Sex and Parkinson's

Sexual problems can affect many people with Parkinson’s. This can be due to the physical effects of the condition on things such as co-ordination and speed of movement, or emotional issues like low mood or depression. Parkinson’s doesn’t affect everybody’s sexual functioning though. While some couples experience problems, a significant number don’t.

Both men and women can experience difficulties with sex. Sex is an important part of life for many people, so any problems you experience may have a big effect on your life. Sexual problems can be overcome or another form of intimacy can be found.

Sexual problems can affect either the person with Parkinson’s or their partner. Finding out one of you has a life-changing condition can change your view of your physical relationship. It may be less or even more important than before, as you feel you need to make the most of your time together for fear of less ability, or simply want to express your love for one another.

If you have Parkinson’s, it can affect your sexual self-esteem. You may feel less attractive or desirable. If you’re a carer, you may worry you’re being demanding by wanting to have sex with your partner. Having new roles as carer and cared-for may sometimes make it hard to feel like equal sexual partners.

These factors, as well as the impact of the condition and medication on the body, can affect sexual function.

Our sexual relationships change over our lifetime and problems happen in most relationships at some time or another. They may resolve themselves, or a couple may have to:

• adjust what they do together to take account of changing physical abilities
• redefine their expectations to fit with reality – some couples may think it’s a problem not to be enjoying regular sex, while others may be perfectly satisfied with a sensual caress once a month

If you’ve been in a relationship where sex has been good and you’ve both felt comfortable and confident talking about your desires and limitations, then it may be easier to face the challenges Parkinson’s can bring. You may have to work harder to get over the hurdles if this has been an awkward topic in the past. It’s worth trying – the increased openness and creativity required in your sex life may make it better than before.

Difficulties with sex can often happen when something disrupts your sexual responses. Causes of sexual problems include movement problems, fatigue and depression. These difficulties are common in people with and without Parkinson’s, so it may not be easy to tell whether a problem is a result of your condition or not.

The physical ability to have sex is affected by the nervous system, so it’s more common for people with neurological conditions, like Parkinson’s, to experience problems.

Some Parkinson’s symptoms may affect sexual activity. Below we look at these and what you can do to help treat and improve these issues.

Movement problems

The physical symptoms of Parkinson’s, like stiffness, rigid muscles and slowness of movement, may affect sexual activity. Making sure your Parkinson’s medication is working effectively may help improve these symptoms – speak to your specialist or Parkinson’s nurse. They may also be able to give you advice on sexual positions that may help you.

Fatigue

Fatigue can be a symptom of Parkinson’s. If it is an issue, try being intimate or having sex at a different time of the day when you have more energy.

Bowel and bladder problems

Fear of incontinence may make you or your partner nervous about sexual activity.

If you experience urinary incontinence, certain drug treatments may be helpful. Using the loo before intercourse may also help. For some people, using a catheter to help empty your bladder may be appropriate.

If you experience bowel incontinence, an enema before intercourse or using an anal plug can help.

The Bladder and Bowel Community can offer more information. 

Find out more about bladder and bowel problems and Parkinson’s.

Medications

Any medications you’re taking should be reviewed for side effects that may affect sex. Some drugs for depression can cause a reduction in sexual desire, problems with arousal and delayed, or lack of, orgasms. It’s best to speak to your specialist or Parkinson’s nurse about the options available for you so you can continue to get the most benefit from your medication.

Lowered sex drive

Many people with Parkinson’s and their partners have a lowered sex drive. This is often more to do with the psychological and emotional impact of diagnosis than as a direct result of the condition. General tiredness and depression, which are common for someone with Parkinson’s, can also lower desire. Your GP or specialist will look to treat any depression or mood disorders you may experience.

There are many different things you can try to get in the mood for intimacy or sex. You should do whatever suits you as a couple, but you could try the following:

• Take time to relax in the bath.
• Have a sensual massage by candlelight.
• Do something more energetic or playful together to get you in the mood.
• Revive the spark by investing in new lingerie or sex toys, watch an arousing video or read erotic stories to each other.
   

Whatever you do, agree beforehand that your goal is to get close and enjoy time together. The result may be sex, but it may not. Take the pressure off by investing your energy into creating the right environment. Then the outcome will happen more naturally.
 

Problems with sexual arousal 

Both men and women can struggle with becoming aroused sexually. You may experience this as a side effect of Parkinson’s medication or of the condition itself, or because of tiredness, stress, depression or low self-esteem.

The most important way to overcome this is to try to relax.

Before seeking treatment, try to rule out any emotional causes, such as stress, or tensions in your relationship.

