If the symptoms of MS are making intimacy challenging for you, know that there are strategies that can help.
Sexual dysfunction can be defined as experiencing difficulty during any phase of the sexual cycle that contributes to dissatisfaction for the individual or partners involved.
It’s a common issue for people with multiple sclerosis (MS) that can have a detrimental impact on all people.
The most common complaints of sexual dysfunction in men with MS are:
- erectile dysfunction: the inability to achieve or maintain an erection sufficient for penetrative intercourse or to reach climax
- ejaculatory dysfunction: the inability to efficiently ejaculate during orgasm
- orgasmic dysfunction (anorgasmia): inability or difficulty reaching orgasm
- reduced libido: diminished desire for sex or arousal to touch or visual stimulus
- premature ejaculation: climaxing too rapidly for sexual satisfaction
In general, most healthcare providers will point to 3 categories when discussing the reasons behind sexual dysfunction:
- Primary dysfunction refers to the neurological or nervous system lesions of MS that can contribute to issues such as loss of sensation and erectile dysfunction. This can occur due to the effects of MS on the pathways in the brain and spine. Some medications used in treating MS can impair sexual function due to effects on the brain or spine.
- Secondary dysfunction includes nonsexual changes such as fatigue, pain, and bladder or bowel dysfunction. Medications used in the treatment of MS can cause side effects that may cause secondary dysfunction.
- Tertiary dysfunction points to emotional and psychological concerns, such as depression, anxiety, and relationship difficulties. Even though MS can be relapsing and remitting, the emotional issues can be a problem even when the disease is in remission.
The first step in recovery for any medical condition that creates physical and emotional distress is to seek help. Unfortunately, when addressing sexual issues, this is often the first roadblock.
According to a report by the National Multiple Sclerosis Society, 63 percent of people with MS say they’ve never talked about sexual difficulties with their healthcare provider — and only 20 percent even remember having a healthcare provider ask about sexual dysfunction.
1. Start by talking
Talk to your primary care provider, your neurologist, or a urologist about the issues you’re experiencing.
Sexual health experts are also great resources. The American Association of Sexuality Educators, Counselors, and Therapists (AASECT) is an excellent resource for finding a knowledgeable and compassionate healthcare provider to talk about these important health issues.
2. Focus on heart-healthy eating
Interestingly, the same things you do for heart health are known to improve sexual function in men.
Maintaining adequate blood flow to the heart requires healthy eating patterns and exercise. The same goes for improving blood flow to the penis. Blood flow to the shaft of the penis creates an erection.
3. Get moving
Exercise helps to keep weight managed, improve fatigue, and aid overall mental health.
Exercise with MS can be a challenge depending on your current physical limitations. Movement is key, understanding that what you can do may be different at times based on your MS symptoms.
Exercise programs can include aerobic activities such as running, walking, biking, or swimming, as well as gentle yoga-based stretches and postures.
Finding some activities that work for you and that you enjoy should be the goal.
4. Focus on pelvic floor health
The muscles of your pelvic floor are the key to success for maintaining erections, ejaculation, and sensation of orgasm. Muscles can become weak due to MS lesions in the spine.
These important muscles contract to hold the blood in the shaft of the penis to maintain erection, improving your ability to sustain an erection and decreasing episodes of premature ejaculation.
Strong pelvic floor muscles will also contribute to improved sensation of orgasm.
Pelvic floor physical therapy is an effective way to learn to strengthen and improve pelvic floor function for overall pelvic health, including sexual function.
5. Plan ahead
Fatigue can be a major factor with sexual intimacy for those with MS.
Planning ahead for a sexual encounter can help you pace your day’s activities to conserve energy. Thinking about intimacy may also improve desire and boost your sex drive.
This may not seem as desirable as spontaneity, but prioritizing sex by planning and preparing doesn’t diminish the act. Rather, it assigns it as important in your life.
Take advantage of sexual imagery, magazines, and other literature. If you have a partner, send messages throughout the day to set the stage for what’s to come.
Consider morning sex if fatigue is an issue, or if you want to take advantage of a morning erection.
6. Know your medication options
There are medication options for men experiencing erectile dysfunction, including men with MS.
If spasticity in your muscles creates difficulty with any aspect of sex, then speaking with your doctor about an antispasticity medication to take prior to intimacy may be helpful.
Medications have side effects, so taking advantage of all non-medication interventions prior to requesting a prescription is usually the best route.
A healthy sex life has benefits that encompass the emotional, social, and physical aspects of life.
If your symptoms of MS are making intimacy challenging for you, know that there are strategies that can help. Seeking knowledge and care when necessary is the first step toward a more fulfilling sex life.
Erin Glace, PT, MSPT, PRPC, is a pelvic health specialist with over 25 years of experience treating people with pelvic floor problems. She has focused her passion and practice on the development of innovative and comprehensive pelvic health programs. In 2019, Erin started Mommy Care PT with the mission of improving women’s lives through online education about preparation and recovery from pregnancy and childbirth.