BACKGROUND: Chronic (normotensive or low pressure) hydrocephalus is 
characterized clinically by gait disturbance, cognitive and urinary impairment, 
known as Hakim's triad. Nothing has been reported about impairment in sexual 
function, which could involve both the patient and the patient's partner.
METHODS: Out of 97 patients undergoing shunt placement for chronic 
hydrocephalus, 28 male patients (28.8%) referenced sexual dysfunction before 
operation. In these cases, we performed a preoperative and postoperative survey 
of sexual activity.
RESULTS: In the preoperative period, all 28 patients reported having no sexual 
activity or arousal, from 2 to 4 years before the operation. Following shunt 
placement, 22/28 (78.5%) of patients regained variable sexual desire within a 
period ranging from 3 to 8 weeks, affording normal sexual activity with their 
partner.
CONCLUSIONS: Sexual dysfunction can be part of the very early clinical 
background in patients with Hakim's triad and neuroradiological imaging 
compatible with chronic hydrocephalus. Restoration of sexual ability and arousal 
should be considered among the postoperative goals in these cases, together with 
improvements in cognition, gait, and urinary continence.