Abstract
Introduction:
There is a need for a comprehensive assessment of sexual dysfunction in patients with young-onset Parkinson’s disease (PD) to better understand its impact on this population. This study aimed to assess sexual dysfunction in patients with young-onset PD.
Methods:
This case-control study was conducted using a self-administered International Index of Erectile Function Scale (IIEF) questionnaire. The questionnaire included questions related to sexual function, including the ability to achieve and maintain erection and sexual desire. The participants included 30 individuals with young-onset PD and 30 controls without PD who were matched for age and gender.
Results:
The study enrolled 30 patients with an average age of 37.2 ± 5.29 years and PD symptom duration ranging from less than two years to over two years. Most patients were classified as having stage 2 or 3 PD and exhibited a range of symptoms, such as bradykinesia, tremors, rigidity, and postural instability. The findings revealed that 40% of the PD group experienced moderate erectile dysfunction, while 23.33% reported severe dysfunction, in contrast to the absence of dysfunction observed in the control group. The analysis indicated that patients with a disease duration of less than two years had higher scores across all five components of the IIEF questionnaire. Furthermore, anxiety, depression, increased medication use, and disease severity significantly affected sexual function.
Conclusion:
This study highlights the impact of young-onset PD on sexual function and underscores the importance of the early recognition and management of sexual dysfunction in patients with PD.
Introduction
Parkinson’s disease (PD) is a neurodegenerative disease with a multifactorial etiology, characterized by loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc).1 Dopamine via its action on the direct and indirect circuits of the basal ganglia modulates motor movements. Dopamine deficiency leads to bradykinesia, tremor, rigidity, and later in the course of the disease also leads to postural instability.2 PD is also associated with nonmotor symptoms, such as cognitive impairment, which may precede motor symptoms by more than a decade and is often a presenting complaint.3,4 These nonmotor symptoms contribute significantly to the overall morbidity of the disease and reduce quality of life. Among these nonmotor symptoms, sexual dysfunction (SD) is a prominent and frequently overlooked aspect, especially among young-onset PD (YOPD) patients.1 Early-onset Parkinson’s disease (EOPD) accounts for 3%–5% of all PD cases and is classified based on the onset of symptoms into “juvenile” (less than 21 years) and “young-onset” PD (YOPD 21–45 years).5 The prevalence rate of PD in India has been reported to be 27 in every 100,000 and 15% of those diagnosed with PD are under 50 years.6
SD is frequently observed in patients with YOPD.7,8 The severity varies with the stage of the disease and various contributory psychological factors.9 The underlying pathophysiology behind this causation includes autonomic nervous system involvement, motor symptoms of PD making sexual intercourse difficult, and fatigue. Anti-Parkinsonian medications, such as dopaminergic agents, may interfere with reward mechanisms, thereby affecting sexual satisfaction and psychological issues.2,10,11 A study done in 1995 showed that 33.4% of men experienced changed sexual activity after the onset of PD which correlated with increasing time of treatment and advanced Hoehn-Yahr stages.12 Singer et al. have reported 60.4% of their patients with PD had erectile dysfunction (ED).13 Lipe et al. in their study showed similar numbers.9
SD has a significant impact on quality of life.10 SD affects approximately 43% of the women and 31% of the men in the general population.11 ED, with a prevalence of up to 79%, is the most common complaint among men with PD.12 The most common SD has been reported to be loss of libido, which is twice as common as in the healthy population (83%).12–14 SD can also negatively impact partnerships.15,16 Despite its high prevalence and significant impact on quality of life and relationships, SD is often underestimated and/or not recognized in clinical practice and is not openly addressed by patients or physicians.
There is a dearth of studies exploring this aspect among YOPD patients in the Indian setting. Hence, this study aimed to assess the prevalence of SD among patients with YOPD and explore various contributory factors to address the issue that is less discussed, especially in a developing country scenario.
