The impact of narcolepsy symptoms and treatment on sex life - current evidence and reports

Narcolepsy significantly impairs sexual activity and satisfaction, with up to 81.1% of patients affected. Autonomic dysregulations contribute to sexual dysfunction, including erectile dysfunction in 48% of men and reduced vaginal lubrication in 81% of women. Orgasmolepsy negatively impacts sexual and social relationships in over a third of respondents. Sleep paralysis accompanied by hypnagogic hallucinations can create an impression of sexual assault, leading to anxiety, PTSD features, depressed mood, and in extreme cases suicide attempts. Among medications for narcolepsy, only methylphenidate may increase libido and reduce erectile dysfunction. A holistic approach including behavioral interventions, cognitive-behavioral therapy, and education is crucial for treatment.

Study at a glance

Abstract

Introduction: Narcolepsy (NT) can manifest as excessive daytime sleepiness (EDS), cataplexy, hypnagogic (HHG) and hypnopompic (HHP) hallucinations, sleep paralysis, orgasmolepsy – all of which may affect patients' functioning. The aim of the study was to determine the impact of NT, specific sexual dysfunctions and drugs used in NT on sex life. Materials and methods: A narrative review was conducted, using keywords: narcolepsy, sexual dysfunctions, medications in narcolepsy from repository inception to March 17, 2024 searching PubMed/MEDLINE, Google Scholar, Crossref, Cochrane databases. The quality of the reviewed articles was assessed using the Scale for the Assessment of Narrative Review Articles (SANRA). Results: Sexual activity and satisfaction are reduced in up to 81.1% of patients. There are often multiple co-occurring autonomic dysregulations in patients, including the genitourinary system, causing sexual dysfunction (erectile dysfunction in 48% of men; vaginal lubrication in 81% of women). Orgasmolepsy negatively affects sexual and social relationships in more than 1⁄3 of respondents. Sleep paralysis can be accompanied by HHG, which often present the impression of sexual assault and harassment. They may cause anxiety, post-traumatic stress disorder (PTSD) features, depressed mood, in extreme cases leading to suicide attempts. Of the drugs used in NT, only methylphenidate can increase libido and reduce erectile dysfunction in NT. Conclusions: Orgasmolepsy, sexual and autonomic dysfunction in NT significantly reduce patients' quality of sex life. Sleep paralysis with sexual HHG can reduce psychological well-being. A holistic intervention approach, using behavioural interventions, cognitive-behavioural therapy, education of the patient and their loved ones, is crucial in the treatment of sexual difficulties. Keywords: narcolepsy, sexual dysfunctions, medications in narcolepsy