Sex and brain and neurological disorders

Abstract

Sexual pleasure originates in the brain, from the “reward sites”, erotic stimulation activate specific brain regions and, at peripheral level, genitalia are connected to the central nervous system via the autonomic nervous system. Damage to or modification of these central and peripheral structures is expected to alter sexual function. In severe brain injuries of traumatic or vascular origin the patients frequently report to have discontinued sex with the partners. Sexual consequences of traumatic brain injuries and stroke are similar, but in stroke it is not clear whether these effects are attributable to the concomitant use of antypertensive. In epilepsy, sexual gestures, genital automatisms and even spontaneous orgasms may be manifestations of complex partial seizures. In temporal seizures erotic perceptions may be manifestations of the epileptic aura. Erectile dysfunction and premature ejaculation is common in men affected by Parkinson's disease probably in relation to the alteration of dopamine system that characterize this neurodegenerative disorder. Hypersexuality is on the contrary traditionally described in association with the treatment of this disease with levodopa. Erectile disfunction may be an early sign of extrapyramidal disorders affecting the autonomous nervous system as in the case of multiple system atrophy. Sexual dysfunction is frequently reported when the spinal cord is involved by traumatic injuries or multiple sclerosis. Altered sexual function may be consequence of compression of cauda equina, peripheral neuropaties, or injuries to the peripheral autonomc neurvous system. We suggest that accurate neurological investigation should be mandatory in the management of persons with sexual problems.