Sexual Effects of Parkinson's Disease in Men

Parkinson’s disease (PD) is a progressive neurological disease that affects movement, posture, balance, and speech. Symptoms can include tremors in the hands or fingers, slow movement, muscle rigidity, balance problems, involuntary movements, decreased ability to perform automatic movements like blinking or smiling, slurred speech, or other speech changes.

Many men with Parkinson’s disease also experience non-motor symptoms like erectile dysfunction and other sexual health symptoms. In this blog post, we’ll cover what causes Parkinson’s-related sexual dysfunction in men and what you can do about it.

Parkinson’s Disease and Erectile Dysfunction

Parkinson’s disease affects the autonomic nervous system, which controls involuntary processes including sexual arousal. Specifically, Parkinson’s disease impacts a part of the brain known as substantia nigra, where it causes dopamine-producing nerve cells to die.

Dopamine is a brain chemical that can coordinate smooth muscle movement, which makes it important in sexual function. The cavernous smooth muscle of the penis needs to relax in order for blood to flow into the area and trigger an erection and dopamine plays a role in this process.

When dopamine levels decline in Parkinson’s disease, it can affect the function of the cavernous smooth muscle and its role in erections.

Other Ways in Which Parkinson’s Disease Affects Sexual Function

Dopamine also plays a role in sex drive and sexual interest, so lower levels can affect sexual health.

Parkinson’s disease can also cause impaired sexual coordination and cause muscle tremors and rigid muscles, which can lead to sexual problems.

In addition, Parkinson’s disease can cause physical pain or discomfort during sex and lead to decreased libido and overall fatigue that leaves you drained and without enough energy for sex.

People with Parkinson’s disease often have reduced sexual feeling that accompanies their poor sexual functioning, leaving them unable to have an orgasm and other sexual issues. Some research suggests 40% to 50% of men with Parkinson’s experience premature ejaculation, which may be caused by antiparkinsonian medications.1

Depression Can Lead to Sexual Health Issues

Along with other non-motor symptoms, depression is common in people with Parkinson’s disease and affects up to 40% of people with the condition.

Feelings of depression in Parkinson’s disease may be caused by the diagnosis itself and how it will change your life, the physical limitations that come with the disease, or changes in brain chemicals like dopamine that are involved in mood and well-being. For this reason, depression can lead to sexual issues.

Antidepressant drug therapy to treat depression in PD patients also can lead to erectile dysfunction.

Emotional Issues and Sexual Problems

Other mental health issues can result in sexual difficulties in Parkinson’s patients. Anger, stress, and grief can all interfere with a healthy sex life.

Feelings of reduced self-esteem can also lead to low libido and sexual problems. Low self-esteem in men with Parkinson’s disease can be caused by changes in skin that can cause low body image.

People with Parkinson’s can also emit certain odors due to three chemicals produced in the sebum: hippuric acid, eicosane, and octadecanal.2 Men who are sensitive to this musky smell may have body image issues.

Relationship Issues and Parkinson’s Disease

Relationship problems can get in the way of a healthy sex life in PD patients. It’s difficult to maintain sexual satisfaction when the two of you are under stress dealing with the psychological challenges that go along with a Parkinson’s disease diagnosis.

Your partner may have to take on more responsibilities once your Parkinson’s disease progresses, which can leave them feeling too exhausted for sex. In addition, because Parkinson’s symptoms often get worse at night, the two of you may sleep in separate bedrooms, which decreases sexual intimacy and spontaneous sex.

Your partner also may have to get used to several aspects of a Parkinson’s diagnosis, including awkward body movements and a stiff facial expression.

Both of you may need to change your expectations and the roles you play in the relationship. If you have Parkinson’s disease, your partner may have to do more of the chores and become more of a caregiver. These changing roles can affect your sexual relationship and ultimately your sexual response and sexual identity.

Hypersexuality and Parkinson’s Disease

Medications used to treat Parkinson’s disease symptoms called dopaminergic drugs can cause the opposite problem to ED. These drugs increase dopamine, so in some men, they cause the rare side effect of excessive sex drive, libido, and sexual function.

