In the latest episode of our podcast "Odyssey of Healing," answers to questions about sexual life and urological disorders in Parkinson's disease by neuro-urologist Ivan Kuvin.
In the latest episode of our podcast “Odyssey of Healing ” answers to questions about sexual life and urological disorders in Parkinson’s disease from neuro-urologist Ivan Kuvin
Do not take these answers as medical advice for your case and do not self-medicate! Each case is individual and requires a specialist consultation, You can easily get an online consultation here. Answers to frequently asked questions are provided for educational purposes.
Ivan Kuvin: Our main mission is a comprehensive approach, as Parkinson’s disease affects many organs and systems. The urologist is responsible for the patient’s quality of life, including issues with urination and sexual life. We identify the root cause of problems and prescribe the correct diagnosis and treatment.
Ivan Kuvin: Problems with urination are often related to disorders of the nervous system. Our task is to determine what exactly causes these disorders and help the patient cope with them.
Ivan Kuvin: Patients with Parkinson’s disease often experience changes in their sexual life. An active sex life helps reduce the risk of disease progression and improves psycho-emotional well-being.
Ivan Kuvin: Yes, research shows that men with erectile dysfunction around the age of 40 have an increased risk of developing Parkinson’s disease, especially if there are comorbid conditions such as diabetes or hypertension.
Ivan Kuvin: Sexual activity contributes to the improvement of emotional and physical well-being. Patients who lead an active sexual life reduce the risks of disease progression.
Ivan Kuvin: We talk with patients about what they need, how often to have sex to bring maximum pleasure and improve their condition.
Ivan Kuvin: Sexual life improves mood and self-esteem, which minimizes the impact of illness on quality of life.
Ivan Kuvin: We create a trusting atmosphere, discuss delicate issues in an “intimate setting,” so the patient can openly talk about their problems.
Ivan Kuvin: Relatives and partners help the patient not to withdraw into themselves, encouraging dialogue and problem-solving. Their support is extremely important.
Ivan Kuvin: Medications such as phosphodiesterase type 5 inhibitors (e.g., Viagra, Tadalafil) are used, as well as prostaglandin injections. In severe cases, penile prosthesis may be considered.
Ivan Kuvin: Hormone replacement therapy improves the course of Parkinson’s disease, especially with low testosterone levels, which affect sexual desire and activity.
Ivan Kuvin: Men over 45 are recommended to undergo an annual examination by a urologist to identify hidden issues such as prostate adenoma, prostate cancer, or inflammatory diseases.
Ivan Kuvin: Even in the absence of complaints, men are recommended to visit a urologist once a year for prevention and diagnosis of possible diseases.
Ivan Kuvin: Among the risk factors are vascular disorders, hormonal changes, neurological problems, as well as comorbidities such as hypertension and diabetes.
Ivan Kuvin: Drugs such as phosphodiesterase type 5 inhibitors (Viagra, Tadalafil), as well as injectable forms with prostaglandins, help manage erectile dysfunction.
Ivan Kuvin: Treating a patient is a team effort. The neurologist prescribes the main therapy, while the urologist helps address specific issues related to urination and sexual life.
Ivan Kuvin: We collaborate with a neurologist to adjust therapy. For example, if a medication causes hypersexuality, we discuss the possibility of replacing it.
Ivan Kuvin: In severe cases, penile prosthesis surgery is performed to help restore sexual function in patients.
Ivan Kuvin: An active sex life improves psycho-emotional and physical well-being, which helps slow the progression of the disease.
Ivan Kuvin: Every patient is unique. We conduct diagnostics, including hormonal and cancer screening, to develop an individualized treatment plan, improve quality of life, and extend the patient’s youth.
Damir Lukmanov: This is the podcast “Odyssey of Healing,” where we meet doctors from the V.S. Buzaev International Medical Centre and learn about advanced medicine. Opposite me is the pleasant-looking neuro-urologist and andrologist Ivan Alekseevich Kuvin. Hello!
Ivan Kuvin: Hello!
Damir Lukmanov: We have mentioned many times that the work at the V.S. Buzaev International Medical Centre is team-based. We will again discuss Parkinson’s disease, considering that our content is likely to be of greater interest to those who have already encountered this issue, their relatives and friends, and those who are about to begin some form of treatment. In front of me is a neuro-urologist. What is your role in this team of specialists addressing the problem of Parkinson’s disease?
Ivan Kuvin : What, so to speak, is our main mission. Let’s start with the fact that this disease is quite complex.
Damir Lukmanov: I want to note that some of your colleagues have already mentioned Parkinson’s disease as a kind of journey that simply needs to be overcome, preferably in the company of pleasant and highly qualified specialists.
