Studies show that between 30-90% of people living with Parkinson’s disease may experience intimacy issues. I know that is a large range, but the important take away is that it is common and should be talked about! Challenges with intimacy can affect the person with Parkinson's as well as their partner. Let's learn more about common challenges and some helpful tips.
Common Intimacy Challenges
Sexual arousal
People with PD may experience a reduced sexual desire and/or motivation to engage in intimate activities. This may be in part from emotional issues like depression or lower self esteem, or this can be a result from changes to our reward and motivation system in our brain.
Lack of climax
A combination of reduced sexual arousal and limited physical functioning can lead to difficulty achieving an orgasm even when you are sexually active.
Vaginal dryness
Women with PD may have difficulty with being or staying lubricated which may result in painful sex and even bladder infections.
Erectile dysfunction
ED can be a symptom of Parkinson's itself, or a side effect of different medications, like certain blood pressure medications and anti-depression medications.
Sexual discomfort
Many women can experience sexual discomfort whether or not they are having challenges with lubrication. Pelvic floor muscles may be tight or poor mobility in other areas like your hips or back can contribute or cause sexual discomfort.
Hyper-sexuality
People with PD may experience an increased sexual interest or a compulsive sexual behavior.
Hyper-sexuality is when one is preoccupied with sexual thoughts and impulses, have an increased demand for sex, and can sometimes even be involved with excessive use pornography. Impulse control disorders are a common non-motor symptom of PD due to the changes in our reward system in our brain with PD or in some people who take dopamine agonists.
Physical difficulties
People may experience limitations with sexual positions and/or difficulty reciprocating intimate touch due to rigidity, slowness of movement, tremor, or pain. Some people may feel overly fatigued and may not be interested in intimacy due to their lethargy.
Communication
Communication can be a really important aspect of intimacy for many people. If your voice is impacted by PD or if your cognition is impacted by PD, this can be a challenge for both you and your partner.
Emotional issues
Sexual disorders may be due to depression, anger, stress, grief, apathy, and mental fatigue. Parkinson's disease does not only take a physical toll, but it also impacts our emotional and mental health. These things can greatly impact our sexual desire and ability to enjoy intimacy.
Incontinence
Many people with PD experience incontinence. In fact, many people without PD experience incontinence as they age. Inability to control one's bladder or bowel function may influence their participation in more intimate activities.
Tips for Intimacy and PD
Communication and behavior
Try to create open communication between you and your partner. Share your concerns and experience so they can have a better understanding of how to help. Try to gain a deeper understanding of what you and your partners physical limitations and comfortability are of each other. This is the first and most important step to developing intimacy.
Some have found great results with the intercourse approach - intentionally practicing growing intimacy through sexual stimulation without intercourse, then adding intercourse back in later on.
For those with compulsive sexual behavior, sometimes just a change in medication can help. Other times, people may need more help from a therapist.
Erectile dysfunction
Talk with your doctor about any medications that may be helpful to treat erectile dysfunction or help improve sexual arousal. There are many medications and natural supplements that can help, or it may be as simple as changing one of your current medications.
Physical limitations
Scheduling intimacy around your "on" times or during the best time of day for your motor symptoms can be helpful. Just because you schedule your intimacy does not mean it is any less meaningful or special.
Some decide to divide attention when physical limitations are impacting intimacy. This means one day the intimacy session may be focused on the needs of one partner, and on another day the roles are reversed. Some people find greater satisfaction with this approach and will find less physical challenges when time is divided.
Pain during sex
Pelvic floor therapy can be really helpful to address any tight muscle groups along your pelvic floor that can be contributing to pain during sex. Talking with a sex therapist or experimenting with different tools can be helpful for those who are experiencing pain due to poor lubrication and/or poor arousal.
Emotional issues
Talk with your partner and your doctor if you think you are experiencing any emotional or mental challenges. Talking with a therapist can help work through any problems that are negatively influencing your life. Engaging in stress management activities like meditation, deep breathing, and yoga can help reduce stress and make one more engaging during intimacy. Not everyone needs therapy, but that is for you to decide!
Ejaculation
Behavioral techniques and/or vibratory stimulation can be helpful to improve ejaculation. Talking with a sex therapist or trying out different tools on your own can be extremely helpful. Oral medications and topical medications can also help.
Medications
Talk with your doctor about any medications that may be impacting your sexual function. This subject is taboo, so chances are they won't ask until you do.
Incontinence
Some medications can be helpful to combat this. Others may find benefit from emptying the bladder and avoiding drinks for 2 hours before intimacy. For those with bowel incontinence, using an enema before intimacy or other tools such as a plug may be helpful. Pelvic floor therapy can also help work on any behavioral issues contributing to incontinence and work on improving your pelvic floor to reduce your incontinence. Both women and men can see a pelvic floor therapist, but not every therapist is trained to help men.
Intimacy challenges are common, but they are commonly not addressed. Talk with your health care professional about any challenges you are experiencing.
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