Sexuality and sexual health in primary tic disorders

Sexuality and sexual health are essential for the overall well-being of all individuals. In neurology, research traditionally focused on disorders of sexual function associated with syndromes that present with specific lesions of the spinal cord and brain. In neuropsychiatric tic disorders, however, early research addressed sexuality and sexual behaviors in a wider context and beyond the strict diagnostic categories of sexual dysfunction, including gender identity and sexual orientation. Although these studies provided important insights in the behavioral structure of adults with primary tic disorders and Tourette syndrome, many of these early findings were not replicated subsequently and should, therefore, be critically reconsidered. This chapter provides a comprehensive catalog of existing data on sexuality and sexual health, including gender identity, sexual orientation, sexual dysfunction, adverse sexual experiences, compulsive sexual behaviors, and paraphilic disorders in adults with primary tic disorders. It also discusses the role of comorbidities, particularly attention-deficit/hyperactivity disorder, as well as the impact of neuropsychiatric medication. Additionally, it catalogs, for the first time, different therapeutic approaches that may improve sexual health in adults with primary tic disorders. Finally, knowledge gaps and methodological limitations are also addressed. Ultimately, this chapter's goal is to carefully present existing data, map underexplored needs, and highlight ways to respectfully address them both in clinical practice and through future research.