While excessive sex drive sounds like fun, in reality, it’s too much of a good thing. Hypersexuality can include thinking and talking about sex a lot, such as during inappropriate times.

This is a rare effect of dopaminergic drugs that happens in an estimated 3.5% of patients.3

Treating Sexual Problems in Parkinson’s

Your doctor can work with you to treat sexual health issues in Parkinson’s. Here are some ways they may suggest dealing with sexual changes that occur due to the disease:

ED Medications

There is help for sexual dysfunction in Parkinson’s disease. Treatment options include sildenafil citrate (Viagra), as well as other ED pills.

One study looked at the use of 50 - 100 mg of sildenafil citrate in 10 male patients with Parkinson’s disease over two months.4 Use of the ED medication was linked to a statistically significant improvement in overall sexual satisfaction, satisfaction with sexual desire, ability to achieve and maintain an erection, and ability to reach orgasm. The main adverse reaction was a headache reported several times in one subject.

Several other studies have reached similar conclusions. One study of 33 men found that the ED drug improved sexual intercourse and depression.5 In another trial, researchers studied 12 men with Parkinson’s and 12 men with multiple system atrophy, a rare nervous system disorder that is similar to Parkinson’s.6 Men taking Viagra experienced improved ED, although the multiple system atrophy patients experienced a severe drop in blood pressure (orthostatic hypotension).

Parkinson’s Medications

Some Parkinson’s medications like levodopa, which is converted in the brain into dopamine, or a dopamine agonist, a type of drug that mirrors the effects of dopamine, can increase sexual functioning. Therefore, these are sometimes used for ED in Parkinsonian patients.

Change Your Routine

Parkinson’s symptoms are often worse at night, so having sex earlier in the day can be helpful. Exploring new positions and finding those that are the most comfortable also can make things go easier.

Resolving Relationship Issues

Open communication about your concerns and fears can open the door to sexual intimacy. Talk things out together and consider visiting a professional counselor to help you work through your issues. Joining support groups can reduce the stress of the disease and its symptoms.

Frequently Asked Questions About Parkinson’s Disease and Sexual Dysfunction

Why Does Parkinson’s Cause Erectile Dysfunction?

Parkinson’s patients often experience sexual dysfunction symptoms for a number of reasons. Here are some factors that can interfere with sexual function in male PD patients:

By affecting the autonomic nervous system, which is involved in sexual response, Parkinson’s disease can cause sexual dysfunction.
Parkinson’s lowers levels of a brain chemical called dopamine, which plays a role in sexual function by controlling the cavernous smooth muscle of the penis, which in turn is involved in healthy erections.
Parkinson’s causes muscle rigidity, coordination problems, awkward body movements, and tremors, all of which can lead to sexual dysfunction.
Pain and fatigue can also reduce sexual activity and lead to low libido.
Many Parkinson’s patients have feelings of depression, which also can cause sexual dysfunction. In addition, ED is a side effect of antidepressant medications.
Relationship issues resulting from a Parkinson’s diagnosis can affect sexual desire, sexual identity, and sexual issues.

What Is The Best ED Treatment for Parkinson’s?

Treating ED in Parkinson’s involves several treatment options. Your healthcare practitioner may suggest ED medications. Antiparkinsonian medications that boost dopamine levels may spark increased sexual interest and sexual activity.

Talking out relationship issues with each other and talking with your doctor about drugs that cause sexual dysfunction as a side effect are two other options. Attending a support group can also reduce stress, which ultimately can improve your sexual relationship.

Can You Take Viagra If You Have Parkinson’s?

Several studies show that Viagra is safe and effective in men with Parkinson’s disease. For example, one study investigated the use of 50 - 100 mg of Viagra in 10 male patients with Parkinson’s disease during eight sexual encounters over two months.4 Use of the ED medication was linked to a statistically significant improvement in overall satisfaction with sexual activity, satisfaction with sexual desire, ability to achieve and maintain an erection, and ability to reach orgasm

Does Levodopa Cause Erectile Dysfunction?

The Parkinson’s drug levodopa is actually used to counteract ED caused by Parkinson’s, since this medication increases dopamine and therefore may increase sexual functioning in some men. In other men, sexual dysfunction does not respond to levodopa treatment.7