Sexual Dysfunction and Multiple Sclerosis
MS is a demyelinating disease which affects the central nervous system (CNS), causing a variety of problems such as fatigue, spasticity, muscle weakness, imbalance, altered bladder and bowel control, and sexual dysfunction. Sexual dysfunction is a common symptom in MS and affects more than 75% of people living with the disease; a frequency greater than that reported in other chronic diseases. Sexual dysfunction in MS has many causes.
Primary causes may be the direct result of demyelinating lesions in the CNS that can affect sexual response and sexual feelings. Primary sexual dysfunction includes decreased or loss in libido, painful or uncomfortable genital sensations (burning, tingling, numbness), and/or altered orgasmic response in both women and men. Women may experience decreased vaginal lubrication and dryness, inorgasmia, and low sex drive. Men may experience difficulty achieving and/or maintaining an erection, and diminished frequency of ejaculation.
Secondary sexual dysfunction problems arise as a consequence of disability caused by MS. Examples of secondary symptoms include poor bladder and bowel control, fatigue, muscle weakness, spasticity, immobility, tremor, cognitive impairment, and sensory problems. Secondary sexual dysfunction can also be a result of non-MS health conditions such as hypertension, diabetes, depression, hypercholesterolemia, obesity, and smoking. In addition, medications that are used for MS (spasticity, urinary frequency, sensory pain) and non-MS diseases (hypertension, diabetes, depression) can further contribute to secondary sexual dysfunction.
Tertiary sexual dysfunction in MS occurs as a result of disability related to psychological, social, and cultural issues that affect sexual response. These variables can include anxiety, low self-esteem, altered marital and family roles, changes in body image, and fear of rejection by one’s partner.
Although sexual dysfunction is a prevalent problem, and can be caused by a host of variables, for both men and women, it is a topic that is frequently overlooked, and often left undiscussed and untreated. All MS symptoms, regardless of type, deserve attention if our goal is to enhance our health and well-being.
Importance of Addressing Sexual Dysfunction
Sexual function is a vital element to a person’s health and well-being. People living with MS are sexual beings, yet health care providers often ignore or forget this part of a patient’s identity. This avoidance to address and treat sexual dysfunction profoundly impacts the quality of life for all people living with MS; not only the person with MS but also his/her partner.
In reports of men with MS, sexual dysfunction may range from 23% up to 91%. Women may report sexual dysfunction up to 85% of the time. Eighty percent of the sexual dysfunction problems in men consist of erectile dysfunction. In women, up to 72% report decreased libido and hyposexuality. Sexual dysfunction not only adversely impacts quality of life but it contributes to other problems as well. These problems can consist of:
Relationship conflict (marital problems noted in 71% of people with sexual dysfunction)
Depression, embarrassment, isolation, despair
Performance anxiety
Avoidance and fear of intimate relationships and sexual encounters
Recognition of sexual dysfunction can help people with MS,
Understand the problem
Lead to treatment
Build healthier relationships
Enhance self-esteem
Reduce depression
Promote patient-healthcare provider relationships
Improve quality of life
Sexual Dysfunction Management
The first step in management of sexual dysfunction is to acknowledge that sexual dysfunction is a significant health care problem that most people with MS face at some point in their lives. It is also important to realize that sexual dysfunction is a subject that often goes under-recognized and under-treated. The second step is to talk about your sexual dysfunction concerns with your health care provider. Physical therapists can address positioning techniques that enhance sexual comfort. Clinical psychologists can work with individuals or couples in promoting sexually sensitive communication to enhance sexual performance. Occupational therapists can instruct people in the use of sexual devices that can enhance sexual pleasure. Additional sexual dysfunction treatments may include:
Medical sex education materials
Oral medications (Viagra-sildenafil, Levitra-vardenafil, Cialis-tadalafil)
Topical hormones
Sex therapy (body mapping other than genitals)
Counseling
Provision of sexual devices (vibrators, lubricants)
Intracorporeal injection of medication into the penis
Noninvasive physical treatments for erectile dysfunction (vacuum tumescence penis pumps)
Surgery for erectile dysfunction (implantation of inflatable or semi-rigid rods)
Sexual dysfunction is a very prevalent problem in the MS population. It is a complex and dynamic interaction of physical, psychological, social, cognitive, and practical factors (financial). The person with MS, health care team, and health care community must work together to reduce sexual dysfunction if we hope to improve the quality of life for all people living with MS.
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