“Sexual health is the fundamental right of each person to enjoy and control his/her sexual and reproductive behavior in accordance with social and personal ethics,” states the World Health Organization, 2004. The Tel Aviv movement disorders center, a Parkinson’s Foundation Center of Excellence believes in helping their patients with Parkinson’s disease (PD) in all facets of life, including sexual health.
The center feels an obligation to assist people with Parkinson’s in overcoming difficulties with sexual function along with many other motor and non-motor symptoms. This is the only center among the 42 Centers of Excellence in the Parkinson’s Foundation network that has an experienced sexual specialist, Sharon Peleg Nesher, RN, MA, serve as an integral member of their multidisciplinary team.
People with PD frequently experience sexual dysfunction (SD). Any combination of Parkinson’s-related symptoms like pain, limitation of movement, fatigue and sleep disorders — coupled with emotional changes such as anxiety and depression — as well as medication side effects can trigger sexual dysfunction. PD symptoms can affect many aspects of sexuality, including intimacy and erotic experiences, thereby adding to a couple’s discord and general dissatisfaction. “You can sense or experience sexual problems throughout all stages of Parkinson’s, starting when the symptoms are only beginning,” Sharon said.
Many people with Parkinson’s have difficulty addressing their sexuality issues. At the center in Tel Aviv, the team finds that patients are typically embarrassed and uneasy when bringing up sex to health care providers, often diminishing the topic because they feel it is not a life-threatening issue. However, when asked to rate a variety of disabling motor and nonmotor symptoms, people with PD rated sexual dysfunction as the 12th out of 24 most bothersome Parkinson’s symptoms [Politis et al, 2010].
How exactly does a sex therapist help patients in a movement disorders unit? On a weekly basis, Sharon visits the center and administers highly qualified sexual health assessments to patients with Parkinson’s and provides them, and sometimes their partner as well, with personalized counseling. Patients are referred to Sharon by the center’s team members and other health care professionals throughout the community.
“Intimacy is an important aspect of human behavior that involves communication, physical and emotional closeness and interpersonal interaction,” said Yael Manor, PhD, CCC-SLP, multidisciplinary team coordinator. “Our sex therapist helps patients understand the cause of their sexual dysfunction symptoms and adjust the intimate interactions between them and their partners.”
Often, the tension a couple experiences from managing Parkinson’s and sexual dysfunction at the same time can be quickly alleviated from just their first session with an experienced sex therapist. There is no charge for the first session, which is when the patient is evaluated. Subsequent sessions are generally covered by health insurance in Israel. Sometimes couples see dramatic results beginning in the first session when the sex therapist encourages couples to touch and kiss each other and provides them with ways they can enjoy intimacy again.
During therapy sessions, Sharon evaluates the patient’s sexual difficulties and dysfunctions, their current sexual expression and background, and the effect of the patient’s neurological condition on their sexuality. She will also suggest treatments for sexual dysfunction. She provides some practical advice about planning sexual activity and overcoming motor function restrictions, and offers the couple some tips on improving intimacy. Couples receive personalized ways they can improve their intimacy based on their lifestyle, as well. When needed, she will refer a patient to another health care professional for further consultation and treatment.
“We provide an optimal sexual health comprehensive assessment and do all we can to alleviate sexual dysfunction as it relates to Parkinson’s disease in the hopes that helping patients better their sexual health will be commonplace in the movement disorders field,” said Tanya Gurevich, MD, the Tel Aviv movement disorders unit director.
Currently, the Tel Aviv center is conducting a study to tactically assess the sexual needs of patients with Parkinson’s. The team hopes that the research will address intimacy and sexual dysfunction for people with PD on a broader level. “We hope that this research will be applied and transformed into practical guidelines and interventions for the entire Parkinson’s community,” Dr. Gurevich said.
Talking about sexuality and intimacy is not easy for most people. Parkinson’s disease itself, along with its medication side effects and symptoms, can increase sexual dysfunction. The Tel Aviv center operates based on the fact that patients are more likely to follow recommendations when they feel that their clinician understands their difficulties and cares about the outcomes. In the case of sexuality and intimacy issues, the clinician may be going beyond, helping patients express their issues and talk through their most private moments.
Since not everyone has access to a sex therapist where they seek treatment, Sharon feels that patients should speak to their doctor about changes in their sex life. “Most doctors wait for the patient to bring up sexual health,” Sharon said. “Your doctor wants to understand all aspects of your health. If you’re not sure how to approach the topic, begin by stating that you would like to discuss an intimate and personal topic. Then list the ways you have seen a change in your sex life over the course of the last few months or years.”
The Tel Aviv center is at the forefront of patient care and brings a profound knowledge of sex therapy to the Centers of Excellence Network. “We feel a strong responsibility to enable our patients to use their fundamental rights to love and be loved and to experience intimate relationships, as well as provide them with tools which can lessen the impact that Parkinson’s can have on their sex life,” Dr. Manor said. “Joan Collins, the symbol of timeless youth and beauty, said that sex is better than Botox for staving off aging. We do our best to support and assist our patients to actively apply her advice.”
Tips for a Healthy Sex Life from Sex Therapist Sharon Peleg Nesher, RN, MA:
- Sex is vital for our quality of life. Discuss it openly with your partner on a regular basis.
- Don't wait to feel spontaneous. Initiate and plan intimacy sessions.
- Explore the most comfortable positions in bed.
- Tell your partner what is right for you.
- Ask your physician about different kinds of erectile dysfunction medications.
- Remember that sexuality is not only intercourse, but a basic need for every human being throughout all stages of life, irrespective of age.
In these videos produced by the Parkinson's Foundation, a sex therapist explains how Parkinson’s affects sexual functioning: www.parkinson.org/pd-library/videos/how-does-pd-affect-sexual-functioning and how to talk to your physician or spouse about sexual dysfunction: www.youtube.com/watch?v=2NV5iRPt7jA.
To learn more about sexual health and Parkinson’s visit: www.parkinson.org/understanding-parkinsons/living-well/Sexual-Health.
Sharon Peleg Nesher, RN, MA, Sexual counselor
Yael Manor, PhD CCC-SLP, Multidisciplinary team coordinator
Tanya Gurevich, MD, Neurologist and MDU director