Dr Marina-PicilloMarina Picillo, MD
Data from the PRIAMO study, a longitudinal, prospective, first-of-its-kind study in Parkinson disease suggests that sexual activity is associated with lower motor and nonmotor disability, as well as better quality of life in men with Parkinson disease. However, no similar associations were observed for women with Parkinson disease.

According to the investigators, led by Marina Picillo, MD, assistant professor, department of medicine and surgery, Università degli Studi di Salerno, these findings should promote periodic inquiry regarding patient sexual life by movement disorder specialists treating patients with Parkinson disease. As measured by a semi‐structured gender‐tailored interview, those who had been sexually active in the past 12 months were more likely to have lower motor disability (P =.002), better quality of life (P =.006), and lower depression scores (P =.004).

“As patients with Parkinson's disease have to cope with important changes in their sexual function, achieving a satisfying intimate and sexual relationship is often a challenge. On the other hand, evidence shows that quality of sexual expression improves general satisfaction of life in [Parkinson] patients,” Picillo and colleagues detailed.

They wrote that there are several explanations which might account for the gender discrepancies in this study, such as the gender differences which exist in motor symptoms and nonmotor symptoms in early Parkinson, societal attitudes which might preclude women from speaking about sexual and genital issues, as well as the representation in this cohort (33% women vs 67% men).

PRIAMO enrolled 1142 patients, though this specific analysis included only the 355 patients at Hoehn and Yahr stage ≤2 and considered to have early-stage Parkinson. The cohort was then stratified by gender (men, n = 238; women, n =  117), as well as being sexually active (SA, n = 200) or not sexually active (NSA, n = 155). All told, 155 men and 45 women with Parkinson were deemed sexually active. Data were recorded at baseline, 12-month (±4) follow-up, and a second follow-up at 9 to 16 months.

The overall prevalence of sexual activity was reduced over the longitudinal phase in the entire group (baseline, 56.3%; 12 months, 53.7%; 9-16 months, 50.8%), though men were more likely to be sexually active at all time points.

At baseline, the SA men (n = 155) had a mean Unified Parkinson Disease Rating Scale III (UPDRS-III) score of 17.46, a mean Mini-Mental State Exam (MMSE) score of 27.43, a mean Parkinson's Disease Questionnaire–39 (PDQ-39) total score of 153.5, and an EuroQol visual analogue scale (EQ-VAS) score of 66.91. The NSA men (n = 83) had respective scores of 20.84, 26.67, 164.9, and 61.87.

UPDRS-III scores were better with men in the SA group (coefficient, –2.881; 95% CI, –4.732 to –1.030; P =.002), as well as PDQ‐39 scores (coefficient, −24.196; 95% CI, −44.884 to −3.508; P =.022), EQ‐VAS scores (coefficient, 0.083; 95% CI, 0.023–0.143, P =.006) and lower depression scores as measured by the Hamilton Depression scale (coefficient −1.245, 95% CI −2.104 to −0.387, P =.004). MMSE was not associated with sexual activity in men nor women.

During interviews with patients, Picillo and colleagues asked gender-specific questions (men, 9 questions; women, 7 questions), including the patient’s reasoning for not being sexually active. “Briefly, men complained of loss of erection, impotence and orgasmic disorder as well as sexual dissatisfaction, whilst women had reduced sexual drive and arousal and orgasmic dysfunction as well as sexual dissatisfaction,” they wrote. The investigators added that for the most part, both men and women failed to provide a response for not being sexually active.

Additionally, men in the SA group were less likely to experienced gastrointestinal symptoms (odds ratio [OR], 0.56; 95% CI, 0.39–0.82; P =.003) and less likely to experience apathy (OR, 0.42; 95% CI, 0.29–0.97; P <.001). Notably, less frequent treatment with levodopa was also associated with sexual activity in men (OR, 0.65; 95% CI, 0.43–0.97; P =.037).

The investigators did acknowledge some limitations, including the lack of longer observation and a control group, the data’s risk of being affected by recall bias, and that reduced sexual activity can simply reflect reduced motivation. They concluded that more study will be required to confirm the data in men as well as explore these relationships in women.

“The goal of treatment of sexual function in [Parkinson] should not be limited to maintaining full genital functions but, rather, to achieving pleasure and satisfaction, reducing anxiety and concerns, increasing intimate couple communication and reducing relationship tension,” Picillo and colleagues wrote. “Our data confirm these theories and should prompt clinicians to broadly address sexual issues not limited to sexual dysfunction in [Parkinson] patients.”
REFERENCE
Picillo M, Palladino R, Erro R, et al. The PRIAMO study: active sexual life is associated with better motor and non‐motor outcomes in men with early Parkinson's disease. Eur J Neurol. Published online July 2, 2019. doi: 10.1111/ene.13983