Sex and PD - Making Relationships Work

SEX AND PD - MAKING RELATIONSHIPS WORK

The Danish philosopher Kierkegaard once said, "Life is not a problem to be solved but a reality to be experienced," and the American psychologist M. Scott Peck observed that "life is difficult!" So it is that struggling with difficulty is a part of life but it is not life itself.

For those with PD and their care-partners, it may seem as if they have more than their fair share of problems. When the disease and dealing with it become uppermost in their daily lives, they can feel overwhelmed. Inevitably this can have the undesired side-effect of getting in the way of relationships. In the case of couples, their lovemaking can be diminished or temporarily (or even permanently) extinguished. Let's consider some of the issues that may get in the way of intimacy for loving couples who are sharing their lives with an uninvited and unwelcome extra partner Parkinson's disease and consider some possible remedies.

It is important to note that, even in the most successful and long term relationships (where health problems are not a factor), sexual problems of one kind or another often occur at some time. Therefore, where one or both partners have a health problem, it increases the odds that there will be problems in the marital relationship. The key to dealing with those problems is a four letter word ending in ...k, which means intercourse and, you've guessed it that word is TALK!

Relationships do not work automatically. A huge amount of effort, time and energy is required to maintain and sustain them. Good communication on all matters is essential, yet one area many couples neglect is talking about sex. If your parents were uncomfortable telling you about sexual matters, then you may be similarly inhibited. This is not surprising, and many couples fall into the trap of presuming that no other couples could possibly have difficulty discussing sexual matters with each other, or that others could also be experiencing difficulties in their sex lives. In reality, the vast majority of loving couples experience times when their love lives are at a low ebb.

When things go wrong in other areas of our lives we tend to try to remedy them, but when it comes to our sexual relationships, our embarrassment can inhibit us from taking remedial action. All things being equal, normal work and family pressures can have us so exhausted that lovemaking is the last thing on our minds. For many couples, the pattern of their lovemaking can become staid and predictable. There's no harm in that, of course, but the decision to plan significant romantic events, with and for each other, is essential. It is not true that the best sexual encounters are spontaneous a little planning goes a long way, and that includes making time for intimacy. If that means making an appointment with one another, then why not do so? A romantic phone call, telling your partner how much you love him/her and arranging a quiet private time, can boost your relationship. Don't just think about doing it do it!

Long term illness of any kind will very often affect a person's libido or sex drive. In order to maintain one's sexual function and interest, it will be necessary to learn what works best for you and your partner. The most common sexual difficulties couples encounter relate to lack of desire and lack of arousal.

Depression, which is common in PD, can affect desire and arousal. Carefully chosen anti-depressant medication can be prescribed to great effect. Disturbed sleeping patterns can also interfere with sexual functioning. Regular medical check-ups, eating a balanced diet, and getting a reasonable amount of exercise will all contribute to a sense of well-being, which can contribute to enriching your personal self-esteem, and positively affecting your relationships.

In people with PD, sexual function can be impaired by persistent tremor, lack of mobility and urinary incontinence. For men (especially those with urinary incontinence), it is important to have their prostate gland checked regularly. In women, stress incontinence may be associated with the effects of childbirth.

Just because you have PD doesn't mean that you can't or won't develop other health problems. Parkinson's medications may also have some bearing on sexual function. Some feel that a possible, although infrequent, side-effect of carbidopa/levodopa may be hypersexuality; however, there has been no scientific research to validate this at this time. Hypersexuality, however, can put a strain on one's relationship as much, if not more, than lack of desire. A discussion with your neurologist about medication adjustments as well as consultation with a psychiatrist can be helpful. The motor fluctuations (or being "off ") often associated with PD medications can also affect sexual function.

For women, menstrual problems, childbirth and the rearing of small children and other family pressures, as well as the physical changes which occur before, during and after menopause, can all have a direct or indirect impact on levels of desire. Add the difficulties associated with PD to these, and it is not in the least bit surprising that one's libido can be low. An understanding and helpful internist and/or gynecologist can prove useful allies on the medical side. For both men and women, family planning issues are also of great significance, and decisions in this area are the responsibility of both partners yet another reason why we need to get talking!

In the case of male impotence (where the man cannot achieve or maintain an erection), there are a number of therapeutic approaches which can be explored. It is essential that medical advice be sought, because it is important to establish the exact cause. Sometimes impotence has a physical cause, or there may be psychological reasons for it. A urologist can be of assistance in determining the cause of the impotence and offering medical options. The good news is that there is an extremely high success rate in the treatment of male impotence.

Everyone changes with time, and our needs, capacity and desires change too. This is natural and inevitable. The line from the Glen Campbell song "...there's been a load of compromising on the road to my horizon..." rings true, and talking things through honestly and constructively is enormously helpful. The following questions may prove a useful starting-point:

 Are you happy with the amount of our lovemaking?

 Do you enjoy it?

 Was there a time when it was better?

 Do you want to make it better?

Then honestly, without interrupting, take the time to tell each other how you are feeling. Suspend any desire to assign blame. Choose not to feel hurt, and try to listen with empathy putting yourself in the other's shoes. Make notes if you find it useful, and try to tease out all the issues. It is really surprising how we can underestimate the depth of our partner's feelings on intimate issues. We all have hidden fears and anxieties which can help us to build up walls of resentment, which in turn prevent us from reaching out to each other and really communicating with love!

Another tip is to try to make some time for reminiscence. Think back to the early part of your relationship. Remind yourself of the exciting sexy times you had together. Then tell each other what you remember. If you do this while sharing a quiet, candle-lit meal or snuggled up on the couch, you can rekindle fond memories of earlier times. Then bring your thoughts to the present, and tell each other what you still love about each other. There is no substitute for telling your partner how much you love him/her. Then remind yourself of just how much fun kissing can be. Take your time and enjoy yourselves, and don't forget that laughter is wonderfully therapeutic. Remember, too, that good lovemaking does not have to lead to sexual intercourse. Kissing, touching and hugging, and even sensual massage can bring a wonderful sense of well being and closeness that cannot be underestimated. The glossy magazines constantly sell the line that sex is only for the young and the beautiful, yet our need for intimacy does not diminish with age. There isn't any reason why we cannot continue to be intimate with our partners well into old age.

However, if you feel your relationship is in crisis, you may benefit from the assistance of an experienced counselor. You can ask your doctor for a counselor with expertise in these matters or call any of your state's professional counseling organizations. For those who are not ready for counseling or feel they don't need it, there are many excellent publications which can help you both to initiate successful intimacy. Take the time to browse the health section of your local bookstore. One particularly good book for people with Parkinson's is Lucille Carlton's book called Sex, Love and Chronic Illness.

On a final note, the crucial element in restoring balance in your relationship is being pro-active. Examine the issues, take stock, and actually do something! You won't regret it!

Adapted from an article by Dominic McGinley for PALS, a branch of the Parkinson's Association of Ireland.

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