Pre-Morbid and Present Sexual Dysfunction in People with Parkinson's Disease.
Bronner, Gila*,1, Royter, Vladimir2, Korczyn, Amos3, Giladi, Nir4, 1 Sexual Medicine Center, Dept. of Urology, Tel Hashomer, Israel, Israel2 Movement Disorders Unit, Dep of Neurology, Tel-Aviv, Israel, Israel3 Sieratzki Chair of Neurology, Sackler School of Medicine, Tel-Aviv, Israel, Israel4 Movement Disorders Unit, Dep of Neurology, Tel-Aviv, Israel, Israel
ABSTRACT- Objectives: To investigate present and pre-morbid sexual dysfunction of people with Parkinson's Disease (PD). Design and Methods: Subjects: Seventy five (32 women 43 men) non demented non depressed consecutive PD patients, age 31-83 Questionnaires: Assessment by Israeli Sexual Behavior Inventory (ISBI) (Kravetz 1999), including eight scales: sexual satisfaction, intimacy, sexual drive, health perception, anorgasmia, dyspareunia, erectile dysfunction, premature ejaculation (PE). Stage of PD, duration of disease, present pharmacological treatment, associated illnesses- obtained by clinical examination and medical records. Statistical Analysis: Pearson correlation coefficients and student t-test, paired or unpaired assessed associations between variables. Best subset regression identified explanatory variables for changes in each sexual scale. Stepwise regression was performed with combined variables and explaining model was constructed. SPSS was used with 0.05 level significance. Results: PD patients report sexual dysfunction in all scales: 68% ED, 41% PE, dificulties to reach orgasm- 75% women, 40% men, sexual dissatisfaction- 37% women, 65% men. Pre-morbid low desire, intimacy and sexual satisfaction, orgasmic difficulties and dyspareunia contribute to cessation of sexual activity along PD. Stepwise regression demonstrated that medical factors explained sexual deterioration: associated diseases, use of medications, stage of PD among men and use of L-dopa among women. Treatment with L-dopa and dopamine agonists had independent negative effect on erectile function and desire. ED may be an autonomic disturbance, additional to other autonomic disturbances in PD, which can be worsened by chronic dopaminergic treatments (slower gastric emptying time, ortostatic hypotension). Decrease in desire can be explained by lack of motivation and self initiation, following abnormalities at the prefrontal cortex and its subcortical connections, frequently associated with abulic syndrome in PD patients. Additional psychological facotrs may contibute to low desire. DiscussionPrevention of multi sexual dysfunction in PD patients demands early evaluation and treatment adjacent to diagnosis of disease.
Key words: parkinson's disease, sexual dysfunction, Israel sexual behavior inventory, pre-morbid