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Sexual /Sexuality
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IV.Common Behaviour Concerns
G. Sexuality
Although changes in sexual behaviour are often uncomfortable to discuss with family, friends and professionals, they are very common in persons with HD.

Changes in the brain can be associated with changes in sexual interest and functions.

Some persons with HD report that they have increased sexual drive whereas others report diminished sexual interest. Increased promiscuity can be secondary to disinhibition, poor judgment, or impulsivity. Decreased sex drive can be secondary to depression, apathy, or an inability to initiate activity.

Although the reasons for sexual behaviour changes are not fully understood, changes in sexual functioning often need to be addressed.

Possible Causes

-The brain is no longer able to regulate, or gate, the amount of sexual drive a person has, resulting in too much, or too little.

-The delicate balance of hormones in the brain is disrupted by the presence and progression of Huntington disease, resulting in variations in behaviours typically regulated by hormone levels.

Examples

-Bob is "single" for the first time in 20 years but does not have the social skills to appropriately initiate relations.

-Jim is taking a tricyclic antidepressant for a moderate depression and still desires intercourse with his wife but is unable to sustain an erection.

 

 Examples, continued

-Julie is embarrassed about the way her body looks with constant movements; her husband is saddened that she has pulled away from their sexual intimacy.

-Terry has increased his sexual relations dramatically; his family is concerned about sexually transmitted diseases.

Addressing the Changes in Sexual Functioning

Each individual has the right to achieve his/her highest reasonable potential on the continuum of human sexual development.

It is a misconception that inheriting a degenerative disease will cause an end to ones sexuality. There are several ways to better adjust to the changes that Huntington's can bring.

Most important is the need to maintain communication. Readers may want to review the bullets that highlight improving communication and do so with your sexual relationships in mind.

Access to supportive services, educators, and counselors can also be valuable, and community health centres should be able to provide a list of local resources.

Sexuality is a lifelong process of learning about oneself and growing as a social and sexual being. All people have a right and a need to be fully and accurately informed about what unique pleasures, joys, and pain this aspect of identity can bring.

Remember to allow yourself to respond to change and adjust as needed. Respect the space and development of those around, and keep in mind that rarely is it just one party who is affected by change.

Physicians Guide to the Management of Huntington's Disease
Sexual Disorders
Many patients with HD become uninterested in sexual activity. Others may continue to enjoy healthy sexual activity well into the course of the illness.
 
Occasional patients may desire and pursue excessive sexual activity or engage in inappropriate sexual behaviors, such as public masturbation, or voyeurism. The spouse, usually the wife, may be distressed and fearful because the individual with HD may become aggressive if sexual demands are not met. Spouses may be afraid to talk about the problem unless interviewed alone.
 
Interventions are difficult in these circumstances, probably because of the patient's impaired judgement and the strength of the drive.
 
Open communication about sex between the doctor and the family can help to destigmatize this sensitive topic. With open discussion among the parties, distressing sexual behaviors can sometimes be adapted into more acceptable acts.
 
Patients engaging in these behaviors should be assessed and treated for comorbid conditions, such as mania. We have found antiandrogenic therapy helpful in a few of these cases.