A Pragmatic Approach to Sexual Health in Movement Disorders

A satisfying sexual life is essential for maintaining good quality of life and healthy relationships for all individuals, including those with movement disorders and their partners. However, its significance is often overlooked in neurological clinics.

We review the literature and draw from our own experience to offer a practical approach for assessing and managing sexual health issues in patients with movement disorders.

We begin by introducing fundamental concepts of sexual medicine, emphasizing models of sexual response that offer useful frameworks for diagnostic classification and management practices. We then address the most common sexual problems and disorders, including sexual dysfunction, sexual pain disorders, sexual compulsivity, and paraphilic behaviors, and their connections to different movement disorders. Next, we discuss assessment approaches that encompass biological, psychological, and social factors related to sexual health, including investigations for structural, vascular, or hormonal causes. Brief assessment questionnaires are also discussed. In addition to specific sexual therapeutic practices and supportive psychotherapy, we cover adjustments to pharmacological treatments related to movement disorders, as well as the use of mechanical devices. We also address the need for individualized management in specific cases, such as for patients undergoing deep brain stimulation surgery.

Neurologists can play a key role in addressing sexual health concerns, considering the impact of both the disorder and its treatments. A comprehensive approach includes assessing biological, psychological, and sociocultural factors, with interventions like sexual therapy, supportive psychotherapy, pharmacological treatments and medical devices. Further research is needed to establish evidence-based treatments in this population.