[Sexual disorders from the perspective of the neurologist]

The temporal lobes and other cortical regions are involved in the emotional, cognitive and sensorimotor aspects of central control of sexual behaviour, whereas the insula, anterior cingulate and hypothalamus coordinate the activation of the autonomic nervous system. Facilitatory and inhibitory descending pathways modify the activity of thoracolumbar sympathetic and sacral parasympathetic and somatic spinal centres which control the sexual response, i.e. arousal, orgasm and ejaculation. A normal hormonal milieu and vascular system, but also a healthy psychosocial context, are necessary for a fulfilled sexual life. Sexual dysfunction is not uncommon in the general population, particularly in the elderly; it is more common in neurological patients. It significantly lowers their quality of life. The neurologist should diagnose sexual dysfunction in his patients and provide basic management including explanation, suggestions and--if necessary--drugs.