Sex and Parkinson's: Do you know the 8 "sexual health enablers?"
Last month on the blog, our own Dr. Indu Subramanian and her colleagues discussed in detail the psychosocial PD issues and the taboo topic of sex in Parkinson’s disease. This month we are expanding the discussion, based on a recent chapter on “Sexual Health, Wellness and Non-motor Parkinson’s Disease” written by Dr. Subramanian and Dr. Sarah Brindle. These two experts met at a “yoga teacher training” and their collaboration has been dynamite for advancing our knowledge on this topic. Their chapter originally appeared in a book edited by Prof K R Chaudhuri and Miriam Parry. The chapter heavily references the seminal work of Gila Bronner and she should be recognized as a pioneer in this field of sex in PD.
Here we present part II in our blog series in this important area.
What are the general ways to improve my sexual
health from a lifestyle perspective:
From a global healthy lifestyle perspective, eating a whole food, plant-based Mediterranean diet, staying hydrated, and sleeping 8 hours per night can potentially offer PWP a path to thrive; especially from a sexual health perspective.
Saying socially connected is helpful for improving motor and mental state PD outcomes. Exercise is medicine in healthy aging and this is true in PD. Exercising 30-60 minutes per day 5-7 days per week including cardio-based exercises can be beneficial for heart and brain health. Interestingly, exercise has been shown to improve some aspects of sexual function for some folks.
From a mind-body practice perspective; yoga and mindfulness may help with sexual health. Mindfulness as a practice has been shown to improve sexual satisfaction and self-esteem, whereas yoga has been also been shown to improve sexual performance and to help with some specific types of sexual dysfunction such as low libido and premature ejaculation.
Adaptive yoga administered from trained instructors in non-traditional individuals with physical differences and mobility issues; these folks can provide not only a skilled experience with yoga poses and a means to increase body awareness.
Activities such as yoga, can also represent a meaningful social connection to others with PD or even those with other physical challenges.
Holistic Sexual Health Management Concepts: The 8 Enablers
There is a list of 15 basic principles that can be used to address sexual heath issues (Bronner and Gurvich (2019). For those who are interested and motivated to improve their sexual well-being— you should be thinking about specific interventions for healthy sexual expression and thinking about this from a wellness perspective— be open minded and realize solutions may and can take many forms. Multiple sexuality-specific “enablers” are presented here and these will vary depending on the individual PWP and their individual circumstances.
Below we details the “Enablers” we hope you will find useful.
Enabler 1: Routinely communicate about sexual issues regardless of age, gender, stage of disease. Normalize these questions during routine visits in an open communication style by asking simple questions, listening, and responding empathically and non-judgmentally (Bronner et al., 2017). Practical simple and basic suggestions for “how to open a conversation on sex with patients”, as well as ideas for “how to continue” when a question has been discussed by experts like Gila Bronner. You don’t need permission to ask, talk, and get some information. Not everyone needs a certified sex therapist.
Enabler 2: Treat Motor/Non-motor PD symptoms: There are many medical interventions to better manage specific motor and non-motor symptoms and these can collectively represent targeted treatments and may have impact on sexual health.
Enabler 3: Use a multi-disciplinary team approach including rehabilitation therapists (physical therapists, occupational therapists), sex therapists, psychologists specializing in working with chronic health conditions or rehabilitation populations. Cameron, Mona, and Syme (2014) have suggested that sexual expression can be viewed from a medical/rehabilitation perspective—and as an activity of daily living (ADL); We encourage people to think creatively about solutions.
Enabler 4: Treat the urologic/gynecologic Issues: physical symptoms, contraception and fertility, physical positioning for safe and comfortable sexual activity, or planning around unexpected issues (e.g., bladder accidents) (ob/gyn, urology, uro-gynecology).
Enabler 5: Address the mental health issues: Be open in discussions about frustration, low self-esteem, and clinical mental health issues that may affect sexual expression (e.g., depression, anxiety, apathy and fatigue). This can be highly impactful for many folks with Parkinson’s.
Enabler 6: Address the couple and engage the intimate partner: Facilitate open communication. Discuss strategies for intimate partners who also can provide some physical care assistance to the PWP. Facilitate and allow for discussion of dual roles.
Enabler 7: Utilize adaptive behaviors or assistive devices: Sexual aids such as vibrators, dildos, and sexual positioning pillows can be used by individuals with motor or mobility impairments and can be helpful for exploring and discovering sexual responses alone or with a partner (Chance 2002).
Enabler 8: Widen the definition of sexual expression to include more than what is “normal”.
This reframing can be liberating for many individuals. Kaufman, Silverberg, and Odette (2003) have described the myth of “real sex” as the following: “Real sex” has been promoted as progressing from light activities like kissing to the “real” thing; penis-in-vagina intercourse; to simultaneous orgasm in ten minutes or less”.
When the emphasis is taken away from this traditional sexual script of performance, erection, and orgasm to simply experiencing physical pleasure, individuals and intimate partners can experiment and be creative in redefining sexual satisfaction— without such limiting expectations.
If you are a clinician treating persons with
Parkinson’s, here are some additional thoughts:
There are several ways for clinicians to enhance their provision of sexual health care.
Many providers may not have engaged in self-assessment regarding their own perceptions of sexual expression and what they believe to be appropriate in their own lives or in the lives of PWP or other significant health problems. It can be beneficial to identify and to be open and to assess one’s own biases and assumptions so that you can be as objective as possible. Your care should be centered on individual patients’ values and goals.
Mona, Syme, and Cameron (2014) have written a comprehensive review of diagnostic, assessment, and treatment approaches to sex therapy (in folks with disabilities). It is also important to acknowledge that a clinician does not need to be an expert in sexual medicine to provide meaningful sexual healthcare. Clinicians can also work to advocate for consistent sexual health assessment in their multidisciplinary healthcare settings, not just in their own clinics.
Clinicians can play a leading role in seeking out and identifying appropriate patient education materials. Patient-friendly resources such as the Ultimate Guide to Sex and Disability (Silverburg, Kaufman, & Odette, 2003) can provide creative ideas as well as useful information for normalizing the experience of sexual expression in Parkinson’s.
Conclusions
Sexual health is an integral component of the “vitals” that will underpin PD wellness . The issue can be complex and is comprised of physical, psychological, and drug related factors that affect sexual functioning in Parkinson’s disease.
Addressing sexual health using a wellness-based model promotes a holistic culturally-informed multidisciplinary approach; this approach may range from pharmacological and medical treatments to social, psychological, and lifestyle interventions.
The desired outcome positive impacts on sexual dysfunction we believe can and should focus on an “experience.” This experience should focus on physical intimacy and social connectedness.