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Can We Talk?: In our article on neurologic diseases and intimacy, we address the issue head on with frank honesty.

Section Editor(s): Avitzur, Orly MD, MBA, FAAN; Editor-in-Chief

doi: 10.1097/01.NNN.0000511220.43901.2b
Departments: From the Editor

Our feature on intimacy after a diagnosis is open and honest.

For many people with a chronic neurologic disorder, one of the most devastating aspects is its impact on sexual health and function. The loss of intimate relations can threaten even the strongest bond. Over the past 11 years, Neurology Now has brought you stories about how neurologic conditions may change marriages and other relationships. In this issue's “Sexual Healing,” we delve into the subject with great candor in order to answer questions we suspect have been on the minds of many of our readers.

Reduced or altered intimacy is a widespread problem, but it is infrequently addressed by physicians, even those who treat people with conditions such as multiple sclerosis, spinal cord injury, and brain tumors—disorders well recognized to cause sexual dysfunction. Little or no education is provided in this area in medical school or residency programs, and few studies have been done on sexual functioning in people with neurologic conditions; without much direction, neurologists are often ill-prepared for these conversations. So when we discussed this topic with the neurologists on our editorial advisory board, they unanimously and enthusiastically agreed that we should bring it to our readers.

After reviewing the article, Bruce H. Cohen, MD, FAAN, one of our editorial board members, said, “After two decades of clinical practice, I decided to explore sexual health by raising the subject with patients. It was initially awkward and painful for me and my patients.” Dr. Cohen finally decided to start the conversation about erectile dysfunction with his male patients and to offer medications for its treatment. “This is something that is missing from our training and from face-to-face encounters with our patients.”

It has long been recognized that sexual dysfunction is common after stroke, but only recently has it been shown that a lack of or decrease in sexual desire is the most common sexual problem reported—found in more than half of all those who have had a stroke. Likewise, research has shown that more than 50 percent of people with multiple sclerosis have one or more problems with sexual function.

Sexual dysfunction is also associated with epilepsy, Parkinson's disease, and brain tumors, although it's still unclear how much of a role depression or anxiety may play.

The good news is that a variety of strategies and remedies are available to help people regain intimacy, as described in “Sexual Healing.” We also encourage you to bring up sexual matters with your doctors so they can offer resources and treatments.

We always strive to be open and honest with you, and it's in that spirit that we also bring you “Stem Cell Reality,” a story that provides facts about the current state of stem cell treatments, and another, “Going on Record,” that advocates for you to have full access to your medical chart and tells you how to use it to your best advantage.

As always, we look forward to your letters and feedback, so do let us know your thoughts by writing to us at Neurology Now, 333 Seventh Avenue, New York, NY 10001, or emailing us at NeurologyNow@wolterskluwer.com.

Wishing you a holiday season full of joy and love, and a happy and healthy 2017!

Orly Avitzur, MD, MBA, FAAN

Editor-in-Chief

© 2016 American Academy of Neurology