Sexual dysfunction in patients with neurologic disorders

Introduction
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By Jasvinder Chawla MD MBA

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 clinical article, Dr. Jasvinder Chawla of Loyola University Medical Center 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.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Epidemiology
Prevention
Diagnostic workup
Prognosis and complications
Management
Pregnancy
Anesthesia
References cited
Contributors