Ivan Kuvin : Let’s start with the fact that Parkinson’s disease is quite a complex condition that requires a comprehensive approach, as it affects many organs and systems. Undoubtedly, the “captain” in treating this disease is the neurologist specializing in Parkinson’s. However, other specialists also assist. The urologist is responsible for the patient’s quality of life, with important aspects including issues with urination and sexual life. After all, these issues are fundamental to health. When we meet a patient with Parkinson’s disease at different stages, we can already anticipate which problem will prevail. A patient comes to me, I see that they have already been examined by a neurologist, and I already understand what stage they are at. Similarly, I can already imagine what complaints they will bring to me. But in any case, people aged 40 and older mainly suffer from this disease. And these people, even without Parkinson’s disease, may have various health deviations or comorbidities. Therefore, my task as a urologist is to determine the root cause of urination problems, issues in sexual life, and prescribe the correct diagnosis and treatment. And therefore, of course, a doctor of another specialty cannot look as deeply. This is where teamwork comes in, including the neuro-urologist.
Damir Lukmanov: Speaking of root causes and connections, Parkinson’s disease is equally… That is, are there any symptoms, any problems that consistently appear in those who suffer from Parkinson’s disease?
Ivan Kuvin : Very good question. Suppose today we talk about men’s erectile function, sexual life, sexual dissatisfaction: there is interesting data suggesting that people who have erectile dysfunction at around the age of 40 have a risk of developing Parkinson’s disease. If you add comorbidities such as diabetes and hypertension, the risk of developing Parkinson’s disease becomes even higher.
Damir Lukmanov: Listen, am I correct in understanding that a normal sex life and the absence of any urological problems are key to a healthy continuation of life?
Иван Кувин : Yes, absolutely. For both men and women, sexual activity brings significantly more positive emotions—both emotional and physical. Those with Parkinson’s disease who are sexually active significantly reduce their own risks of disease progression. This is very important!
Damir Lukmanov: This is extremely important. Here, I must immediately ask a question: do you think this is more of a physiological feature or a psychological dependency? That is, the person is fine with their sexual life, has a good mood, self-esteem, and consequently minimal, so to speak, impact on the quality of life
Иван Кувин : Yes. Men and women with Parkinson’s disease are generally not in the best emotional state when they first learn of their diagnosis. And, of course, everything related to movement within the paradigm of this disease requires special attention. Sexual intercourse is a huge, let’s say, “big dance.” Fine motor skills, sensitivity, and special skills are needed. And, of course, we calmly discuss with patients in our center how often they should have sex, what they enjoy in sex, what they need, and how we can help them achieve the maximum amount of pleasure to improve their physical and, naturally, psycho-emotional state.
Damir Lukmanov: The topic is quite delicate. You’ve probably encountered patients who are tense and shy to talk about it openly during appointments. How do you “draw them out” to learn all their existing problems and be helpful?
Ivan Kuvin : There are certain medical and personal nuances here. I find it quite easy to communicate with any patient. When a man or woman comes in, and sometimes they come together, we discuss certain aspects of their sexual life. Sometimes I am alone with the patient. And here, in a “private setting,” without any extra ears, the patient is able to share much more with the doctor, even things they haven’t shared in the presence of their partner.
Damir Lukmanov: You said that sometimes patients come in pairs.
Ivan Kuvin : They usually come in pairs.
Damir Lukmanov: For me, it’s surprising because I thought they withdraw into themselves, and that’s precisely the problem. First, help doesn’t come on time if the patient doesn’t speak up about it. How should the patient’s family and friends behave?
Ivan Kuvin : Of course, a person with Parkinson’s disease often withdraws, trying to understand and reevaluate themselves. Here, the task of relatives and close ones is to prevent them from retreating into themselves. They need to be encouraged to engage in dialogue. If it’s a spouse, then it’s essential to talk and motivate the patient to address the issues that might be “stuck” in their mind, hindering their life. It’s usually difficult to get anyone to visit a urologist’s office, even a healthy person. And if they have additional challenges, urology might not be their immediate concern. Yes, they often think about other things. But their sexual life continues nonetheless. If they notice changes in it, it’s important to support them, take them by the hand, bring them to a neuro-urologist, and solve the issues together. Certainly, only support.
Damir Lukmanov: I know that the principle of operation of the V.S. Buzaev International Medical Centre, which you represent, is teamwork. Can you tell us how you interact with your colleagues? Do you have a person who makes the main decisions? Or do you do it collectively, together?
Иван Кувин : Certainly. Here, it will be difficult for one specialist to bring a patient to recovery. Therefore, once again, our “flagship” is This is a neurologist who examines and prescribes therapy. After that, I consult. We discuss “sensitive” issues that the patient may not be ready to open up about, perhaps to a female doctor or other doctors. Here we discuss sexual life. I can say that there are certain medications prescribed by the doctor, but the patient experiences an effect such as hypersexuality. In this case, we need to interact with the neurologist to discuss this case and say: “Let’s try to change this therapy because this medication helps with Parkinson’s disease but slightly interferes with their sexual life.” Some patients don’t want to have sex, while others want it too often. This also affects the quality of life not only for the patient but also for their sexual partner. Therefore, these issues are resolved only through direct contact between specialists. In our center, we are capable of solving this problem!
Damir Lukmanov: Let’s touch on some issues of modern medicine. Are there any modern methods or medications for addressing problems in sex?
