Sexual dysfunction in Parkinson’s disease and other movement disorders
Decrease in sexual desire is common in Parkinson´s disease, especially in women, resulting in stress to their partners (Brown et al 1990). In addition, patients with Parkinson’s disease are often depressed. Erectile dysfunction occurs in half of affected men (Koller et al 1990, Takahashi 1991, Wermuth & Stenager 1995) and nocturnal and morning erections are usually absent. Many affected men have ejaculatory failure, and many women are unable to achieve an orgasm. During sexual arousal tremor is often enhanced, making sexual activity more difficult. In one study, the frequency of sexual dysfunction was similar in patients affected by Parkinson´s disease compared to patients affected by arthritis (Lipe et al 1990). Deep brain stimulation of the subthalamic nucleus has been found to influence sexual well-being in Parkinson´s disease (Castelli et al 2004).
The mechanisms underlying sexual dysfunction in Parkinson’s disease are not well understood. Bladder, and bowel dysfunction is often associated, implying autonomic involvement (Sakakibara et al 2001). There is a high incidence of bladder-detrusor hyperreflexia and of paradoxical contractions of the striated sphincter muscles during defecation (Berger et al 1987, Singer et al 1992). Derangement of cardiovascular regulation may occur (Zesiewicz et al 2003). Treatment with dopaminergic compounds may result in an apparent increase of sexual activity (Uitti et al 1989).
Increased sexual activity is reported in about 10 % of people with Huntington´s disease (HD. However, HD patients may have difficulty in achieving sexual arousal. Paraphilias such as sexual aggression, exhibitionism and pedophilia have been reported (Morris 1995). Disorders of sexual inhibition with pansexuality, occur in Tourette’s syndrome (Comings 1994, Lombroso et al 1995). Increased sexual activity is also reported in patients with Wilson’s disease (Akil & Brewer 1995). Impotence is almost universal among patients with multiple system atrophy, and may be the presenting symptom (Beck et al 1994, Hodder 1997). Neurophysiological studies, particularly external anal sphincter EMG, showing reinnervation in this muscle, are useful in diagnosis of MSA (Vodusek 2001, Pellegrinetti et al 2003).Sexual dysfunction in Parkinson’s disease and other movement disorders
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