Sexual Health

Sexual and reproductive health in neurological disorders: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024).

TL;DR

Sexual dysfunction is a prevalent consequence of neurological disorders, and effective management requires a holistic, multidisciplinary approach including medical, psychological, and rehabilitative interventions as a core component of neurological rehabilitation.

Key Findings

Neurological disorders affect sexual function through multiple pathways beyond genital function, including sensory and motor abilities, pain perception, bladder and bowel control, mood, and hormonal balance.

  • Both central and peripheral nervous systems are impacted by neurological disorders, leading to sexual dysfunction (SD).
  • The review covers central and peripheral neural control of sexual function as foundational to understanding SD in these populations.
  • SD in individuals with neurological conditions remains an 'under addressed issue' despite its significance for overall quality of life.

Erectile dysfunction and anejaculation are common sexual dysfunctions in individuals with spinal cord injury.

  • Spinal cord injury was identified as a specific neurological condition with characteristic patterns of SD.
  • ED and anejaculation were specifically named as predominant manifestations in this population.
  • The review synthesized literature with emphasis on randomized controlled trials and high-quality evidence.

Parkinson's disease is associated with hypersexuality and orgasmic disorders as distinct sexual health manifestations.

  • Unlike many neurological conditions associated primarily with sexual inhibition, Parkinson's disease may be associated with hypersexuality.
  • Orgasmic disorders were also identified as characteristic of Parkinson's disease.
  • This pattern differs from that seen in other neurological conditions, highlighting condition-specific variability in SD.

Brain injuries including traumatic brain injury, stroke, and neurodegenerative diseases can reduce libido and sexual satisfaction.

  • Traumatic brain injury, stroke, and neurodegenerative diseases were grouped as conditions sharing a pattern of reduced libido and satisfaction.
  • These central brain injuries were distinguished from spinal and peripheral conditions in their sexual dysfunction profile.
  • The review examined underlying neurophysiological mechanisms for these effects.

Multiple sclerosis is associated with erectile dysfunction and reduced genital arousal.

  • Multiple sclerosis was identified as having a specific SD profile including ED and reduced genital arousal.
  • This pattern reflects the demyelinating nature of the condition affecting both central and peripheral neural pathways involved in sexual response.
  • The review noted that SD varies by neurological condition, emphasizing condition-specific assessment and management.

Pharmacological and nonpharmacological interventions demonstrate variable efficacy depending on the specific neurological condition.

  • Interventions reviewed included phosphodiesterase-5 inhibitors, vibratory stimulation, hormonal therapy, pelvic floor therapy, and assistive devices.
  • Efficacy was described as variable depending on the neurological condition, indicating no universal treatment approach.
  • A panel of experts reviewed and synthesized the literature with an emphasis on randomized controlled trials and high-quality evidence.

Proper assessment of sexual dysfunction in neurological disorders should include a sexual history and neurological examination with specific attention to genital sensation and reflex testing.

  • Genital sensation and reflex testing were specifically identified as components of neurological examination relevant to SD assessment.
  • Sexual history was identified as a necessary component of evaluation.
  • These recommendations were produced by an expert panel convened for the Fifth International Consultation on Sexual Medicine (ICSM 2024).

A multidisciplinary approach encompassing medical, psychological, and rehabilitative interventions is identified as crucial for optimizing sexual health in patients with neurological disorders.

  • The review explicitly recommends a 'holistic, multidisciplinary approach' for effective management of SD in neurological conditions.
  • Medical, psychological, and rehabilitative domains are all identified as necessary components of care.
  • Addressing sexual health is recommended as 'a core component of neurological rehabilitation to enhance patients' quality of life.'

What This Means

This research synthesizes what is known about how neurological conditions — such as spinal cord injury, Parkinson's disease, multiple sclerosis, stroke, and traumatic brain injury — affect sexual health. The expert panel found that sexual dysfunction is very common in people with these conditions, but it looks different depending on the specific disorder. For example, spinal cord injury often causes problems with erections and ejaculation, Parkinson's disease can lead to unusually high sex drive as well as difficulty reaching orgasm, and multiple sclerosis tends to reduce genital arousal and erectile function. Brain injuries and degenerative diseases more often reduce sexual desire and satisfaction overall. The review also found that various treatments — including medications like PDE5 inhibitors (such as those used for erectile dysfunction), vibration devices, hormone therapies, pelvic floor exercises, and assistive devices — can be helpful, but how well they work depends on which neurological condition a person has. No single treatment works for everyone, and the evidence quality varies across interventions and conditions. This research suggests that sexual health should be treated as a standard and important part of care for people with neurological disorders, not an afterthought. Healthcare providers are encouraged to ask about sexual health, perform targeted physical examinations including genital sensation testing, and coordinate care across medical, psychological, and rehabilitation specialists. The underlying message is that improving sexual health can meaningfully improve overall quality of life for people living with neurological conditions.

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Citation

Elliott S, Birkhäuser V, Courtois F, Gül M, Ibrahim E, Kiekens C, et al.. (2025). Sexual and reproductive health in neurological disorders: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024).. Sexual medicine reviews. https://doi.org/10.1093/sxmrev/qeaf030