Sexual Dysfunction in MS

Researchers delved into the private lives of men with multiple sclerosis (MS) in a recent study and discovered that sexual dysfunction is a common MS complication. Although it’s a topic patients may be reluctant to discuss with their neurologists, they should be aware that intimacy problems are often treatable.

Scientists from the Institute of Psychiatry and Neurology in Warsaw, Poland, interviewed 67 men with MS who were members of the National MS Center. The participants also filled out questionnaires and underwent neurological evaluations, all in an attempt to measure their sexual satisfaction.

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Of those 67 men, researchers found that more than half complained of erectile dysfunction (ED), roughly a quarter reported decreased interest in sex or had issues reaching climax, and nearly a fifth had difficulty with ejaculation. These results didn’t seem to depend on the patient’s age, the amount of time since his diagnosis, or his level of disability.

A 'Wall of Silence'

The researchers concluded that sexual dysfunction "is highly prevalent but commonly overlooked in MS patients and has a significant impact on their sexual quality of life.” Despite these widespread issues, the researchers found that only 6 percent of the study participants had spoken about these problems with their doctor.

The discrepancy between the number of men who suffer from sexual dysfunction and those who report it to their doctor is probably due to the taboo nature of the topic.

Most likely, the subject doesn't come up, according to Megan Weigel, DNP, ARNP-C, MSCN, in an interview with Healthline, "because sexual dysfunction is a sensitive issue both for the person with the problem and the healthcare provider. However, it is possible that people with MS may not know it can be a symptom of the disease."

But if patients can put aside their discomfort long enough to have a frank conversation with their doctor—dropping the wall of silence—it may be possible to treat the problem.

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Sexual Dysfunction Isn’t Just for Men

In an earlier study, the same group of researchers looked at sexual dysfunction in women with MS. While the researchers identified real issues faced by more than three quarters of the patients studied, only 2.2 percent of these women ever told their doctors about their sexual difficulties.

Among the problems women reported were lack of desire, decreased sensation in the genitals, poor lubrication, and an inability to climax. The study found that sexual dysfunction was "less likely in women who assessed their relationship positively but more common in older patients and those who had a positive history of depression.”

In the case of both male and female sexual dysfunction, the problem appears to be widely under-reported and overlooked by medical professionals.

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Communication Is Key

MS is a disease that compromises the central nervous system, and sexual side effects are common among patients. Neurologists are trained to treat all aspects of the disease, including sexual complications. Understanding that it is a side effect of MS, and not due to any personal inadequacy, should quell the anxiety patients feel about discussing intimacy problems with their doctor.

The researchers stressed that neurologists should put more emphasis on sexual dysfunction when they examine their patients and have better screening tools in place. Doctors can treat problems only if they know symptoms exist, so, for patients, speaking up is imperative.

Sexual Dysfunction Defined

According to a 2009 article in MSFocus written by Frederick W. Foley, Ph.D., there are three types of MS-related sexual dysfunction: primary, secondary, and tertiary.

Primary dysfunction is caused by damage to the nerves from MS. Signals from the brain can no longer travel to parts of the body involved in sexual activity. Genital numbness is a classic example of primary dysfunction.

Examples of secondary dysfunction are bowel or bladder issues, spasticity or hand tremors—anything that indirectly complicates intimacy.

The tertiary variety of dysfunction is caused by the emotional aspects of MS—psycho-social or cultural issues that can impact a person’s feelings about sex. Body image, mood swings, and self-esteem can all affect intimacy. The changing dynamic of relationships—when life partners become caregivers, for example—can also play a role in tertiary sexual dysfunction.

Improving Sexual Quality of Life

Patients need not suffer in silence. "There are several ways to help men with MS who suffer from ED," Weigel said. "Medications like Viagra, Cialis, and Levitra may be helpful. If they are not, there are injectable medications and mechanical devices that may be required." For women, lubricants such as K-Y Jelly can help with vaginal dryness, and exploring new techniques for arousal might address loss of libido.

"Sexual dysfunction can be caused by side effects of medications like antidepressants, muscle relaxants, pain medications, and anti-seizure drugs; other medical conditions that affect small blood vessels, like diabetes and hypertension; and psychological issues, like loss, role changes, fear of failure, depression, and anxiety," Weigel said. "Timing of medication dosing, and timing of sexual activity so that it occurs at the time of day with the least fatigue can be helpful. Counseling and sex therapy are also very useful in conquering physical and emotional problems related to sexual dysfunction."

"Remember that as healthcare providers, we should be able to listen with a nonjudgemental, open ear in a nonthreatening environment to sensitive issues," Weigel added. She also suggests that patients write down their concerns and give the list to their doctor. "This could result in an open discussion that would put the person more at ease," she said.

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