You may benefit from:

• changes in routine, such as having sex in the morning when you’ve got more energy, instead of the evening
• an increase in stimulation, such as using a vibrator
• taking plenty of time to set the scene and get the mood right

The more you can do to be sensual together, the better the chances of arousal happening naturally.

Relationship counselling or psychotherapy may be useful if you’re experiencing a lack of sexual interest or desire.

Medications

Any medications you’re taking should be reviewed for side effects that may affect sex. Some drugs for depression can cause a reduction in sexual desire, problems with arousal and delayed, or lack of, orgasms. It’s best to speak to your specialist or Parkinson’s nurse about the options available for you so you can continue to get the most benefit from your medication.

Hypersexuality

Some people who take a type of medication known as dopamine agonists experience impulsive and compulsive behaviour. For a small number of people, other types of Parkinson’s medications, in particular levodopa, have been shown to have similar side effects.

Hypersexuality is a type of impulsive and compulsive behaviour, where someone is focused on sexual feelings and thoughts.

If a person is experiencing this, their sexual impulses become more intense. They might be felt at inappropriate times or towards people other than a partner. This can be distressing for the person and those around them. With hypersexuality, there’s also a risk that someone will behave in a way that’s socially unacceptable, or may even break the law.

This type of behaviour can have a big impact on the person affected and the people around them. It may be accompanied by sexual delusions and hallucinations, such as imagining that a partner is having an affair or thinking others are having sex when they’re not.

If this side effect is mild, then some couples may find they enjoy the extra sex. But for some it may become a difficult and distressing problem, particularly if the sexual desires feel out of control and are out of character.

If you think you’re experiencing this behaviour, the first step is to talk to your specialist or Parkinson’s nurse. You may find it uncomfortable to talk to a healthcare professional about the difficulties you’re having. But remember they’ll have spoken to others with similar problems before and everything you tell them will be confidential.

Sometimes people who experience impulsive and compulsive behaviour may not realise they have a problem. If you notice your partner’s sex drive has increased or their sexual behaviour has changed towards you or anyone else, it’s important to discuss it with a healthcare professional as quickly as possible.

Impulsive and compulsive behaviour can usually be controlled and steps taken to address changes in behaviour. In most cases, a change in medication can ease or remove the problem. Some people may need to seek more professional support, for example from a psychosexual therapist. You can find details of organisations where you can find psychosexual therapists at the end of this information.

Both men and women may experience reduced or absent orgasms. Some men may experience problems with premature or delayed ejaculation.

Treatments for problems orgasming may include therapies like psychosexual therapy or cognitive behavioural therapy. These can help individuals or couples find better ways to communicate sexually.

If you have problems reaching orgasm the following things might help:

Try to minimise any anxiety

If you worry about orgasm, it’s more likely to happen too quickly or not happen at all. Spend more time on general arousal and excitement. Agree that it won’t matter if one of you doesn’t orgasm – you’ll enjoy the time together.

Understand what you enjoy

Masturbation can help you understand what you find enjoyable. Give yourself enough time to explore what you find pleasurable without being disturbed. Feeling ashamed or embarrassed about what you’re doing won’t help you achieve orgasm, so try to relax into the sensations you experience.

Get to know each other

Take time to really get to know each other’s bodies. Ask about the kind of stimulation your partner likes. Try to fine-tune your technique so you’re always giving the best experience. When you approach sex in a more relaxed and exploratory way, orgasm may follow more naturally.

Sex aids

Sex aids including vibrators and vacuum devices may be useful to help with stimulation and orgasm.

Pelvic floor exercises

For some women, pelvic floor exercises may help increase awareness of pelvic floor contractions and improve pelvic tone, which can help with orgasms. These exercises can be tricky, but a physiotherapist, nurse or GP will be able to explain how to do them properly.

Ask for help

If problems persist, then speak to your GP, specialist or Parkinson’s nurse. A change in medication may put you back on track again.

It’s important to remember that many sexual problems can be common in men of all ages, whether they have Parkinson’s or not. So any problems you might have aren’t necessarily as a result of your condition. There may be other causes such as enlargement of the prostate gland.

The prostate is a small gland found only in men. It’s the size of a walnut and surrounds the first part of the tube (urethra) that carries urine from the bladder to the penis.

As men get older, the prostate around the neck of the bladder gradually gets bigger. This is normal in older men, but for some, it causes problems by blocking the flow of urine, which makes it difficult to empty the bladder. It can cause some men to experience the need to urinate more often, a difficulty in starting to urinate, a need to strain or an urgent need to go to the toilet.

Medication may help reduce the size of your prostate, alongside making changes to your lifestyle. Surgery may be recommended for moderate to severe symptoms of prostate enlargement, if medication hasn’t worked.

