- Case Report
- Open Access
Penile strangulation in a patient with Parkinson's disease: a case report
© Pinggera et al; licensee BioMed Central Ltd. 2009
- Received: 19 September 2009
- Accepted: 22 December 2009
- Published: 22 December 2009
Aberrant sexual behaviour such as hypersexuality or exhibitionism has been reported in patients with Parkinson's disease and its therapy.
We report a case of a 67-year-old man with a 10-year history of Parkinson's disease, currently under therapy with L-dopa and bromocriptine, who presented with his wedding ring constricting the base of his penis. The ring could be removed with a ring cutter without complications.
The present literature concerning sexual dysfunction in Parkinson's disease and dopaminergic therapy is discussed. Doctors who treat these patients should be aware of the problem of hypersexuality associated with dopaminergic therapy.
- Sexual Dysfunction
- Dopaminergic Therapy
Penile strangulation with constricting devices is not uncommon. Sexual dysfunction in patients with Parkinson's disease and its therapy has been reported. We report the first case of a Parkinson's patient, who presented with his wedding ring constricting the base of the penis because of autoerotic stimulation.
Studies showed that sexual function is commonly reduced in patients with Parkinson's disease (PD)[2, 3]. Also, it is known that Levo-dopa or other dopaminergics in the therapy of PD may cause hypersexuality[4, 5]. Hypersexuality appears simultaneously with hyperkinesias under treatment with L-dopa and bromocriptine or in a dose-dependend way with bromocriptine and pergolide. Further studies showed that this hypersexuality is caused by an increase in libido, rather than frontal lobe disinhibition [2–5].
In another study the influence of PD on sexuality and partnership was investigated in 2099 patients. Sexual dysfunction occurred in affected women and men with a reduction of sexuality. The patients mentioned specific symptoms of PD and medication as factors influencing their sexuality. Dopaminergic drugs had an influence on their sexual function in 30% of the women and in 64% of the men. Hypersexuality under L-dopa therapy was reported in 10-20% of male and in 40% of female patients.
Three causes are postulated to encounter disturbing hypersexuality. First the use of alternative dopamine agonists, which normally should have no enhancing effect on sexuality. Second the initiation of an anti-psychotic therapy with atypical neuroleptics like clozapine. And third the use of antiandrogens[2, 4–6].
In conclusion dopaminergic therapy of PD has the potential risk of sexual hyperfunction. The attending physician should be aware of increased sexuality or reduced control of behaviour in PD therapy and to manage this by counteractive therapeutic strategies. Critical situations might be caused by change of medication or dosages, keeping in mind that patients might alter intake of medication independently.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the journal's Editor-in-Chief.
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