Author: Orna Moore and Gila BronnerPublished: 11 October 2017
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In the second in our series focusing on sexuality and Parkinson’s, nurse consultant Orna Moore and sex therapist Gila Bronner offer their insights on seeking professional help – and explore the range of treatments available
The physical and emotional changes in Parkinson’s disease may have a dramatic effect on the sex lives of patients and their partners. The motor and non-motor symptoms of the condition, as well as treatments and medications, can lead to problems with desire, arousal, orgasm and sexual satisfaction, reduced self-esteem and potentially to marital tension.
People with Parkinson’s who are experiencing problems can call on doctors and other health professionals for proactive intervention or referral for specialist treatment. But how should people go about getting help?
It’s good to talk Many people feel embarrassed and anxious when they think of consulting a doctor with their sexual problems. Some even feel that it is inappropriate to raise such issues in a medical setting. Others may think that they might be perceived as too old, or too sick for sex. Quite often, people who live with a chronic or progressive condition, such as Parkinson’s, are not aware that their sexual dysfunction is related to the medical condition.
Consequently, they never think that they could discuss their intimate problems with the medical team. Even if couples are not used to talking about these issues, most appreciate an opportunity to figure out what is happening to their sexuality, and how they can cope with the changes imposed by the disease. A trusted professional can be ideal for this task.
A choice of solutions Today, sexual medicine offers a variety of effective treatments for many sexual problems. Sex therapy offers a variety of psychological-behavioural-sexological and couple interventions. The efficacy of these interventions combined with medical therapies can help improve the sexual lives of people who live with Parkinson’s.
Many problems that seem big may have simple solutions, so if you are a man you can talk about your erectile dysfunction with a urologist, and if you are women you can talk about desire changes, pain and lubrication with a gynaecologist. They can advise about lubrication, position changes, or prescribe medications.
Health professionals should encourage people to discuss and explore changes in sexuality and intimacy, which can be a good starting point for successful therapeutic intervention. They should be able to permit people to express and discuss their fears and concerns and as part of the intervention to offer practical strategies to cope with those difficulties.
A loving relationship includes encouragement of intimacy, sensuality, companionship, and friendship, as well as continued knowledge and understanding about the effects that one’s health conditions, medications, and treatment have on sexuality and functioning.
Treatments used in sex therapy, couple therapy and behavioural therapy
– improving communication between partners
– increasing sexual communication skills within the couple
– coping with various motor and non-motor symptoms that effect sexual activity
– assist the couple in planning better settings for sexual activity
– discussing and suggesting comfortable positions
– adapting to a new division of sexual roles, according to the couple’s abilities
– finding creative solutions for limitations in self and partner touching
– intimacy training and erotic tasks
– practicing sensate focus – a process of re-learning physical sensations
– practicing the Intercourse-Outercourse approach
– cooperating with the health providers to reduce the effect of medications on sexual function
Medical treatments for sexual dysfunctions in men and women
Treatments for Erectile Dysfunction – oral medications: PDE5-inhibitors (Viagra, Cialis, Levitra etc.)
– penile injection therapy: a self intracavernosal injection of drug mixture, enhancing blood flow needed for an erection
– vacuum constriction device: an external pump with a band on it, assisting men to achieve an erection and maintain it
– penile prosthesis implantation surgery
– shock wave therapy: can build new blood vessels to the genitals and improve erectile function
Treatment for female arousal problems – lubricating agents
– hormonal therapy: oral medication or local in the vulva and vagina
Treatment for decreased desire – hormonal treatment – testosterone or oestrogen
For comprehensive information about intimacy, sexuality and Parkinson’s, please visit the EPDA website.
Orna Moore is a nurse consultant, working with families with neurodegenerative diseases. She works at the Department of Neurology, Tel Aviv Medical Center, Israel.
Gila Bronner is a sex therapist specialising in sexual rehabilitation. She is director of the Sex Therapy Service at the Sexual Medicine Center, Tel Aviv, and a sex therapist at the Institute of Movement Disorders, Sheba Medical Center, Israel.
Next week Gila and Orna discuss the needs of partner caregivers
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