Methods
This was a hospital-based case-control study that included married men aged between 21 and 50 years with YOPD and who were in an active sexual relationship. The diagnosis of PD was carried out as per the United Kingdom Parkinson’s Disease Society Brain Bank Criteria.14 Patients with a prediagnosed psychiatric disorder, cognitive impairment (those who obtained a score below 24 on the Mini-Mental State Examination [MMSE]), or drugs that can cause ED were excluded from the study. The controls were age-matched, healthy volunteers. The data were gathered over six months from July to December 2020 after obtaining Institutional Human Ethics Committee clearance, certificate No. – JSSMC/IEC/180820/07 NCT/ 2020–21.
Upon obtaining written consent from the study participants, essential information about the demographic details, symptomology, details of the disease’s onset, course, and severity, and medications were collected in a prestructured proforma and transcribed into Microsoft Excel 2019 for descriptive analysis.
The blood pressure was clinically evaluated for orthostatic hypotension, characterized by drop in systolic blood pressure of at least 20 mm Hg or a drop in diastolic blood pressure of at least 10 mm Hg within three minutes of erect standing.15 The severity of PD was scored according to Hoehn and Yahr staging,16 wherein stage 1 was unilateral involvement only, and stage 5 was wheelchair bound or bedridden unless aided.
The Hamilton Anxiety Rating Scale (HAM-A)17 was used to assess anxiety with a 14-item questionnaire. Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0–56, where <17 indicates mild severity, 18–24 indicates mild to moderate severity, and 25–30 indicates moderate to severe. The Hamilton Depression Rating Scale (HAM-D)18 was used to assess depression with a 17-item questionnaire. A score of 0–7 is normal, 8–16 suggests mild depression, 17–23 indicates moderate depression, and scores > 24 are indicative of severe depression. The International Index of Erectile Function Scale (IIEF) questionnaire19 is a 15-item questionnaire that examines four domains of male sexual function: erectile function, orgasmic function, sexual desire, and intercourse satisfaction. Each question is scored between 0 and 5. The severity of ED is classified into five categories based on scoring: 26–30: no ED; 22–25: mild; 17–21: mild to moderate; 11–16: moderate; and 6–10: severe.
Statistical Analysis
Categorical variables are presented as frequencies and percentages. Continuous variables are presented as means, standard deviations, and medians. Intergroup comparisons were performed using the t-test. One-way analysis of variance (ANOVA) and post hoc Tukey tests were used for pairwise comparison analysis. Statistical significance was set at P < .05. Microsoft Excel 2019 was used for data entry, and SPSS version 24.0 for Windows was used for data analysis.
Results
A total of 30 YOPD patients consented to participate in the study, with a mean age of 37.2 ± 5.29 years. Of the 30 patients, 13 (43.3%) had symptoms for less than two years, while 17 (56.75%) patients had symptoms for more than two years. Baseline clinical assessments (case group) are presented in Table 1.Table 1. Baseline Clinical Assessment (Case Group).
| Characteristics | Number (%) n = 30 | |
|---|---|---|
| Age (in years) [mean ± SD: 37.2 ± 5.29] | 21–30 | 4 (13.33) |
| 31–40 | 17 (56.67) | |
| 41–50 | 9 (30) | |
| Symptoms duration | <2 years | 13 (43.33) |
| >2 years | 17 (56.67) | |
| Disease stage | Stage 1 | 7 (23.33) |
| Stage 2 | 11 (36.67) | |
| Stage 3 | 9 (30) | |
| Stage 4 | 1 (3.33) | |
| Stage 5 | 2 (6.67) | |
| Symptoms | Bradykinesia | 30 (100) |
| Tremors | 29 (96.67) | |
| Rigidity | 23 (76.67) | |
| Postural instability | 10 (33.33) | |
| Anxiety severity | Mild | 4 (13.33) |
| Moderate | 9 (30) | |
| Severe | 11 (36.67) | |
| Depression severity | Mild | 5 (16.67) |
| Moderate | 9 (30) | |
| Severe | 11 (36.67) | |
| Treatment | Trihexyphenidyl/rasagiline | 14 (46.67) |
| Levodopa/trihexyphenidyl/amantadine | 8 (26.67) | |
| Levodopa/trihexyphenidyl/amantadine/pramipexole | 8 (26.67) | |
| Erectile dysfunction | No Erectile dysfunction | 5 (16.66) |
| Mild | 4 (13.33) | |
| Mild to moderate | 2 (6.66) | |
| Moderate | 12 (40) | |
| Severe | 7 (23.33) | |
It is noteworthy that all our study participants had varying severities of bradykinesia, 29 (96.7%) had tremors, 23 (76.7%) had rigidity, and 10 (33.3%) had postural instability. None of our patients had a significant drop in blood pressure to satisfy the criteria for orthostatic hypotension or any clinical features of autonomic involvement.
