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Sexual dysfunction in patients with neurologic disorders

Sexual dysfunction in patients with neurologic disorders


Jasvinder Chawla MD MBA, author. Dr. Chawla of Loyola University Medical Center and 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.

Publication dates

Originally released October 22, 2010; expires October 22, 20

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.

• 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 nomenclature

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).

Clinical manifestations

Clinical manifestations depend on the underlying etiology from both central and peripheral nervous systems and to some extent on the aging process. Please see Table 1 (Table 1: ) for neuroanatomical localization, etiology, and laboratory workup. The neurologic history and examination should remain focused on the details of neurologic disorders having sexual dysfunction. Sexual dysfunction (eg, lack of libido, erectile dysfunction and disturbances of ejaculation, deficient lubrication, dyspareunia, problems with orgasm) is not uncommon in the general population. Men should be asked about erectile function (the occurrence of nocturnal erections, morning erections, and erections evoked by genital, visual, auditory, or psychogenic stimuli) and retrograde ejaculation. Women may report problems with vaginal lubrication or the quality of orgasmic sensations (Addis et al 2006; Bl?mel et al 2009).

Central nervous system disorders of the brain.

Cerebrovascular disease. Reduced frequency of intercourse has been reported after stroke and other cerebrovascular disorders. Patients and their partners report that concern about precipitating another stroke leads to a decline in the frequency of intercourse (Monga et al 1986; Munhoz et al 2009). The best predictor of decreased sexual activity in these patients is the degree of dependence in activities of daily living (Korpelainen et al 1998; Jung et al 2008). Locked-in syndrome from a lesion involving the ventral pons can occur from a variety of causes, including primary vascular or traumatic injury to the brainstem. Almost two thirds of the patients reported having sexual desire, but only one third maintained sexual relations (Le?n-Carri?n et al 2002).

Continued at resource.

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