Sexual Dysfunction in Neurologic Disorders

A large number of patients with sexual dysfunction may also have neurological disorders that play a direct role in their sexual functioning. Sexual dysfunction and neurologic disorders are comorbidities that have a negative effect on overall quality of life, and it is recommended that they be treated in tandem. This article aims to briefly cover a variety of neurologic disorders and their direct effects on sexual dysfunction.

Spinal Cord Injury

In men, the prevalence of erectile dysfunction (ED) following a spinal cord injury (SCI) is around 75%. Those with lesions to the lower motor neuron (which control involuntary muscle movement) are more likely to experience ED. Erections tend to be more common amongst those with lesions to the upper motor neuron (which control voluntary movements), and these are more likely to be reflexive in nature. Even if there is an incidence of erection, it is usually not sufficient for satisfactory sexual activity.

Women tend to have more difficulty achieving orgasm following a SCI, with one study finding less than half achieving an orgasm (compared to a healthy control group with 100% able to achieve an orgasm). However, there is far less information on female sexual function following SCI.

Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease that causes damage to the protective coverings over nerve fibers. For men, MS tends to cause issues with ED and ejaculatory dysfunction, orgasmic dysfunction, and loss of libido. Women with MS are more likely to report issues with vaginal lubrication, orgasmic dysfunction, and loss of libido.

Traumatic Brain Injury

Those with a traumatic brain injury (TBI) are more likely to experience decreased sexual arousal. Men may report ED or ejaculatory dysfunction. Women may report dyspareunia and decreased vaginal lubrication. Typically, these reports may come from older patients who are female and have a more severe injury with very prevalent TBI symptoms like cognitive and motor limitations.

Sexual dysfunction from TBIs may be a result of chemical imbalances in the brain, namely serotonin levels due to their direct influence on sexual function. They may also be a result of damage to spinal systems and brainstem structures, similar to that of SCI.

Epilepsy

Epilepsy and various medications to treat it have a significant impact on sex hormones and central control. This is likely due to brain lesions caused by the condition, with different areas of lesions and types of seizures having different effects on sexual dysfunction. Those with temporal lobe and focal epilepsy are more likely to experience sexual dysfunction than others.

In fact, those with epilepsy tend to have lower levels of bioactive testosterone, which suggests there may be a higher number of hyposexual individuals (those with an abnormally low level of sexual interest or behavior) with epilepsy. Men with epilepsy tend to experience ED, hyposexuality, and organic sexual problems, while women tend to report low libido, orgasmic dysfunction, dyspareunia, and lack of sexual arousal.

Parkinson’s Disease

Parkinson’s disease causes dopamine deficiencies in those affected, which tends to present as a consistent tremor, and also tends to cause autonomic, cognitive, and sleep problems. A shared sexual dysfunction between men and women includes hypoactive desire and orgasmic dysfunctions.

Sexual dysfunction in men tends to present as ED or premature ejaculation. Women do not have many differentiating difficulties reported. However, sexual dysfunction may be underreported in this population due to embarrassment from patients.

General Treatment Options and Multidisciplinary Approach

Generally speaking, primary care providers should always be contacted when a patient with a neurologic disorder inquires about sexual dysfunction. Gaining insight from patient history can be incredibly insightful for choosing appropriate testing strategies for patients that ask for help. Some medications used to treat neurologic disorders may interfere with the efficacy of sexual dysfunction or medications to assist.

Additionally, while providers do their best to provide accurate and clear information to patients, the patients still may not have a clue what’s happening. It’s generally just a good idea to keep a new sexual dysfunction patient’s primary neurologist on speed-dial to discuss viable treatment options, etc.

For male sexual dysfunction like ED, it’s good to understand that most ED treatments or medications are perfectly safe. Vacuum erection devices or penile implants may be considered as well. Unfortunately, because women are not studied as often in this area, there is less information as to what specifically is recommended for those with neurologic disorders and sexual dysfunction. This underrepresentation highlights the need for more research and patient-centered assessments of sexual health in women with neurological disorders. Until more research is conducted, a general rule of thumb to remember is that if you are unsure, ask the primary care provider what’s best for the patient’s treatment plan.

Neurologic disorders and sexual dysfunction have a joint impact on quality of life. Between comorbidities of neurologic disorders like depression, anxiety, and sleep disorders, sexual dysfunction may become exacerbated and cause for sexual distress. Treatment planning should consider the role of the autonomic nervous system, stress physiology, and hormonal influences on sexual function. It’s also important to work together with the patient and their primary neurologist for a more individualized treatment approach.

Emotional and Neuropsychological Considerations

Sexual dysfunction in neurological disorders is not only a physical issue, but also often shaped by changes in mood, self-esteem, body image, and relationship dynamics. Neurological injury or disease can alter emotional regulation through changes in brain circuitry, which may heighten anxiety, depression, or emotional withdrawal. These emotional factors can, in turn, disrupt sexual desire, arousal, and satisfaction. A comprehensive treatment plan benefits from integrating mental health support, communication skills training, and stress-reduction strategies alongside medical interventions to address the whole patient, not just the physical symptoms.

Key Points for Clinicians

• Screen for sexual dysfunction in patients with neurological disorders.
• Collaborate with neurologists and mental health professionals.
• Consider both physical and emotional/relationship factors in care.
• Consider sociocultural and religious influences on patients when creating treatment plans.

  ---

References:

Burns, A. S., Rivas, D. A., & Ditunno, J. F. (2001). The management of neurogenic bladder and sexual dysfunction after spinal cord injury. Spine, 26(Supplement). https://doi.org/10.1097/00007632-200112151-00022

Courtois, F., Gérard, M., Charvier, K., Vodušek, D. B., & Amarenco, G. (2018). Assessment of sexual function in women with neurological disorders: A Review. Annals of Physical and Rehabilitation Medicine, 61(4), 235–244. https://doi.org/10.1016/j.rehab.2017.04.004

Lombardi, G., Musco, S., Kessler, T. M., Marzi, V. L., Lanciotti, M., & Del Popolo, G. (2015). Management of sexual dysfunction due to central nervous system disorders: A systematic review. BJU International, 115(S6), 47–56. https://doi.org/10.1111/bju.13055

Raciti, L., De Cola, M. C., Ortelli, P., Corallo, F., Lo Buono, V., Morini, E., Quattrini, F., Filoni, S., & Calabrò, R. S. (2020). Sexual dysfunction in parkinson disease: A Multicenter Italian cross-sectional study on a still overlooked problem. The Journal of Sexual Medicine, 17(10), 1914–1925. https://doi.org/10.1016/j.jsxm.2020.06.010

Silva, M. F., Oliveira, L. M., Ideta, M. M., Paschoalino, M. C., Gonçalves, D. B., Anghinah, R., Paiva, W. S., & Amorim, R. L. (2022). Sexual dysfunction after traumatic brain injury: An integrative review. JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA, 33(3), 323–336. https://doi.org/10.22290/jbnc.2022.330308

Zhao, S., Tang, Z., Xie, Q., Wang, J., Luo, L., Liu, Y., Zhu, Z., Luo, J., & Zhao, Z. (2019). Association between epilepsy and risk of sexual dysfunction: A meta-analysis. Seizure, 65, 80–88. https://doi.org/10.1016/j.seizure.2019.01.004

Çelik, D. B., Poyraz, E. Ç., Bingöl, A., İdiman, E., Özakbaş, S., & Kaya, D. (2013). Sexual dysfunction ın multiple sclerosis: Gender differences. Journal of the Neurological Sciences, 324(1–2), 17–20. https://doi.org/10.1016/j.jns.2012.08.019