The control group had no ED, while 40% of the case group reported moderate dysfunction, followed by 23.33% reporting severe dysfunction. In comparison to the control arm, the case arm scored lower on all five components of the IIEF questionnaire. Table 2 presents the results of the IEF questionnaire.Table 2. IIEF Questionnaire Score.
| Five Components of IIEF | Case (n = 30) | Control (n = 30) | t Value | p Value |
|---|---|---|---|---|
| Mean ± SD | Mean ± SD | |||
| Erective function | 16.33 ± 7.16 | 28.27 ± 1.34 | 8.979 | <.001* |
| Orgasmic function | 5.9 ± 1.52 | 9.53 ± 0.51 | 12.444 | <.001* |
| Sexual desire | 6.27 ± 1.74 | 8.6 ± 0.68 | 6.846 | <.001* |
| Intercourse satisfaction | 9.27 ± 2.12 | 13.1 ± 1.09 | 8.814 | <.001* |
| Overall satisfaction | 6.13 ± 1.31 | 8.6 ± 0.68 | 9.191 | <.001* |
Note: *Statistically significant.
The case group was further divided into two groups based on disease duration: less than two years and more than two years, and erectile function was analyzed; the results are shown in Table 3. All five components of the IIEF were higher in patients with a disease duration of less than two years, and this difference was statistically significant.Table 3. Analysis of Erectile Function Between the Patients with Disease Duration Less Than Two Years Versus Those With Disease Duration More Than Two Years.
| Five Components of IIEF | Less Than 2 Years (n = 13) | More Than 2 Years (n = 17) | t Value | p Value |
|---|---|---|---|---|
| Mean ± SD | Mean ± SD | |||
| Erective function | 21.85 ± 6.03 | 12.12 ± 4.69 | 4.979 | <.001* |
| Orgasmic function | 6.92 ± 1.04 | 5.12 ± 1.36 | 3.969 | <.001* |
| Sexual desire | 7.38 ± 1.12 | 5.41 ± 1.66 | 3.683 | .001* |
| Intercourse satisfaction | 10.62 ± 1.66 | 8.24 ± 1.86 | 3.641 | .001* |
| Overall satisfaction | 7.23 ± 0.83 | 5.29 ± 0.92 | 5.952 | <.001* |
Note: *Statistically significant.
The case arm was also analyzed for patients with rigidity and bradykinesia and compared to those without these features. The results showed no statistically significant differences between the two groups.
