Sexual dysfunction in movement disorders: prevalence, clinical features, associated factors and management

Sexual dysfunction is a common but insufficiently addressed non-motor symptom in movement disorders. While Parkinson's disease (PD) is the condition most frequently investigated, sexual dysfunction is also reported in Huntington's disease, dystonia, and other movement disorders. Clinical presentations are heterogeneous, encompassing reduced desire, erectile dysfunction, ejaculatory and orgasmic disorders, lubrication difficulties, dyspareunia, and hypersexuality. In PD, prevalence estimates vary widely across studies, largely because of differences in disease stage, cultural context, and assessment methodology. The most consistent associated factors include depression, anxiety, age, autonomic dysfunction, and motor disability. Dopaminergic treatment has a bidirectional influence, with potential benefit on hypoactive sexual symptoms but an increased risk of hypersexuality, especially with dopamine agonists. Evidence for treatment remains limited, with the strongest support for phosphodiesterase-5 inhibitors in erectile dysfunction and dopaminergic treatment adjustment in hypersexuality. Sexual dysfunction remains underrecognized in routine practice despite its major impact on quality of life and intimate relationships. Routine screening and multidisciplinary management should be encouraged in the care of patients with movement disorders.