Sex and Parkinson's

Whether you have Parkinson’s or care for someone who does, the condition can affect your sex life, both physically and emotionally.

How can Parkinson’s affect sex?

People with Parkinson’s can experience sexual problems.

This can be due to the physical effects of the condition on things such as co-ordination and speed of movement, and emotional issues such as 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 and the likelihood of experiencing problems increases with age.

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, this 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 every relationship 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.

What sexual problems does Parkinson's cause?

Difficulties with sex can often happen when something disrupts your sexual responses. Causes of sexual problems include movement problems, fatigue or depression.

These difficulties are common in people with and without Parkinson’s, so it may not be easy to tell whether a problem you experience is a result of your condition or not.

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

Movement problems

The physical symptoms of Parkinson’s, such as stiffness, rigidity 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.

Some medications for this, such as amantadine, have been shown to improve sexual function.

If tiredness is an issue, try being intimate or having sex at a different time of the day when you are more alert.

Bowel and bladder problems

Fear of incontinence during sexual activity may have a negative impact not only on self-esteem, but also on personal relationships.

If you experience urinary incontinence, certain drug treatments may be helpful. Emptying your bladder before intercourse may help. For some individuals, 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 may be helpful.

The Bladder and Bowel Foundation can offer more information.

Medications

Any medications you’re taking should be reviewed for any side effects they may have on sexual function.

Some drugs for depression may cause a reduction in sexual desire, problems with arousal and delayed, or lack of, orgasms.

These problems cause many people to stop taking their medication. It is best to speak to your specialist or Parkinson’s nurse about the options available for you.

Do not stop taking your Parkinson’s medication unless your specialist or Parkinson’s nurse tells you to, as this can be dangerous.

Hypersexuality

Some people who take 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 is also a risk that someone will behave in a way that is 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.

While some couples may enjoy the extra sex, 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 are experiencing this behaviour, the first step is to talk to your specialist or Parkinson’s nurse.

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 is 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. Sometimes 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.

Lowered sex drive

Many people with Parkinson’s and their partners experience 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.

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 film 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. The outcome will happen more naturally.

Problems with sexual arousal

Both men and women can struggle with sexual dysfunction. 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

Orgasm problems

Both men and women may experience reduced or absent orgasms. Some men may experience problems with premature or delayed ejaculation, or not ejaculating at all.

Treatments for problems in orgasming may include therapies such as psychosexual therapy or cognitive behavioural therapy. This can help individuals or couples find more helpful ways of sexual communication.

If you have problems reaching orgasm:

Try not to worry

As with all sexual problems, the first thing to do is to try to minimise 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 experience orgasm – you’ll enjoy the time spent together.

Pelvic floor exercises

For some women, pelvic floor exercises may help increase awareness of pelvic floor contractions and improve pelvic tone.

These exercises can be tricky, but a physiotherapist, nurse or GP will be able to explain how to do them properly.

Seek 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.

What sexual problems can affect men with Parkinson’s?

Prostate problems

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, it doesn’t mean that any problems you might have are necessarily as a result of your condition. There may be other causes such as the prostate gland.

The prostate is a small gland found only in men. It is 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 outflow 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.

Some men with an enlarged prostate gland may experience sexual problems, such as erectile dysfunction.

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.

Be aware that a side effect of this surgery may include sexual dysfunction, so it’s important to talk to your healthcare professional about all possible advantages and disadvantages of the procedure.

You should talk to your GP if you begin to experience symptoms. They can assess you and refer you to a urologist if necessary.

Erectile dysfunction

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

When a man is struggling to get aroused, he will 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 such as diabetes or high blood pressure.

Some may have difficulties getting an erection at all, while others get an erection, but then lose it too soon.

If you are experiencing erectile problems, speak to your GP or specialist.

They will ask you about how much response you have to stimulation, or in specific situations, such as when you wake up in the morning, or when you are 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 are 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 if you have any concerns.

There is a range of alternative drugs now available that work in different ways, but are still effective at producing an erection. If you have Parkinson’s, you can get these drugs on the NHS.

Self injection

A drug is available that can be injected into the penis 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.

Pessary

A pessary is less intrusive than an injection. Some men choose a product called ‘MUSE’, which is a pessary that can be inserted into the end of the penis. Speak to your GP to find out more.

A vacuum pump

Vacuum constriction devices are an option for men who do not want to or are unable to take medication.

These can be put around the penis to produce an erection. This option is often more successful for men in stable relationships. 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 is normally a last resort, however.

What sexual problems can affect women with Parkinson’s?

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 therapies relate to the treatment of sexual desire, arousal or orgasm problems and/or sexual 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 might have are necessarily as a result of your condition. There may be other causes, such as:

Menopause

The menopause can affect vaginal lubrication and sexual sensations. If you are experiencing these symptoms and are of menopausal age, you should talk to your GP.

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 previous childbirth.

Lack of tone in pelvic floor muscles can increase this risk. Pelvic organ prolapse and urinary incontinence have a negative effect on sexual function.

Pelvic floor prolapse may be corrected using either a ring pessary or surgery, which may improve sexual function. Talk to your healthcare professional about what options are available to you.

How can I improve my sex life?

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 sex is approached in a more relaxed and exploratory manner, orgasm may follow more naturally.

Sex aids

Sex aids including vibrators and vacuum devices may be of some use to aid stimulation and orgasm.

The Family Planning Association has an online shop, FPA Pleasure, that offers a selection of products and useful guidance for people with reduced mobility and limited manual dexterity. The more you can do to be sensual together, the better the chances of arousal happening naturally.

Speak to healthcare professionals

You may feel uncomfortable talking to a healthcare professional about the issues you are having, but remember they will have spoken to others with similar problems before.

They will need to take your particular needs into account when talking to you, including your attitude towards sex and cultural influence. Remember, the medical profession is governed by strict privacy laws, so anything you do share with a healthcare professional will remain totally confidential.

Although you are not alone in experiencing problems with sex, you may be more affected by particular aspects than others. If you find it difficult to talk about, try writing your questions down and giving them to the person you’re seeing.

You may want to attend appointments with your partner if you have one, so you can discuss the issues together.

Support for your partner

Ideally, you should talk things through with your partner. This can sometimes be difficult, but it is essential for your partner to also get the support they need.

Parkinson’s nurses and Parkinson's local advisers can see people with Parkinson’s and their partners independently to discuss any issues if you don’t feel you can talk to each other about things.

Relationship counselling

If you’ve tried talking to each other about your relationship problems and you feel that you’re not getting anywhere, couple counselling may help. A trained couples counsellor can help you look at your problems differently and improve your communication, to help you overcome any issues you’re facing.

Counsellors can also work with individuals, so you can go alone if you’re single or if your partner doesn’t want to attend. Some people prefer to talk through their feelings on their own, and find this very helpful.

If you think counselling may help, ask your GP if there are services available in your area, or contact your local Relate centre.

They will advise you what they charge and how they may be able to help if payment is an issue. If you’d prefer private counselling, you can get a list of local counsellors from the British Association for Counselling and Psychotherapy.

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Last updated July 2014. We review all our information within 3 years. If you'd like to find out more about how we put our information together, including references and the sources of evidence we use, please contact us at [email protected].