The case group was divided based on the HAM-A test, and participants with and without anxiety and their IIEF scores were compared (Table 4). Of the 30 participants in the case group, 24 (80%) had anxiety. Erective function (mean score: 23.33 ± 8.24), orgasmic function (mean score: 7.17 ± 1.33), sexual desire (mean score: 7.83 ± 2.04), and intercourse satisfaction (mean score: 11.7 ± 2.5) were higher in participants without anxiety. These differences were statistically significant. However, the difference in the overall satisfaction was not statistically significant.Table 4. Comparison of IIEF Score and Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) Score Among the Case Arm.
| Five Components of IIEF | HAM-A | t Value | p Value | |
|---|---|---|---|---|
| Yes (n = 24) | No (n = 6) | |||
| Mean ± SD | Mean ± SD | |||
| Erective function | 14.58 ± 5.82 | 23.33 ± 8.24 | –3.035 | .005* |
| Orgasmic function | 5.58 ± 1.41 | 7.17 ± 1.33 | –2.483 | .019* |
| Sexual desire | 5.88 ± 1.45 | 7.83 ± 2.04 | –2.724 | .011* |
| Intercourse satisfaction | 8.79 ± 1.79 | 11.17 ± 2.4 | –2.716 | .011* |
| Overall satisfaction | 5.92 ± 1.25 | 7 ± 1.27 | –1.897 | .068 |
| Five Components of IIEF | HAM-D | tvalue | pValue | |
| Yes (n= 25) | No (n= 5) | |||
| Mean ± SD | Mean ± SD | |||
| Erective function | 14.48 ± 5.63 | 25.6 ± 7.23 | –3.858 | .001* |
| Orgasmic function | 5.56 ± 1.36 | 7.6 ± 1.14 | –3.136 | .004* |
| Sexual desire | 5.84 ± 1.41 | 8.4 ± 1.82 | –3.553 | .001* |
| Intercourse satisfaction | 8.76 ± 1.74 | 11.8 ± 2.17 | –3.435 | .002* |
| Overall satisfaction | 5.92 ± 1.22 | 7.2 ± 1.3 | –2.117 | .043* |
Note: *Statistically significant.
Similarly, depression was detected in 25 (83.3%) study participants in the case group. The HAM-D scores were compared with their IIEF scores, as shown in Table 4. Statistically significant differences in the scores were noted in all five parameters, with overall satisfaction among patients with depression being only 5.92 as compared to 7.2 among those without depression.
In addition, the effects of the drugs on sexual function were investigated. The study participants were divided into groups according to the number of prescribed medications. Patients taking three or more medications were found to have a significant impairment in sexuality, with the exception of satisfaction with the sexual intercourse component. Details of the analyses are presented in Table 5. It was noted that the majority of the study participants (16; 53.5%) received levodopa, but none reported symptoms of hypersexuality. Patients with severe disease received higher doses of levodopa equivalent.Table 5. Comparison of IIEF Score and Number of Medications Taken Among the Case Arm.
| Five Components of IIEF | No. of Medications Taken | One-way ANOVA | Posthoc Tukey Test | |||||
|---|---|---|---|---|---|---|---|---|
| 2 (n =14) | 3 (n = 8) | 4 (n = 8) | F Value | p Value | 2 vs. 3 Difference (p Value) | 2 vs. 4 Difference (p Value) | 3 vs. 4 Difference (p Value) | |
| Erective function | 21.71 ± 7.26 | 10.88 ± 1.55 | 12.38 ± 1.41 | 14.379^ | <.001* | 10.84 (<.001) | 9.34 (.001) | –1.5 (.83) |
| Orgasmic function | 6.71 ± 1.59 | 5.13 ± 1.25 | 5.25 ± 0.89 | 4.79 | .017* | 1.59 (.034) | 1.46 (.054) | –0.13 (.981) |
| Sexual desire | 7.43 ± 1.45 | 5.25 ± 1.67 | 5.25 ± 0.89 | 9.125 | .001* | 2.18 (.004) | 2.18 (.004) | 0 (1) |
| Intercourse satisfaction | 10.14 ± 2.18 | 8.75 ± 2.44 | 8.25 ± 0.89 | 2.627 | .091 | 1.39 (.277) | 1.89 (.103) | 0.5 (.873) |
| Overall satisfaction | 6.86 ± 1.03 | 5.63 ± 1.41 | 5.38 ± 1.06 | 5.33 | .011* | 1.23 (.056) | 1.48 (.019) | 0.25 (.901) |
Note: ^Welch test; * Statistically significant.