Ivan Kuvin : Erectile dysfunction is a multifactorial problem in itself. Here, issues related to the condition of blood vessels, the hormonal system, and neurological profile come into play, so it’s important to determine what is primary. Remember, at the beginning of our dialogue, we talked about the patient possibly having some predisposing factors? Now we like to talk about hormone replacement therapy. Let’s imagine the profile of our patient: a person over 40 years old. A man comes in with some complaints. Well, obviously, there is a high probability that he will have insufficient testosterone levels, which undoubtedly affects sexual desire and male activity. Therefore, it is very important to find this problem, even if it is accompanying, but we cannot exclude it. Find this problem and eliminate it. If necessary, prescribe hormone replacement therapy. By the way, it improves the course of Parkinson’s disease. The second point: let’s imagine that the patient has concomitant hypertension. How can we manage without a cardiologist? We can’t. So we involve a cardiologist to correct arterial hypertension. Now, the patient is “covered” from two sides, seemingly unrelated directly to Parkinson’s disease.
Damir Lukmanov: From the aspects that significantly affect its quality of life.
Ivan Kuvin : Of course! Medications for treating erectile dysfunction are standardized worldwide; the important factors are the dosage and the form in which they are administered: tablet or injection? My job here is to understand, analyze, evaluate, and prescribe medications for erectile dysfunction treatment, adjusting if necessary. This, of course, takes some time, but we are not in a hurry. For the Buzaev Medical Center, the main goal is for the patient to achieve the desired treatment results during this period of their condition. By the way, phosphodiesterase type 5 inhibitors, well-known medications like Viagra and Tadalafil, are effectively used for treating erectile dysfunction in Parkinson’s disease, but the dosage varies for everyone. There are injectable medications into the penis containing prostaglandins, which is the next stage of erectile dysfunction treatment. But, in principle, all this is possible. The patient needs to work with a neuro-urologist to understand how to use these properly. And all this helps prolong their youth with Parkinson’s disease—male, sexual youth, of course.
Damir Lukmanov: During a conversation with your colleagues, we found out that Parkinson’s disease is not a sentence, but we are still talking about alleviating symptoms, and the disease itself is not curable. In your case, patients suffering from Parkinson’s disease and having problems with urination and erectile dysfunction. Can you cure patients, at least within your specialty?
Иван Кувин : I would say that curing is very optimistic.
Damir Lukmanov: We are optimists, yes.
Иван Кувин : We can bring it to a perfect state. And we actively use this, using our knowledge and skills. Patient compliance is also important here, meaning adherence to therapy, as well as the involvement of their sexual partner. We understand that the primary dialogue between the sexual partner and the patient, the conversation “what do you want, how do you want it, what is needed for you to feel better?” should lead to the patient being in my office – the office of a urologist-andrologist, where we address these delicate issues.
Damir Lukmanov: So, do I understand correctly that once a patient contacts you, they become your charge, and you guide them throughout the illness? How often should regular check-ups be done? Or only as the condition worsens, when symptoms appear?
Ivan Kuvin : Let’s start with the fact that a man over 45 should see a urologist once a year.
Damir Lukmanov: So even if there are no problems?
Ivan Kuvin : Yes. In addition to erectile dysfunction, there is also prostate adenoma, prostate cancer, which is becoming more common in younger people, inflammatory reactions, urolithiasis, which hasn’t gone away, so a person should undergo a “check-up.” And here, if a person is already under active observation – yes, we schedule with them: you’ll come in a month, in two months. Not all patients are concerned about erectile dysfunction, especially at the onset of the disease. But we can already diagnose hidden risks, the same hormonal screening, the same cancer screening, ultrasound, blood tests, none of this has been canceled. Therefore, in general, it is individual. I don’t remember us ever treating anyone in a template manner at our center. A wonderful team. We work absolutely individually with each person.
Damir Lukmanov: Speaking of breaking the mold, can you mention anything within the framework of perhaps innovative methods or some interesting achievements in the world of medicine related to your field?
Ivan Kuvin : There is a surgical question. If a person has erectile dysfunction that does not respond to oral or injectable forms, then the person may be referred for penile prosthesis implantation. This is an interesting topic, but it will affect not only patients with Parkinson’s disease.
Damir Lukmanov: I suggest summarizing. Problems with erectile function and urination are often encountered in Parkinson’s disease, right?
Ivan Kuvin : Yes.
Damir Lukmanov: Sexual life is very important during the treatment of Parkinson’s disease.
Ivan Kuvin : Yes, it helps maintain psycho-emotional status and physical condition. We know that an active sex life prevents the progression of Parkinson’s disease.
Damir Lukmanov: Relatives of the patient, while providing all possible support, must ensure that the patient undergoes a complete examination.
Ivan Kuvin : Certainly. Because relatives and sexual partners are the first people who know almost everything about the patient. And in this “doctor-relative-spouse(-partner)-patient” connection, we can prevent many complications associated with Parkinson’s disease.
Damir Lukmanov: Regular check-up of the body. Age 45+ – this is a mandatory examination once a year.
Ivan Kuvin : Yes, a urologist examination, ultrasound, cancer screening, and a test for sex hormones.
Damir Lukmanov: I think we have covered this delicate topic comprehensively. Thank you very much for the interesting and informative conversation! Good luck!
Ivan Kuvin : Thank you very much!
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