Hypersexuality (HY) is an under-recognised yet clinically significant behavioural complication of certain neurological disorders. We conducted a preregistered systematic review (PROSPERO CRD42023446088) encompassing 394 studies and 46,516 participants to synthesise evidence on its aetiologies, manifestations, assessment practices and management. Most cases were iatrogenic (≈61%), typically linked to dopaminergic therapy in Parkinson’s disease, followed by acquired forms from focal lesions, traumatic brain injury, or neurodegenerative syndromes (≈25%), and a smaller subset associated with the management of deep brain stimulation (≈4%). Across these conditions, convergent evidence implicates dysfunction within fronto-striatal–limbic circuits: dopaminergic overstimulation or structural compromise of orbitofrontal and ventromedial regions reduces inhibitory control and amplifies reward drive, producing increased libido and compulsive or disinhibited sexual behaviours. Despite the growing clinical burden, assessment remains inconsistent — nearly half of studies relied solely on unstructured notes, and informants were formally consulted in fewer than 10% — possibly leading to under-ascertainment. Effective management requires aetiology-informed sequencing: verifying temporal linkage to neurological or pharmacological factors, reversing modifiable causes, integrating behavioural and pharmacological strategies, and supporting caregivers. Current diagnostic frameworks exclude secondary forms of HY, leaving most neurological cases unclassified. We propose recognising hypersexuality due to neurological conditions as a distinct entity and implementing structured, multimodal screening at key clinical junctures. Together, these findings define HY as a multidimensional neurobehavioural syndrome unified by disexecutive–reward imbalance and call for an evidence-based model of recognition and care.
Hypersexuality across neurological disorders: A systematic review of aetiologies, clinical manifestations, assessment methods, and management strategies
Schincariol A.;Devita M.;Scarpazza C.
2026
Abstract
Hypersexuality (HY) is an under-recognised yet clinically significant behavioural complication of certain neurological disorders. We conducted a preregistered systematic review (PROSPERO CRD42023446088) encompassing 394 studies and 46,516 participants to synthesise evidence on its aetiologies, manifestations, assessment practices and management. Most cases were iatrogenic (≈61%), typically linked to dopaminergic therapy in Parkinson’s disease, followed by acquired forms from focal lesions, traumatic brain injury, or neurodegenerative syndromes (≈25%), and a smaller subset associated with the management of deep brain stimulation (≈4%). Across these conditions, convergent evidence implicates dysfunction within fronto-striatal–limbic circuits: dopaminergic overstimulation or structural compromise of orbitofrontal and ventromedial regions reduces inhibitory control and amplifies reward drive, producing increased libido and compulsive or disinhibited sexual behaviours. Despite the growing clinical burden, assessment remains inconsistent — nearly half of studies relied solely on unstructured notes, and informants were formally consulted in fewer than 10% — possibly leading to under-ascertainment. Effective management requires aetiology-informed sequencing: verifying temporal linkage to neurological or pharmacological factors, reversing modifiable causes, integrating behavioural and pharmacological strategies, and supporting caregivers. Current diagnostic frameworks exclude secondary forms of HY, leaving most neurological cases unclassified. We propose recognising hypersexuality due to neurological conditions as a distinct entity and implementing structured, multimodal screening at key clinical junctures. Together, these findings define HY as a multidimensional neurobehavioural syndrome unified by disexecutive–reward imbalance and call for an evidence-based model of recognition and care.
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