The study participants were also divided into subgroups according to their disease stage according to the Hoehn and Yahr staging classification. Significant impairment of sexual function was observed in all the study participants with increasing disease severity. This difference was statistically significant, and patients with stage 4 and 5 disease had the most SD among all patients. Details of the analysis are presented in Tables 6 and 7.Table 6. Analysis of IIEF Components and Stage of the Disease.
| Five Components of IIEF | Stage of Disease | N | Mean | Statistics/Mean Squares | df2 (welch)/F (ANOVA) | p Value |
|---|---|---|---|---|---|---|
| Erective function | 1 | 7 | 19.29 ± 7.251 | 12.264 | 11.708 | .001* |
| 2 | 11 | 20.55 ± 7.076 | ||||
| 3 | 9 | 11.33 ± 1.732 | ||||
| 4/5 | 3 | 9 ± 1 | ||||
| Total | 30 | 16.33 ± 7.155 | ||||
| Orgasmic function | 1 | 7 | 6.86 ± 1.069 | 7.773 | 4.658 | .01* |
| 2 | 11 | 6.18 ± 1.722 | ||||
| 3 | 9 | 5.56 ± 0.882 | ||||
| 4/5 | 3 | 3.67 ± 0.577 | ||||
| Total | 30 | 5.9 ± 1.517 | ||||
| Sexual desire | 1 | 7 | 7.71 ± 1.604 | 9.345 | 4.061 | .017* |
| 2 | 11 | 6.27 ± 2.005 | ||||
| 3 | 9 | 5.78 ± 0.667 | ||||
| 4/5 | 3 | 4.33 ± 0.577 | ||||
| Total | 30 | 6.27 ± 1.741 | ||||
| Intercourse satisfaction | 1 | 7 | 11.14 ± 1.773 | 16.054 | 5.109 | .007* |
| 2 | 11 | 9.27 ± 2.284 | ||||
| 3 | 9 | 8.67 ± 1.118 | ||||
| 4/5 | 3 | 6.67 ± 0.577 | ||||
| Total | 30 | 9.27 ± 2.116 | ||||
| Overall satisfaction | 1 | 7 | 7.14 ± 0.69 | 6.068 | 5.047 | .007* |
| 2 | 11 | 6.27 ± 1.555 | ||||
| 3 | 9 | 5.78 ± 0.667 | ||||
| 4/5 | 3 | 4.33 ± 0.577 | ||||
| Total | 30 | 6.13 ± 1.306 |
Note: *Statistically significant.
Open in viewerTable 7. Analysis of the Comparison with the Stage of the Disease.
| Dependent Variable | Comparison Group | Compared with | Mean Difference | Std. Error | p Value |
|---|---|---|---|---|---|
| Erective function | Stage 1 | Stage 2 | –1.26 | 2.752 | .967 |
| Stage 3 | 7.952* | 2.868 | .047 | ||
| Stage 4/5 | 10.286 | 3.927 | .065 | ||
| Stage 2 | Stage 3 | 9.212* | 2.558 | .007 | |
| Stage 4/5 | 11.545* | 3.707 | .022 | ||
| Stage 3 | Stage 4/5 | 2.333 | 3.794 | .926 | |
| Orgasmic function | Stage 1 | Stage 2 | 0.675 | 0.625 | .704 |
| Stage 3 | 1.302 | 0.651 | .214 | ||
| Stage 4/5 | 3.190* | 0.891 | .007 | ||
| Stage 2 | Stage 3 | 0.626 | 0.581 | .705 | |
| Stage 4/5 | 2.515* | 0.841 | .029 | ||
| Stage 3 | Stage 4/5 | 1.889 | 0.861 | .152 | |
| Sexual desire | Stage 1 | Stage 2 | 1.442 | 0.733 | .227 |
| Stage 3 | 1.937 | 0.764 | .078 | ||
| Stage 4/5 | 3.381* | 1.047 | .017 | ||
| Stage 2 | Stage 3 | 0.495 | 0.682 | .886 | |
| Stage 4/5 | 1.939 | 0.988 | .228 | ||
| Stage 3 | Stage 4/5 | 1.444 | 1.011 | .494 | |
| Intercourse satisfaction | Stage 1 | Stage 2 | 1.87 | 0.857 | .155 |
| Stage 3 | 2.476* | 0.893 | .047 | ||
| Stage 4/5 | 4.476* | 1.223 | .006 | ||
| Stage 2 | Stage 3 | 0.606 | 0.797 | .871 | |
| Stage 4/5 | 2.606 | 1.155 | .135 | ||
| Stage 3 | Stage 4/5 | 2 | 1.182 | .348 | |
| Overall satisfaction | Stage 1 | Stage 2 | 0.87 | 0.53 | .374 |
| Stage 3 | 1.365 | 0.553 | .089 | ||
| Stage 4/5 | 2.810* | 0.757 | .005 | ||
| Stage 2 | Stage 3 | 0.495 | 0.493 | .748 | |
| Stage 4/5 | 1.939 | 0.714 | .053 | ||
| Stage 3 | Stage 4/5 | 1.444 | 0.731 | .223 |
Note: *Statistically significant.
Discussion
