Sexual dysfunction in patients with neurologic disorders

Jasvinder Chawla MD MBA (Dr. Chawla of Loyola University Medical Center and Chief of Neurology at Hines VA Hospital has no relevant financial relationships to disclose.)
Zachary N London MD, editor. (Dr. London of the University of Michigan has no relevant financial relationships to disclose.)
Originally released October 22, 2010; last updated February 17, 2017; expires February 17, 2020

This article includes discussion of sexual dysfunction in patients with neurologic disorders, psychosexual dysfunction, and sexual disorder. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Sexual dysfunction is common in a variety of neurologic disorders. Symptoms include lack of sexual desire, erectile dysfunction in men, decreased lubrication in women, and disturbances of ejaculation and orgasm. Sexual dysfunction can be the result of a lesion involving neural tissue specifically relevant for sexual responses or lesions in other neural structures more generally involved in control of behavior. The term “hypoactive sexual desire disorder” is used to define a decline in desire for sexual activity, alone or with a partner, associated with personal distress. In this article, the author addresses sexual dysfunction in neurologic disorders and discusses how recognition and adequate management of sexual dysfunction related to underlying neurologic disorders can greatly improve patients' quality of life.

Key points

 

• Sexual dysfunction may be the presenting symptom of a developing neurologic disease or it may be due to more general effects of a neurologic disorder.

 

• Sexual dysfunction may manifest as decreased sexual desire, erectile dysfunction in men, decreased lubrication in women, and disturbances of ejaculation and orgasm.

 

• The history should include details of neurologic disease as well as any past history of endocrine, cardiovascular, psychological, and psychiatric disturbances.

 

• A detailed neurologic examination will provide better understanding of the underlying neurologic disease.

 

• Sexual dysfunction can be seen in patients with neurologic disorders localized to the central or the peripheral nervous system.

 

• The extent of the sexual dysfunction can vary based upon the localization site, natural history, and the age of onset.

 

• Forebrain areas regulate the initiation and execution of sexual behavior; the medial preoptic area integrates sensory and hormonal signals; and the amygdala and other nuclei play a role in the execution and reward aspects of sexual function.

 

• Neurophysiological tests can be utilized as direct extensions of the clinical neurologic examination.

Historical note and terminology

Sexual dysfunction in neurologic disease can be classified as relating to primary, secondary, and tertiary factors. Primary factors include those stemming from physiological disturbance of sexual function or pharmacological effects. Secondary factors include those related to sensorimotor, bladder, and bowel disturbances and higher brain dysfunction. Tertiary factors include those related to psychosocial and cultural changes resulting in the disease (Foley and Iverson 1992).

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