Bronner Gila, Korczyn Amos D
Department of Urology Sexual Medicine Center Sheba Medical Center Tel-Hashomer Israel.
Department of Neurology Movement Disorders Institute Sheba Medical Center Tel-Hashomer Israel.
Mov Disord Clin Pract. 2017 Nov 16;5(1):6-13. doi: 10.1002/mdc3.12561. eCollection 2018 Jan-Feb.
Patients with Parkinson disease (PD) and their partners report deterioration in their sexual life. Sexual dysfunction (SD), an important and often ignored aspect, is common in PD. Motor and nonmotor symptoms are involved in limiting pleasure and disturbing function. Sexual dissatisfaction is more common in men that in women. Frequently, both patients and partners have SD associated with PD, and both need suitable treatment. These issues need to be evaluated by neurologists or PD nurses and by specialized sex therapists. The objectives of this study were to describe the complexity and multidimensional nature of sexual problems in PD, enable practitioners to assess and treat sexual difficulties of their patients, and increase awareness of the role of sex therapy in the therapeutic process of PD.
Based on clinical experience of over 30 years in movement disorder clinics and a review of the literature, the authors suggest practical approaches, including an "Open Sexual Communication" module, prescribing medications, and/or referring to specialists.
The longitudinal nature of treating neurologic patients puts physicians in an important position to introduce sexual issues and to assess and plan the interventions and follow-up needed to ensure that sexual difficulties are resolved. The management of hypersexuality requires a thoughtful distinction between lack of opportunities for sexual expression, limited ability to perform, and true hypersexuality. Sex therapists have a major role in the assessment and treatment of the multiple factors that may underlie sexual dissatisfaction in PD, differentiating between hypersexual behaviors and other sexual preoccupation behaviors, and training the professional team.
帕金森病（PD）患者及其伴侣报告称他们的性生活质量下降。性功能障碍（SD）是PD中一个重要但常被忽视的方面，很常见。运动和非运动症状会限制愉悦感并干扰性功能。男性的性不满比女性更常见。通常，患者及其伴侣都存在与PD相关的性功能障碍，两者都需要适当的治疗。这些问题需要由神经科医生或PD专科护士以及专业的性治疗师进行评估。本研究的目的是描述PD中性问题的复杂性和多维度性质，使从业者能够评估和治疗患者的性困难，并提高对性治疗在PD治疗过程中作用的认识。
基于在运动障碍诊所30多年的临床经验以及文献综述，作者提出了实用的方法，包括“开放性性沟通”模块、开药和/或转诊至专科医生。
治疗神经科患者的长期性使医生处于引入性问题、评估和规划所需干预措施及随访以确保解决性困难的重要位置。对性欲亢进的管理需要仔细区分性表达机会不足、性功能受限和真正的性欲亢进。性治疗师在评估和治疗可能导致PD患者性不满的多种因素、区分性欲亢进行为和其他性关注行为以及培训专业团队方面发挥着重要作用。