To the best of our knowledge, this is the first study to investigate SD in patients with YOPD in India. The mean age of the study participants was 37 years.
Resting tremors, rigidity, bradykinesia, impaired postural reflexes, and gait unsteadiness are classic clinical signs of PD. Another sign that is 100% sensitive but not fully specific for PD is a positive response to levodopa. The symptoms of YOPD are similar to those of late-onset PD (LOPD); however, some clinical features appear to be more pronounced in YOPD. According to studies, wearing-off, on-off, and levodopa dyskinesias, as well as dyskinesias in general, were much more common in YOPD patients (59% vs. 37%).20 In our study, clinical examination of the participants revealed that all 30 participants had bradykinesia of varying severity, 96.7% had tremors, 76.7% had rigidity, and 33.3% had postural instability. None of the study participants had cognitive dysfunction. This pattern is consistent with the global profile of the YOPD.5,21,22
The assessment of psychological aspects among our study participants showed that 80% had anxiety and 83.3% had depression. In a comparative study of PD patients with younger age of onset versus older age, the presence of anxiety and depression was found to be 11.1% and 8.7%, respectively. Patients with PD are known to have a higher prevalence of anxiety and depression when compared to the general population.23 This was more pronounced in patients with YOPD. No studies have assessed psychological variables in patients with YOPD in India. The higher proportion of anxiety and depression in our study was due to the additional economic burden and issues with efficient employment and out-of-pocket expenditure for healthcare. SD has been consistently found to be associated with depression and a state of unemployment.7 Depression and SD in PD form a vicious cycle; each, in turn, increases the propensity to develop the other and further increases the severity.
Disease severity was gauged using the historically established Hoehn and Yahr system, and the majority of the patients were in the second stage 11 (36.67%), despite most of the patients having a disease duration of more than two years (56.7%), reflecting the relatively slower progression of YOPD.
When compared to the controls, there was a statistically significant difference in all parameters of the IIEF questionnaire between cases and controls. This finding indicates the presence of rampant SD in patients with YOPD. This is consistent with another study in PD patients, which showed that 80% of men and 79% of women stated that their current sexual frequency was less than that before the onset of PD.24 Similarly in another study, the proportion of patients with sexual problems was reported to be 68% and 36% among the men and women who participated in it.1
To further understand the cause of SD in our patients, we performed further subgroup analyses based on disease severity, disease duration, clinical features, number of drugs, and SD.
SD is a common, but underappreciated, nonmotor symptom of PD. Several studies have found that SD is significantly more common in patients with PD than in healthy controls. The prevalence of SD in the general population is approximately 45% and 33% among women and men, respectively, with wide variations across studies.25,26 In our study, 83.33% of the cohort reported having sexual problems.
