Sexual dysfunction (SD) is a common, yet under-reported, non-motor symptom (NMS) of Parkinson’s disease (PD). Addressing such a problem and asking about it should be a constant part during assessment and follow up of parkinsonian patients. It is usually underestimated due to either patients’ special issues as social issues or physician neglection of the problem in comparison to other motor and non-motor complaints. This problem could have a severe impact on quality of life of patients and could have a serious impact on other manifestations which add to patients suffering. Several mechanisms of sexual dysfunction in PD were reported, independent of disease severity, including autonomic dysfunction, central dopaminergic deficiency, psychosocial factors, and medication side effects [
17]. In the present study, we found that sexual dysfunction is prevalent among both male and female patients with PD. Our findings are consistent with previous work that also reviled the high prevalence of SD in patients with PD and the effect of PD on sexual functions [
18‐
21]. Our results also showed that patients with PD have significantly worse sexual function compared to healthy controls, with lower scores in desire, arousal, lubrication, orgasm, satisfaction, and pain in women, and lower scores in erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction in men, which goes with previous studies that addressed sexual domains most affected by PD [
4,
18,
22,
23]. Sexual dysfunctions have a high impact on quality of life (QoL), which has been previously addressed in patients with PD [
4,
5]. In our sample, most of the patients declared that their sexual problems negatively affect their relationship with the partner and overall QoL. Reduced sexual activity and satisfaction in patients with PD could be related to physical disability related to the disease, as well to other PD non-motor symptoms as depression, lack of motivation, and sleep disturbances which may lead to bed separation [
24]. We also found that most patients with PD attribute their sexual dysfunction to aging rather than to the disease or its treatment, which highlights the importance of patient education on the multiple factors that could be related to sexual dysfunction in PD. Aging has been proved to be a main factor regarding sexual dysfunction as shown by other studies [
6,
25]. Sakakibara and colleagues in 2001, compared the sexual functions in different age groups (30 s, 40 s, 50 s, and 60 s) and reported significant decline in the frequency of sexual intercourse and orgasm in elder PD patients [
26]. Another study demonstrated more frequent and severe sexual dysfunction in late onset PD than early onset PD patients and attributed differences to the age of onset [
27]. In the same context, we have to underline that sexuality is still an embarrassing topic for women. Only 2% of women sought medical advice regarding their sexual problems, compared to 30% of men in our sample. This issue should encourage medical providers to discuss symptoms of sexual dysfunction with their patients with PD. This may be challenging since this topic is not covered in the UPDRS, in addition to cultural barriers rendering patients, particularly women, in addressing their sexual problems and habits. However, going through a routine symptom review during regular visits and referring patients to sex therapy, couple therapy, and behavioral therapy, where appropriate, may be helpful. Overall, medical providers should be encouraged to initiate conversations about sexual dysfunction with their patients and educate them on the potential causes and treatments available. In our study, sexual functions correlated negatively with disease severity, as assessed by UPDRS and HY stage. Our results suggest that increased severity of motor impairment and decreased overall activities of daily living negatively affect sexual function which seem logical, and these results go side to side with previous studies that reported a correlation between disease severity and sexual dysfunction in patients with PD [
7,
28,
29]. These observations may address the importance of motor rehabilitation in improving patient’s sexuality. Furthermore, we reported worse sexual functions with longer disease duration in men with PD; however, no similar correlation was found in female patients. Some studies also showed no correlation between sexual dysfunction and PD duration [
18,
30]. This association between disease severity and the occurrence of non-motor symptoms, including autonomic dysfunction, has been widely reported in the literature [
31]. As PD progresses, patients often experience a greater burden of non-motor symptoms, including sexual dysfunction, which can significantly impact their quality of life [
32]. Kinateder and colleagues found that male patients with ED had a significantly longer PD duration [
5]. Although several studies have suggested that the burden of non-motor symptoms as a whole is higher in the akinetic-rigid phenotype compared to tremor-dominant phenotype [
33‐
35], to the best of our knowledge, this is the first study that directly assesses the relationship between PD subtype and sexual dysfunctions. We found that in women with PD, sexual dysfunctions are more prevalent in the akinetic-rigid and mixed subtypes compared to tremor-dominant phenotype. However, no similar correlation was found in men with PD. The observation of differences in sexual dysfunction scores between PD subgroups aligns with our hypothesis that certain motor phenotypes of PD might correlate with distinct patterns of sexual dysfunction. However, the specific reasons behind these differences warrant further investigation. Potential Explanations include neuroanatomical variations which may influence the neural pathways responsible for sexual function, leading to differences in sexual dysfunction [
36]. It is also possible that patients with certain PD subtypes receive different medications or experience varying responses to dopaminergic therapy, which could impact sexual function differently [
31]. Non-motor symptoms play a crucial role in PD and can significantly affect sexual function. It's plausible that patients with specific PD subtypes may experience more pronounced non-motor symptoms, which could contribute to differences in sexual dysfunction [
32]. The identification of these differences in SD scores among PD subgroups underscores the importance of considering PD heterogeneity when assessing sexual dysfunction. Future research should delve deeper into the underlying mechanisms behind these differences, exploring neurobiological, pharmacological, and psychosocial factors.