Men with Parkinson's disease (PD) who are sexually active have fewer motor and non-motor symptoms and better quality of life, new research shows. "This is the first prospective longitudinal study involving a large cohort of Parkinson's disease patients suggesting that sexual activity is associated with lower motor and non-motor disability as well as with better quality of life in men," the authors write. "These findings should prompt movement disorders specialists to periodically inquiry about their patients' sexual life," they add. The study was published online July 2 in the European Journal of Neurology. Neglected Topic "We are not saying the relationship between sexual activity and Parkinson's symptoms is causal — only that we have found a link," lead author Marina Picillo, MD, University of Salerno, Italy, told Medscape Medical News. "This is a first observation, a first step into this topic which is completely neglected. Everyone thinks that patients with neurodegenerative disease don't have a sexual life but our data shows that is clearly not the case," she added. There is very little information about the role of sexual activity in neurogenerative diseases, Picillo noted. "Any research that does exist is related to sexual dysfunction. But we know being sexually active improves quality of life in the general population and patients with Parkinson's are probably no different in this regard. Clinicians and other health professionals should talk more about sexual activity to their Parkinson's patients," she said. The current analysis used data from a subgroup of patients in the PRIAMO study, a large Italian multicenter observational study designed to assess the prevalence and evolution of non-motor symptoms in patients affected by different parkinsonian syndromes; the study included a cross-sectional and a longitudinal prospective 24-month follow-up. As part of the study, PD patients underwent interviews about Parkinson's symptoms at baseline and at two follow-up visits — 12 months and 21 to 28 months after the baseline visit. As part of the interview, patients were asked whether they had been sexually active within the last 12 months. Of the 355 patients (67% men) who answered the question, 56.3% reported they were sexually active at the first time point, 53.7% at the second interview, and 50.8% at the third. Men were more likely than women to be sexually active at all time points. After multivariable and logistic analyses, results showed that at 2 years, male patients who were sexually active were less likely to have non-motor symptoms, especially apathy (odds ratio [OR], 0.42; P < .001) and gastrointestinal symptoms (OR, 0.56, P = .003). In addition, sexual activity for men was less frequently associated with treatment with L-dopa (OR, 0.65, P = .037). No such association was found in women. In addition, men who engaged in sexual activity had less severe motor disability as measured by the Unified Parkinson's Disease Rating Scale part III (UPDRS-III; coefficient -2.881, P = .002); better health related quality of life (39-item Parkinson's Disease Questionnaire, coefficient -24.196, P = .022; and EuroQol visual analogue scale, coefficient 0.083, P = .006); and lower depression scores (Hamilton Depression scale; coefficient -1.245, P = .004). Again, there were no such associations in women. Cognitive function, as measured on the Mini-Mental State Examination, was not associated with sexual activity either in men or in women. "Further studies are needed to investigate whether being sexually active leads to an improvement in symptoms, and we also need more studies in women," Picillo said. Ask About Sexual Activity Commenting on the findings for Medscape Medical News, David B. Vodušek, MD, Institute of Clinical Neurophysiology, University Medical Centre, Ljubljana, Slovenia, said that the title of the current article, "Active sexual life is associated with better motor and non-motor outcomes in men with early Parkinson's disease," seems to imply that sex can ameliorate PD. "While I have nothing against patients pursuing an active sexual life with a notion that it is good for them — sex will, indeed, improve their quality of life — the discussed study does not claim to have found an alternative cure for Parkinson's," he said. "In research, as the authors rightly point out, the most commonly used tools to evaluate non-motor symptoms as well as health-related quality of life in Parkinson's contain either a few, or no, items related to sexual function," Vodušek said. "Valid tools for future research of sex in Parkinson's thus need to be introduced." He added that effective pharmacologic and behavioral therapies for sexual problems are available, and thus clinicians should be proactive and ask all patients with PD about their sexual activity. "If this article alerts neurologists to that, it has amply added to the quality of care of Parkinson's patients," he said. Also commenting for Medscape Medical News, Beckie Port, PhD, research manager at the London-based nonprofit organization Parkinson's UK, said it is well understood that sexual activity is an indicator of good health in the general population. This study, she said, suggests that asking patients with PD about their sexual activity during clinical examinations "may act as a surrogate measure for motor and non-motor symptoms in men, after finding a correlation between the two." "Further studies are needed to confirm the finding, but it is important to note that this research does not suggest that sexual activity is the cause of lower motor and non-motor disability and better quality of life in men, only that there is an association," Port said. This study was supported by an educational grant from Boehringer Ingelheim, Italy. The authors and commentators have disclosed no relevant financial relationships. Eur J Neurol. Published online July 2, 2019. Full text Source