The analysis of sexual function in relation to disease duration revealed a statistically significant association. The mean overall satisfaction was 7.23 in patients with a disease duration of less than two years, compared to 5.29 in those with a disease duration of more than two years. Similarly, when compared with the stage of the disease using the Hoehn and Yahr scale, patients with advanced disease, as indicated by a higher stage, had impaired sexual function. This is consistent with other studies evaluating this aspect,24 and is likely related to worsening contributory pathophysiological factors.
ED was the most common SD in our case cohort at 83.33%, which is slightly higher than that reported in previous studies on smaller cohorts, where the prevalence of ED ranged from 68.4% to 79%.27,28 This far exceeds the prevalence in the healthy population, where ED is reported in none of the men. Studies have shown that ED prevalence increases with age. Shamloul and Ghanem describe an increasing prevalence, ranging from 2% to 9% in men aged 40–49 years to 50%–100% in men aged 50 years and older.29 In our study, severe ED was found in men aged 35 years and older.
Additionally, our study results showed that an increase in the number of drugs was directly related to worsening SD. Although dopaminergic medications may disrupt the reward pathway,7 this may also reflect an indirect effect of the advanced disease stage rather than the side effects of the drugs themselves.
The pathophysiology leading to the causation of SD is multifactorial complex and interconnected, often exacerbating the effect of the other.1 The motor symptoms may cause physical difficulty in intercourse. The quality of sexual life (QOSL) is related to overall disease severity and not just the motor score.2 Fatigue can also play an important role. Anti-Parkinson’s drugs also have some effect on libido and sexual response, so motor function is best in the morning and worst at night in many patients. Anxiety and depression, whether in the patient or partner, can also affect libido and sexual performance. Further stress can occur if the partner misinterprets a lack of facial expression as an expression of disinterest.30,31
A study formulating a score assessing the QOSL in patients with PD concluded that because of their study, the participants were comfortable discussing their sexual issues.2 In India, stigma is associated with an open discussion regarding sexual function. This study found a high prevalence of SD among patients with YOPD. Increased awareness of SD is the first step toward addressing this issue efficiently.
A point of relevance is that our patients also expressed a sense of comfort after confiding on their issues. Most of our patients had not volunteered about these complaints; however, once they were asked specific questions regarding the same, they were comfortable addressing the matter at hand.
Sexual function is a complex entity that is influenced by emotional, psychological, and physical factors. It is an important marker of quality of life and is a collective measure that encompasses several components, including desire, orgasmic function, and satisfaction. In PD patients, there is a complex interplay between varying levels of psychological factors, physical impairment, autonomic disturbances, and the disease process itself, leading to SD. An additional obstacle encountered when dealing with SD is the apparent stigma attached to an open discussion regarding the same. Patients are hesitant to express issues in these aspects, and thus fail to receive the necessary help that can mitigate the problem. Awareness of these aspects among clinicians is of utmost importance to efficiently address these problems.
The limitations of our study are the small sample size and the evaluation of SD only in males. Additionally, the IIEF focuses primarily on current sexual functioning, identifying only a partial understanding of the domains of sexual functioning, excluding erection, without providing specific information about the sexual functioning of the partner.
Conclusion
This study showed that SD is common in patients with YOPD and is a common problem in young patients with PD. Despite its high prevalence, this problem has not been commonly addressed. Patients with YOPD have additional economic and social responsibilities that add to stressors. This problem must be addressed as part of a holistic approach to patient management. Comorbid factors like depression and anxiety also need to be addressed to improve overall quality of life.
Ethical Approval
The study was approved by the Institutional Human Ethics Committee, Letter No.: JSSMC/IEC/180820/07 NCT/ 2020–21 and participants were informed about the purpose, procedures, risks, and benefits of the study before agreeing to take part.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
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