Reproduced here with the permission of the author

The Danish philosopher Kierkegaard once said "Life is not a problem to be solved but a reality to be experienced", and the American psychologist M. Scott Peck observed that "life is difficult!" So it is that struggling with difficulty is a part of life - but it is not life itself.

For those with PD, and their carers, it may seem that they have more than their fair share of problems. When the disease, and dealing with it, become uppermost in their daily lives, they can become swamped and sometimes overwhelmed. Inevitably this can have the undesired side-effect of getting in the way of relationships. In the case of couples, their lovemaking can be diminished, and may be temporarily (or even permanently) extinguished. What I propose to do in this article, is to take a sane and sensible look at some of the issues that may get in the way of intimacy for loving couples, who are sharing their lives with an uninvited and unwelcome extra partner - Parkinson's Disease - and to consider some possible remedies.

It is important to note that, even in the most successful and long term relationships (where health problems are not a factor), sexual problems of one kind or another will inevitably occur at some time. Therefore, where one or both partners have a health problem, it is virtually certain that there will be problems in the marital relationship. The key to dealing with those problems is a four letter word ending in ...k, which means intercourse - and, you've guessed it - that word is TALK!

Relationships do not work automatically. A huge amount of effort, time and energy is required to maintain and sustain them. Good communication on all matters is essential, yet one area many couples neglect is talking about sex. If your parents were uncomfortable telling you about sexual matters, then you may be similarly inhibited. This is not surprising, and many couples fall into the trap of presuming that no other couples could possibly have difficulty discussing sexual matters with each other, or indeed that they could be experiencing difficulties in their sex lives. In reality, the vast majority of loving couples experience times when their love lives are at a low ebb.

When things go wrong in other areas of our lives we tend to try and remedy them, but when it comes to our sexual relationships, our embarrassment can inhibit us from taking remedial action. All things being equal, normal work and family pressures can have us so exhausted, that lovemaking is the last thing on our minds. For many couples, the pattern of their lovemaking can become staid and predictable. There's no harm in that of course, but the decision to plan significant romantic events, with and for each other, is essential. It is not true that the best sexual encounters are spontaneous - a little planning goes a long way, and that includes making time for intimacy. If that means making an appointment with one another, then why not do so? A romantic phone call, telling your partner how much you love them, and arranging a quiet private time, can boost your relationship no end. Don't just think about doing it - do it!

Long term illness of any kind will inevitably affect a person's libido or sex drive. In order to maintain one's sexual function and interest, it will be necessary to learn what works best for you and your partner. The most common sexual difficulties couples encounter, relate to lack of desire and lack of arousal. Depression, which is common in PD, can affect desire and arousal. Carefully chosen anti-depressant medication can be prescribed to great effect. The same applies if your sleeping pattern has gone haywire. Regular medical checks, eating a balenced diet, and getting a reasonable amount of exercise, will all contribute to a sense of well-being, which can contribute to enriching your personal self-esteem, which will positively affect your relationships.

In PD patients, sexual function can be impaired by persistent tremor, lack of mobility and urinary incontinence. For men (especially those with urinary incontinence), it is important to have their prostrate gland checked regularly. In women, stress incontinence may be associated with the effects of childbirth. Just because you have PD, that doesn't mean that you can't or won't develop other health problems. Parkinson's medications can have some bearing on sexual function too. A potential side-effect of levodopa/PDS is that of hypersexuality, which can put a strain on one's relationship as much, if not more, than lack of desire. The motor fluctuations (or being "off") associated with PD medications can also affect sexual function.

For women, menstrual problems, childbirth and the rearing of small children and other family pressures, as well as the physical changes which occur before, during and after the menopause, can all have a direct or indirect impact on levels of desire. Add the difficulties associated with PD to these, and it is not in the least bit surprising that one's libido can be low. An understanding and helpful GP and/or gynaecologist can prove useful allies on the medical side. For both men and women, family planning issues are also of great significance, and decisions in this area are the responsibility of both partners - yet another reason why we need to get talking!

In the case of male impotence (where the man cannot achieve or maintain erection), there are a number of therapeutic approaches which can be adopted. It is essential that medical advice be sought, because it is important to establish the exact cause. Sometimes, impotence has a physical cause, or there may be psychological reasons for ot. It is worth noting that, if it has taken a while for the problem to develop, then it will take a while for the problem to be resolved, and the good news is that there is an extremely high success rate in the treatment of male impotence.

I have been unable to find out if there are any unacceptable interactions between PD medications and Viagra, although there are a number of natural remedies which clain to provide similar success to Viagra, without any unacceptable side-effects or interactions. For further information about these, I recommend that anyone with Internet access should use a search engine called http://www.dogpile.com and key in the words "sexual dysfunction" in inverted commas. This will provide a list of Internet sites which you may find both interesting and useful - even if only to realise how common such problems really are!

Everyone changes with time, and our needs, capacity and desires change too. This is natural and inevitable. The line from the Glen Campbell song "...there's been a load of compromising on the road to my horizon..." rings true, and talking things through honestly and constructively is enormously helpful.The following questions from the RELATE Guide to loving relationships may prove a useful starting-point:

• Are you happy with the amount of our lovemaking? Y/N
• Do you enjoy it? Y/N
• Was there a time when it was better? Y/N
• Do you want to make it better? Y/N