction, difficulties reaching orgasm (delayed ejaculation), and a gap in desire within the couple.nnnCONCLUSIONSnComplaints about hypersexual behavior in patients with Parkinsons disease must be carefully evaluated, involving a multidisciplinary team. A comprehensive diagnostic and therapeutic algorithm is suggested.

Sexuality and Parkinson’s Disease

There is increasing public awareness that sexual dysfunction is a real problem affecting the health, wellness, and emotional well-being of innumerable women and men. Sexual function is an aspect of human behavior that encompasses relationship, physical and emotional intimacy, feelings, thoughts and interpersonal interaction. According to the World Health Organization (WHO) declaration (1), fundamental rights exist for the individual, including the right to sexual health and the capacity to enjoy and control sexual and reproductive behavior. Individuals are entitled to be free of fear, shame, guilt, false beliefs, and organic disorders that might inhibit normal sexual response and impair sexual relationships and reproductive function. Because healthy sexual functioning is an integral part of normal life, it should be incorporated into health care plans along with other factors ensuring quality of life. Health professionals, being at the front line of health care services, should play a major role in advocating sexual health rights.

Sexual Preoccupation Behavior in Parkinson’s Disease

People with Parkinsons disease (PD) present with problematic sexual behaviors that are often misunderstood or ignored. Sexual problems in PD are part of axa0non-motor syndrome, and they play axa0 prominent role in the life of affected individuals and their partners. Based on our considerable clinical experience, we describe four common types of sexual preoccupation behaviors in people with PD: (1) sexual behavior with underlying sexual dysfunction, (2) sexual desire discrepancy with partner after restored desire, (3) hypersexuality and compulsive sexual behavior, and (4) sexual behavior with underlying restless genital syndrome. We also suggest methods of assessing and diagnosing these sexual behaviors, and propose alternative possible treatments for people with PD and their partners/caregivers. Understanding these four behavioral types will assist healthcare professionals in explaining and educating people with PD and their partners, contribute to decreased stress and tension between them, and help them manage these sexual issues.