by Dr Ali Mackett
Traditionally Parkinson’s disease (PD) has been considered a motor disorder, however as the disease progresses there are a number of recognised non-motor complications. These may not be directly related to the dopaminergic pathway, and may therefore develop in patients with well controlled motor symptoms . One particular area, which has arguably been under-reported by both researchers and clinicians , is around sex and intimate relationships. Individuals living with PD have a very high incidence of sexual dysfunction. 47-70% of female patients report a fall in libido [3,4] and 80% a reduction in sexual activity after diagnosis . Males tend to report high levels of erectile dysfunction (68.4%) (3) and sexual dissatisfaction (65%) .
There are multiple factors contributing to a change in function and satisfaction and they can be broadly divided into physical, psychological, social  and medication related. Physical changes impacting on sexual function include high levels of autonomic dysfunction  even in the pre-motor phase . Furthermore even simply the presence of motor symptoms could impair sexual functioning . Psychological factors include high levels of depression  and anxiety which can have a negative impact on sexual interest . With rates of dementia at 43% at 10 years  another layer of complexity is added to intimate relationships especially around the area of consent. Social factors centre on the change in relationship status with some couples changing from a partnership to a carer-patient model. Finally, impulse-control disorders including hypersexuality have long been recognised as a side effect of dopaminergic medications . This survey was to evaluate whether patients with Parkinson’s disease were given the opportunity to discuss their relationships.
Survey of all patients in a relationship attending a movement disorder clinic at a large teaching hospital over a one month period. All patients in this clinic were aged over 70 years. Fifteen surveys were completed.
Seventy-three percent of patients had not had the opportunity to discuss their relationships with a health professional. Those who had discussed, predominantly spoke to their consultant or specialist nurse, only one patient spoke to their GP. One hundred percent of those who did speak to a health professional found it either helpful or very helpful. There was a low uptake of the Parkinson’s UK booklet (13%) on relationships and opinion on the use of this book was divided in those who read it. Thirty-three percent of patients felt they had not been informed of the side effects of their medication. Finally, no patients in the survey wanted any further information at this stage.
Obviously this was a very small study in a single centre limiting any generalisable conclusions, however the worth of this survey is in raising awareness of this issue. All participants who had the opportunity to discuss their relationships found it helpful. It was noteworthy that no patients requested any further information or advice, however it should be acknowledged that participants in this survey were older. Evidence suggests younger patients are more likely to report greater levels of sexual dysfunction , therefore may desire more information and support. Hand’s study highlighted the high degree of correlation between severe relationship problems and concern around their level of sexual functioning . As stated above sexual dysfunction is extremely common but patients rarely initiate discussion. It is therefore recommended that there should be a low threshold for discussing relationships in a sensitive manner at an appropriate time.
The movement disorder clinic team at the Norfolk and Norwich University Hospital (Dr Niruban, Dr Sabanathan, Fiona Reading, Leslie Crump, Leslie Wells and Jenny Fielder)
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