Addressing sexual difficulties in Parkinson's disease.

Sexual difficulties are common but under-recognized in Parkinson's disease (PD), significantly affecting quality of life. They include both sexual dysfunction (SD) - a non-motor symptom - and hypersexuality (HS) - an impulse control disorder (ICD). SD often presents as reduced libido, arousal issues, or orgasmic problems, while HS involves compulsive sexual thoughts or behaviors, often linked to dopamine agonists. These opposing symptoms may coexist, adding to diagnostic complexity. Sexual health in PD is influenced by neurological, vascular, endocrine, psychological, and medication-related factors. Despite its impact, sexual difficulties are rarely discussed in clinical settings due to limited time and patient reluctance. A proactive, nonjudgmental approach is essential. This review aims to equip neurologists with practical, time-efficient strategies to identify and manage sexual difficulties in both men and women with PD.