You should talk to your GP if you begin to experience symptoms. They can assess you and refer you to a urologist (a doctor specialising in problems with the bladder, kidneys and male reproductive organs) if necessary.

Erectile dysfunction

Research has shown one of the sexual problems that affects men is not being able to get aroused.

When a man is struggling to get aroused, he’ll find it difficult to get an erection. This is a common problem even in men who don’t have Parkinson’s, especially as they get older, or if they have medical conditions like high blood pressure or diabetes. Some may have difficulties getting an erection at all, while others get an erection, but then lose it too soon.

If you’re having erectile problems, speak to your GP or specialist. They’ll ask about how much response you have to stimulation, or when problems happen, such as when you wake up in the morning, or when you’re with a partner. This is because erectile problems may affect you in different ways at different times. When someone has a neurological condition, erectile problems are not always assumed to be related to emotional issues.

There’s a range of options your GP or specialist may explore with you. These include:

Viagra/Cialis/Levitra

Medication is one option for treating erectile problems. Research has shown that Viagra is safe for most men with Parkinson’s to use,  but talk to your GP, specialist or Parkinson’s nurse before taking it. There’s a range of alternative drugs now available that work in different ways, but are still effective at producing an erection.

Self injection or pessary

A drug is available that can be injected into the penis, or inserted in the end of the penis as a pessary, to produce an erection. A man can be taught the self injection technique. This treatment needs supervision at first. Specialists such as urologists and, occasionally, GPs, run clinics that provide this treatment.

A vacuum pump device

Vacuum constriction devices are an option for men who don’t want to or are unable to take medication. These can be put around the penis to produce an erection. Speak to your GP, specialist, Parkinson’s nurse or pharmacist for advice before you buy one.

Surgery

Surgery to implant a penile prosthesis may be an option for men with erectile problems. It’s normally a last resort, however.

Women are most likely to experience problems with vaginal lubrication, low desire or orgasm.

A woman may continue to enjoy sex, even if her body isn’t really in the mood (though it’s important not to try penetration unless you’re aroused, as it can be painful).

There are not so many evidence-based treatment options for female sexual problems, but they can include hormonal treatments, psychosexual therapy and treatments for any pain.

Some women feel pain during sex. You may also experience fewer feelings or a lack of sexual excitement, or lack of lubrication when you have sex. Your GP or specialist may recommend trying anaesthetic gels, vaginal lubricants or different methods to reduce any pain.

It’s important to remember that many sexual problems can be common in women of all ages, whether they have Parkinson’s or not. So, it doesn’t mean that any problems you have are necessarily a result of your condition. There may be other causes. We’ve listed some below.

Pelvic floor prolapse

Women may experience prolapse of pelvic organs such as the bladder or womb. This happens when organs have dropped out of their usual position, perhaps in relation to ageing and childbirth. Lack of tone in pelvic floor muscles can increase this risk. Pelvic organ prolapse can have a negative effect on sexual function.

Pelvic floor prolapse can be corrected in a number of ways, including vaginal pessaries to support the vaginal walls and organs, or surgery. Talk to your healthcare professional about what options are available to you.

Menopause

The menopause can affect vaginal lubrication and sexual sensations. If you’re experiencing these symptoms and are of menopausal age, you should talk to your GP, who will be able to suggest treatments including hormone replacement therapy (HRT).

Try to minimise any anxiety

If you worry about orgasm, it’s more likely to happen too quickly or not happen at all. Spend more time on general arousal and excitement. Agree that it won’t matter if one of you doesn’t orgasm – you’ll enjoy the time together.

Understand what you enjoy

Masturbation can help you understand what you find enjoyable. Give yourself enough time to explore what you find pleasurable without being disturbed. Feeling ashamed or embarrassed about what you’re doing won’t help you achieve orgasm, so try to relax into the sensations you experience.

Get to know each other

Take time to really get to know each other’s bodies. Ask about the kind of stimulation your partner likes. Try to fine-tune your technique so you’re always giving the best experience. When you approach sex in a more relaxed and exploratory way, orgasm may follow more naturally.

Sex aids

Sex aids including vibrators and vacuum devices may be useful to help with stimulation and orgasm.

The Family Planning Association has its own e-commerce website, Desire and Pleasure, which offers a selection of products and useful guidance for people with reduced mobility and limited manual dexterity.

Pelvic floor exercises

For some women, pelvic floor exercises may help increase awareness of pelvic floor contractions and improve pelvic tone, which can help with orgasms. These exercises can be tricky, but a physiotherapist, nurse or GP will be able to explain how to do them properly.

Ask for help

If problems persist, then speak to your GP, specialist or Parkinson’s nurse. A change in medication may put you back on track again.