Sexual Dysfunction in Parkinson Disease: A Multicenter Italian Cross-sectional Study on a Still Overlooked Problem

Background:Prevalence rates of sexual dysfunction (SD) in Parkinson's disease (PD) are likely to be under-estimated and their etiology is still unknown. More understanding of this issue is needed.Aim:To investigate prevalence of SD and its variables, including gender differences, in a sample of PD patients.Methods:This multicenter observational study included 203 patients (113 males and 90 females) affected byPD (diagnosed according to UK Parkinson's Disease Society Brain Bank clinical diagnostic criteria 28), and livingin 3 different Italian regions. Patients were evaluated using a semi-structured interview (a 40-item ad hocquestionnaire, developed by the authors to investigate patient's 3 main life areas: sociodemographic information,illness perception, and sexuality) and specific standardized scales to investigate SD, as well as by means of tools toassess their motor impairment, daily life activities, and disease-related caregiver burden (CBI).Main Outcome Measures:The International Index of Erectile Function and the Female Sexual FunctionIndex.Results:Sexual dysfunction was observed in about 68% of men, and in around 53% of women loss of libidobeing the main sexual concern in both sexes. Men were significantly more affected by SD than women (c2(1)¼4.34,P-value¼.037), but no difference in the severity of the dysfunction emerged between genders.Around 85% of PD patients had a stable couple relationship, and about 40% were satisfied with such a rela-tionship. However, about 57% of the patients stated that the disease affected their sexual life, especially due toreduced sexual desire, and the frequency of sexual intercourses. Moreover, significant differences between subjectswith SD and subjects without SD were found in UPDRS (I-II-III domains), in Hamilton Depression RatingScale and CBI scores.Clinical Implications:Clinicians dealing with PD should pay more attention to sexual issues, as discussing andtreating sexual problems enters the framework of a holistic approach, which is mandatory in chronic illness.Strengths & Limitations:The major strengths of this study include the multicenter nature of the study, toovercome single-center methodological bias. The main limitation is the relatively small sample size, and theabsence of a control group, even if there are growing literature data on sexuality and aging supporting ourfindings.Conclusion:SD is a highly prevalent and devastating problem in patients affected by PD, negatively affectingtheir quality of life