Having reviewed the physiological changes involved in sexual response in
the normal heahhy individual, the effects of neurological disease on the
arousal and orgasmic phases should be examined. Although this section will
review problems that may be pertinent to specific disease groups, it is worth
emphasizing that within each group the person must be considered as
someone with unique needs and not necessarily the same as others with the
1. Peripheral Neuropathy
Sexual dysfimction may be expected where there is involvement of the
autonomic system There are however few pubhcations on the subject of
this problem in female diabetics. There is conflicting evidence regarding
orgasmic dysfunction. Some suggest that orgasm may be achieved only
after an extended and heightened level of stimulation, the explanation
offered being that the orgasmic response is under syn^athetic control and
this control may be interrupted in diabetic neuropathy (Unsain et al 1982).
Others researchers describe no significant difiference between diabetics and
control groups (Jensen 1981). Women may have difficulty achieving the
excitement phase and lubrication may be less evident (Jensen 1981) though
whether there is a neurogenic explanation for this is unclear. Techniques to
increase sexual satisfection have tended to focus on this stage of the sexual
response cycle (Hawton 1990).
2. Parkinson's Disease
Investigations into the area of sexual dysfunction in Parkinson's disease (PD)
have not been numerous. The majority of the Hterature has examined the
side-effects of levadopa treatment on sexual functioning (Ballivet et al 1973
and Vogel and Schiffier 1983). However many factors may contribute to
sexual problems in this patient group, namely: involvement on the
autonomic nervous system, side-effects of anti-Parkinsonian drugs and
various physical disabihties e.g. fatigue and poor motor function.
Psychological influences may include depression and anxiety (Gotham et al
1986 and Brown et al 1976).
In a recent study by Brown et al (1989), women with PD reported a range
of dysfunctions and difficulties. These were reduced fi'equency in sexual
orgasmic dysfunction. Problems of arousal and non-sensuality were not as
common as in the men with PD nor did the women report a high level of
dissatisfaction with their sexual relationship. The men were significantly
older than the women in this sanq)le (p< 0.05) but there was no difference in
level of physical disability. There was no correlation between the degree of
reported sexual dysfunction and the reported level of physical disabihty as
measured by an activities of daily living scale. However dysfunction was
associated with duration of disease. Autonomic dysfunction and side-effects
of medication did not appear to contribute to the presence of dysfunction in
these patients. However the strain of coping with disabihty borne by the
spouses pointed to a strong correlation with sexual dysfimction in the
partners of those with PD. The authors stressed that sexual dysfunction did
not appear to be related solely to Parkinsonian symptoms and that other
factors impinged. Although PD tends to affect those in the older age
bracket, sexual interest does not necessarily diminish with age (Masters and
Johnson 1970). As such there is no reason to suppose that PD patients
would not benefit from counselling and therapy
3. Spinal Cord Injury
Sexual dysfunction in women with spinal cord injuries (SCI) has received
less attention than that of their male counterparts (Conmarr and Vigue 1978,
Thornton 1981 and Larsen and Hejgaard 1984). Lesions above TIG may
result in a loss of sensation, but direct stimulation may enable the male to
achieve an erection and the female to e?q)erience vaginal engorgement.
Lesions below TIG result in a loss of syn^athetic outflow and psychogenic
erection and vasocongestion responses will be lost. If the sacral segments
are intact, then direct genital stimulation may produce reflex phenomena.
Sexual desire may be threatened by other factors such as spasticity,
influenced by malaise, pain, anxiety and the onset of disability (Closson et al
1991). Physical and psychological processes are often inextricably linked
(Spica 1989). The person with a SCI may perceive themselves as
unattractive and therefore adopt a passive role because they are unsure of
their capacity for "normal" sexual functioning (Strasberg and Brady 1988).
4. Cerebro Vascular Accident (CVA)
When discussing the incidence of sexual dysfunction amongst stroke victims,
the difficulty is in deterrnining to what extent the problem is a consequence
of neurological damage and how much is age related. This is an important
question because strokes are usually a disease of the elderly (RCP 1989).
There appears to be some disagreement amongst researchers as to the
prevalence of sexual dysfunction in this patient group (Bray et al 1981,
Boiler and Frank 1982, Hawton 1984, Monga et al 1986 and Ducharme
1987). One e?q)lanation for this may be the disparity in ages in the different
sanq)les. In a study of those with a mean age of 49 years (Hawton 1984),
sexual activity resumed pre-stroke level with some modifications. Post
stroke sexual activity may bear some relation to the level of sexual desire
prior to the CVA (Bray et al 1981). In a study of stroke patients with a
mean age of late fifties, sexual activity had stopped in 5 out of 6 couples
(Humphrey and Kinsella 1980). Problems reported in stroke patients are a
reduction in hbido and changes in vaginal lubrication and orgasm in women
(Monga et al 1986). A reduction in the level of sexual satisfaction following