Cognitive Behavioral Therapy (CBT) to address unhelpful beliefs about sexual functioning/sexuality.
Treatment of Secondary Causes
- Fatigue
Treatment:
Energy conservation strategies such as planning sexual activity during a time of the day when MS fatigue is at its lowest; taking naps; using ambulation aids.
Pharmacologic treatment of fatigue as outlined in the Mellen Center Approach on management of fatigue.
- Bladder and Bowel Symptoms
Treatment:
Behavioral strategies include restricting fluid intake before sexual activity, selfcatherization just before sexual activity, planned bowel movements twice a day and before sexual activity, use of condoms for concerns of urinary leakage in men.
Pharmacological interventions include the use of anticholinergic medications (may decrease vaginal lubrication which can be alleviated with the use of a water-soluble lubricant).
- Spasticity
Treatment:
Active symptomatic management.
Physical therapy focusing on range of motion exercises.
Take antispasticity medication 30 minutes prior to sexual activity.
Explore alternative sexual positions to minimize discomfort or pain from spasticity.
- Cognitive changes
Treatment:
To improve attention and concentration needed for successful sexual activity, the goal is to minimize nonsexual stimuli and maximize sensual and sexual stimuli.
Cognitive rehabilitation may be recommended.
Treatment of Tertiary Causes
- Body image
Treatment:
Cognitive Behavioral Therapy (CBT).
Couples counseling or sex therapy.
- Role reversal
Treatment:
If sexual partner is the primary caregiver, it may be helpful to incorporate other family members to perform caregiving duties for the patient to reduce “role conflict”.
Individual or couples counseling.
- Depression
Treatment:
Cognitive Behavioral Therapy (CBT).
Consider SNRIs such as venlafaxine, desvenlafaxine, or duloxetine as opposed to SSRIs, such as fluoxetine, paroxetine, sertraline, or citalopram, which may result in more sexual side effects.
Consider adding Wellbutrin to antidepressant regimen as this medication has a lower profile of sexual dysfunction as a side effect.
- Sildenafil (Viagra) is the only medication evaluated in clinical trials in men with MS.
**Contraindicated when patient is on nitrate-based cardiac medications, as they can lower blood pressure excessively.
**It is recommended to refer the patient to a specialist in this area.
Note: All patients should be evaluated by their physician to be sure they are healthy enough for sexual activity.