Sexual Activity and Post-Polio Syndrome
Susan Perlman, M.D.
Reported by Mary Clarke Atwood
Rancho Los Amigos Post-Polio Support Group Newsletter - July 2000
Editorial assistance by V. Duboucheron, S. Perlman
Neurologist Susan Perlman is Director of the Post-Polio Clinic at UCLA Medical Center and also Director of their Neurogenetics Clinic. At the University of California-Los Angeles (UCLA) Dr. Perlman is an Associate Clinical Professor of Neurology.
Although very little is published about the effects of sexual activities on people with PPS, other studies can provide useful guidelines for PPS patients. An Internet search of the National Library of Medicine produced only one study on sexual activity of people who had polio, although there were studies on sexual activity of people with other lowered neuromuscular functional status such as cardiac patients, COPD patients, people with lung problems, fragile elderly, etc. This research provides valuable information that can be useful for PPS patients as well.
This report contains portions of abstracts from seven studies on sexual activity followed by Dr. Perlman's comments on each. It includes information about which PPS patients will tolerate sex better, suggestions for preventing possible overuse of muscles during sexual activities, and comments regarding the peripheral autonomic nerves which control sexual response to a great degree, including erectile capability. The report concludes with a brief question and answer section.
In a survey of 330 polio survivors (242 female, 88 male respondents, with new symptoms of PPS in 87% and 74% respectively):
Erectile dysfunction was reported as severe (no erections) in 20 men (24.1%) aged 42 to 79 years (median age 61 years). Nine of these men were 55 years old or younger. Twelve men (14.5%) aged 35 to 68 years reported poor quality erections, and 50 men (60%) reported occasional erectile dysfunction. Women with symptoms of PPS had a 30.3% prevalence of change in sexual function, versus none of the women without PPS group. The nature of the changes in sexual function among these women was not specifically analyzed. We attributed changes in sexual function among women to several causes, including weakness of the pelvic and lower abdominal muscles, fatigue and generalized debility, and back or lower extremity pain.
The high prevalence of sexual dysfunction among both sexes in the PPS group is striking. This questionnaire did not provide adequate detail to identify precisely the etiology of sexual dysfunction in these patients. The men with erectile dysfunction in the PPS group were relatively young, suggesting that their impotence is probably not of vascular origin. It seems likely that these men have a neurologic basis for their erectile dysfunction.
Because poliomyelitis is a disease that primarily affects motor neurons, however, it is not immediately apparent why this group should be likely to have impotence as a sequela of poliomyelitis.
The change in sexual function seen among female respondents may be a result of weakness of the pelvic floor muscles or generalized debility or fatigue.
Polio survivors are not immune from other causes of sexual dysfunction unrelated to their original polio (diabetes, smoking, medication side-effect, depression).
In order to properly advise cardiac patients in the regulation of their sexual activity, more basic physiologic information was needed concerning the cardiovascular effects of sexual intercourse. This study examined the effects of the male's position during sexual intercourse on heart rate and blood pressure (BP) responses [the same as aerobic stimulus measurements] .
This study indicates no difference in the heart rate and BP responses of the male during sexual intercourse in two different positions [male-on-top vs. male-on-bottom] .
On the treadmill a goal might be to increase a person's pulse rate to 2/3 of maximal for 20 minutes. This study shows that pulse rate does increase during sex but it is not known how long a person's pulse rate remains at this level. Therefore sexual activity may not meet the full criteria for aerobic training /cardiac conditioning and shouldn't replace a good pool exercise program, for those who can tolerate it.
Sexual intercourse can involve many muscles, depending upon the activity leg, arm, chest, as well as pelvic muscles. Depending on the muscles that a person is using, there could be some muscle overuse involved in sexual intercourse.
Sexual intercourse isn't going to hurt the patient as long as the individual respects the variety of muscles that have to be used. Persons in better general shape can tolerate sex better. But, it is important to remember that the range of satisfactory sexual interaction involves more than muscles.
It is well known that athletes in the U.S. are told to abstain from sexual intercourse prior to athletic competition. The rationale for such policy appears to be related to the hypothesis that sexual intercourse decreases the athletes' ability to perform efficiently and/or maximally. But the effect that sexual intercourse may have on exercise performance has not been examined widely .
The purpose of this study was to determine the effects of sexual intercourse 12 hours prior to maximal treadmill exercise on aerobic power, oxygen pulse, and double product (i.e., an index of cardiac work.) Eleven male subjects were tested on the treadmill with or without prior sexual intercourse.
The results from the maximal exercise tests showed that aerobic power, oxygen pulse, and double product were not different. Therefore, the data suggest that it is justified to dismiss the point of view that sexual intercourse decreases maximal exercise performance.
This study suggested that sexual activity of athletes before a big game would not be expected to decrease their energy levels or power. But it also did not show that athletes would do better if they had sex the night before a game. (These would be immediate effects, not long term conditioning effects.) So, sexual intercourse doesn't worsen energy levels or power, but may not improve them either, in the short term.
Sexual dysfunction after a myocardial infarction is a common problem said to occur in 50% to 75% of all patients. Sexual dysfunction often antedates the myocardial event .
Studies of the cardiovascular response during sexual intercourse are few, but those that exist consistently show that there are wide individual variations in heart rate, blood pressure, and oxygen consumption .
