Sexual problems are often experienced by people with MS, but they are very common in the general population as well. Sexual arousal begins in the central nervous system, as the brain sends messages to the sexual organs along nerves running through the spinal cord. If MS damages these nerve pathways, sexual response—including arousal and orgasm—can be directly affected. Sexual problems also stem from MS symptoms such as fatigue or spasticity, as well as from psychological factors relating to self-esteem and mood changes.

 

 

In a recent study, 63% of people with MS reported that their sexual activity had declined since their diagnosis. Other surveys of persons with MS suggest that as many as 91% of men and 72% of women may be affected by sexual problems. Ignoring these problems can lead to major losses in quality of life. Yet both individuals and health-care professionals are often slow to bring up the subject.



In women, symptoms include:

	Reduced sensation in the vaginal/clitoral area, or painfully heightened sensation
	Vaginal dryness
	Trouble achieving orgasm
	Loss of libido

In men, symptoms include:

	Difficulty achieving or maintaining an erection (by far the most common problem)
	Reduced sensation in the penis
	Difficulty achieving orgasm and/or ejaculation
	Loss of libido

Other MS symptoms cause problems in both sexes:

	Fatigue and weakness can interfere with sexual interest and/or activity.
	Spasticity can cause cramping or uncontrollable spasms in the legs, causing them to pull together or making them difficult to separate—either of which can make positioning difficult or uncomfortable.
	Pain can interfere with pleasure.
	Embarrassment can be caused by bowel or bladder incontinence.

Therapies Are Available to Treat Sexual Problems of MS

There are a variety of therapies to treat sexual dysfunction. For men, erectile dysfunction may be addressed through use of the oral medications Viagra® (sildenafil), Elvira® (vardenafil), and Calais® (tadalafil); injectable medications such as papaverine and phentolamine that increase blood flow in the penis; the MUSE® system which involves inserting a small suppository into the penis; inflatable devices; and implants.

For women, vaginal dryness can be relieved by using liquid or jellied, water-soluble personal lubricants, which can be purchased over-the-counter. It is a common mistake to use too little of these products. Specialists advise using them generously. Petroleum jelly (Vaseline®) should not be used because it is not water-soluble and may cause infection.

Both men and women with MS and their partners can benefit from instruction in alternative means of sexual stimulation, such as the use of a vibrator, to overcome slow arousal and impaired sensation. Abnormal sensations and spasms can often be controlled through use of medication. Techniques such as intermittent catheterization or medication can control urinary leakage during intercourse.

Fertility, Conception, and Sexually Transmitted Diseases

MS does not affect the basic fertility of either men or women, although sexual problems may interfere with the ability of a man with MS to father a baby. "Dry orgasms," that impair fertility, have been reported by men with MS in several studies. These problems have been successfully treated with medication or through techniques to harvest sperm for insemination. Men who are concerned about fertility issues should consult a urologist experienced in this area.

Women and men with MS are also advised that they must make the same decisions and take the same precautions regarding birth control and sexually transmitted diseases as anyone else.

Emotional Issues

The emotional factors relating to changes in sexual function are quite complex. They may involve loss of self-esteem, depression, anxiety, anger, and/or the stress of living with a chronic illness. Counseling by a mental health professional or trained sexual therapist can address both physiologic and psychological issues. This therapy should involve both partners.