134 Prevalence of Sexual Dysfunction in Parkinsonian Men: A Literature Review
Authors: Rafati Y , Alzweri L 
Published: April 2022

ABSTRACT

Introduction
Parkinson's disease (PD) is one of the most common age-related progressive neurodegeneration disorders with incidence increasing 5-10-fold between the sixth to ninth decade of life. Aside from aging, the male sex is also a significant factor in developing PD. Men are twice as likely to develop PD, have an earlier age of disease onset, and an increased rate of disease progression than that of women. Recently, greater attention has been placed towards the quality of life in PD patients, of which non-motor symptoms play a significant role. Sexual dysfunction is an often-overlooked non-motor symptom, which requires patients to reinvent their sexuality thus forcing their partners to cope with these changes in addition to the consequences of Parkinson's disease. Although sexual dysfunction correlates with a reduced marital and life satisfaction, the dysfunction is neglected due to the sensitivity of the topic, prioritizing motor symptom complaints, and attitudes of patients.

Objective
The purpose of the study is to conduct a systemic review to evaluate the prevalence of the dominant sexual dysfunction characteristics in parkinsonian men to optimize their quality of life.

Methods
A systemic review was conducted according to the methodology following the PRISMA guidelines. A search was carried out across PubMed, CINAHL, Academic Search Complete, and PsychInfo using the term “Parkinson's disease” and “Sexual Dysfunction” with the latter expanded to include related terms such as “libido,” “low libido,” “impotence,” “erectile dysfunction,” “ejaculation,” and “orgasmic disorder.” There were no temporal or demographic restriction.

Results
A total of 956 references were identified, 428 were directed for reading titles and abstracts. A total of 81 articles were excluded for full-text reading. Based on inclusion and exclusion criteria, 15 studies met the criteria and were included into the review. The studies were published between 1990 and 2020. It was not possible to perform a meta-analysis due to the heterogeneity present in the studies. In the selected studies, six scales were used to measure sexual dysfunction: Arizona Sexual Experience Scale (ASEX), Brief Index for Sexual Function (BISF), International Index for Erectile Dysfunction (IIEF), Israeli Sexual Behavior Inventory (ISBI), Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction (SCOPA-AUT), and in-house questionnaires. Across the six sexual dysfunction scales, the average reported impaired libido was 40.93% (range = 2%-83%), erectile dysfunction was 54.27% (range = 21.05%-79%), ejaculatory dysfunction was 37.83% (range = 3.16%-79%), and orgasmic dysfunction was 47.88% (range = 0%-87%).

Conclusions
The review indicates a high prevalence of sexual dysfunction in parkinsonian men; however, insufficient evidence to support or refute the significance of the sexual dysfunction parameters in parkinsonian men. A link between Parkinson's disease and sexual dysfunction via dopamine deficiency and psychosocial deficits has been hypothesized. Increasing awareness and addressing the usually overlooked sexual dysfunction in parkinsonian men can potentially improve their quality of life significantly. Health care providers may consider initiating a conversation regarding sexual function or refer to a sexual medicine specialist thus optimizing the non-motor aspect of parkinsonian men's quality of life.

Disclosure
No