Patients who reach 5 to 6 metabolic equivalents (METS) on stress-testing without ischemia or arrhythmias can in all likelihood resume their normal sexual activities without any risk .
Although this study was for heart risk, it could be used in parallel fashion for people with muscle problems. Patients who can tolerate 5-6 METS would compare to Halstead's PPS Class III: Clinically stable polio. * People in this category have no new weakness.
People with clinically stable polio should not be afraid that sexual activity is going to weaken them or cause any more problems than other activities. However, people who fit into Halstead's PPS Class IV have clinically unstable polio, with new weakness, and may notice some fatigue with sexual activity. These people can modify what they are doing thus making sexual activities as least fatiguing as possible by changing position, altering the amount of time, etc.
*National Rehabilitation Hospital Limb Classification for Exercise, Research, and Clinical Trials in Post-Polio Patients; By Lauro S. Halstead, Anne Carrington Gawne, and Bao T. Pham. This article can be found on the following website:
Objective -- To determine the relative risks of nonfatal myocardial infarction (MI) triggered by sexual activity among the general population and in patients with prior coronary heart disease .b) Enhancing sexual performance in COPD.
Conclusions -- Sexual activity can trigger the onset of MI. However, the relative risk is low Moreover, the relative risk is not increased in patients with a prior history of cardiac disease and regular exercise appears to prevent triggering .
The fear of dyspnea [difficulty breathing] and reduced exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) are often limiting factors in their participation in sexual activity .
The phases of sexual intercourse can be correlated with the energy requirements of other activities, such as walking or household tasks, to determine an individual's activity tolerance. Energy conservation techniques and breathing retraining can then be coordinated with sexual activity .
Throughout this process, education is critical to assure the COPD patient that dyspnea during sex is not any more dangerous than during other well-tolerated exercise.
For people with PPS, the odds are good that if you are doing some kind of gentle conditioning (whatever can be tolerated), sexual activities should be well tolerated.
Autonomically mediated cardiovascular responses were evaluated in 20 subjects with antecedent poliomyelitis and compared to data from an age-and sex-matched control group.
The polio subjects had a lower heart rate response to the Valsalva manoeuvre but the same respiratory sinus arrhythmia as the controls. From this it is concluded that the polio subjects had normal vagal function.
The polio subjects had a greater initial heart rate increase but the same blood pressure response to the orthostatic position as the controls. This indicates a normal function of the sympathetic nerves. The greater heart rate increase is most likely caused by a displacement of blood to the legs because of muscle atrophy.
The polio subjects had a smaller blood flow increase as an initial response to reduced beta-adrenergic vasodilation, possibly due to a reduced vasomotor drive.
It is concluded that subjects with antecedent poliomyelitis have no significant dysfunction of the peripheral autonomic nerves. Thus, there is no deterioration of the peripheral autonomic nerve function in parallel with the progressive muscle atrophy and paralysis earlier described in post-polio subjects.
This was the only article that could be found on this subject that involved people with PPS. This study concludes that people who had polio have no significant dysfunction of the peripheral autonomic nerves.
The peripheral autonomic nerves are those which control sexual response to a great degree. This system is involved with sexual activity -- the vascular changes that occur and also some of the muscle changes. The peripheral autonomic nerves, which feed into erectile capability and other responses, are not effected by PPS. Therefore organic impotence on this basis should not occur as a result of PPS, and in general, the system should work. If there is some muscle fatigability, depending on the activities of the people involved, Halstead's Metabolic Equivalents provide guidelines. If a person with PPS is doing a gentle conditioning exercise as a routine part of his health maintenance, the person will do better sexually as well.
Questions and Answers
DR. PERLMAN: - Orgasm involves some repetitive contraction of several muscle groups, but not enough to qualify as true exercise. As for cardiac conditioning benefits, sex is not going to replace a good pool exercise program for someone who can tolerate it.
DR. PERLMAN: - A vibrator shouldn't be harmful to PPS patients. It is actually less fatiguing potentially than regular intercourse would be because it uses fewer muscles, unless there is gripping or other arm related involvement. It depends upon how the vibrator is being used.
DR. PERLMAN: - Sexual intercourse could possibly be too stressful for some PPS patients because it uses many other muscles (leg, arm, chest, and pelvis). However, sexual activity isn't going to hurt the patient as long as the individual respects the variety of muscles that have to be used. Persons in better general shape can tolerate sex better.
DR. PERLMAN: - At UCLA Medical Center, Dr. Jacob Rajfer (310/794-7700) and Dr. Andrea Rapkin (310/794-5110) see Dr. Perlman's disabled patients (male and female respectively) with sexual dysfunction. There is no comprehensive program per se. Neurorehabilitation (Dr. Bruce Dobkin, 310/794-1195) probably also deals with this issue in its brain and spinal cord injury patients, but only as an associated problem.
To Contact UCLA Post-Polio Clinic
Dr. Susan Perlman
300 UCLA Medical Plaza, Suite B200
Los Angeles, CA 90024-6975
Reprinted from Rancho Los Amigos Post-Polio Support Group Newsletter July 2000.
© 2000 Mary Clarke Atwood
The Rancho Los Amigos Post-Polio Support Group meets the 4th Saturday, from 2:00-4:00 in Downey, CA.
Contact: RanchoPPSG@hotmail.com for more information.
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