Sexual dysfunction is a very common symptom and complication of multiple sclerosis (MS). It’s something health care experts tend to overlook, but it’s also a topic many people may be uncomfortable discussing with their doctor. The good news is you don’t have to put up with symptoms. There are ways to manage these issues. Here’s what you need to know.
What Causes Sexual Dysfunction With MS?
Generally, doctors look at different parts of your sexual response cycle to check for dysfunction. This includes libido (sexual drive), orgasm, or arousal.
But with MS, experts don’t fully understand the causes of sexual dysfunction. Many think that sexual changes related to the condition happen because of three different factors: primary, secondary, and tertiary causes.
In MS, primary causes are things related to physiological issues from lesions in your cortex (the outer layer of your brain) and spinal cord. These lesions can lead to numbness or a “pins and needles” feeling, which can affect your genitals and cause:
- A lower sex drive
- Less vaginal lubrication
- Erectile dysfunction, or trouble getting or keeping an erection
- Trouble reaching orgasm
- Genital numbness or less genital sensation
Some MS medications can trigger similar issues.
Secondary causes are related to nonsexual changes from your MS. They might include:
- Fatigue
- Pain
- Bladder and bowel issues
- Spasticity, muscle tightness that leads to locked or bent positions
Factors like these can indirectly lead to sexual dysfunction. For instance, if you’re always fatigued, it’s hard to find energy for sex.
Your sexual dysfunction could also be from psychosocial factors, which are considered tertiary. Examples include:
- Changes in your social roles
- Feeling discouraged
- Anxiety and depression
- Relationship-related difficulties you may have due to your condition
How Common Is Sexual Dysfunction With MS?
Research suggests that 40% to 80% of women and 50% to 90% of men with MS also have sexual dysfunction. In one study, 67% of people surveyed with MS said that they always or almost always had symptoms of sexual dysfunction in the last 6 months. Another clinical sample showed that overall, 60% of people with MS had some type of sexual dysfunction.
How Do Doctors Check for Sexual Dysfunction With MS?
When you go to your doctor for routine bladder and bowel function checks, you can also have them look for any issues related to sexual dysfunction.
Before they begin your checkup, your doctor will review all current medications you take. This is important because some drugs may have side effects that affect your sexual function.
Your doctor may then use something called the Multiple Sclerosis Intimacy and Sexuality Questionnaire 19 (MSISQ-19). It asks 19 questions that touch on all three – primary, secondary, and tertiary – causes of sexual dysfunction. The MSISQ-19 is made especially for people with MS.
The questions use a five-point scale that measures how often MS symptoms have affected your sexual function in the last 6 months. A “one” rating means never affected while a “five” rating refers to always affected.
The questionnaire is simple and usually takes about 2 minutes to finish. You can complete it before your doctor’s appointment if you like.
How Do Doctors Treat Sexual Dysfunction With MS?
They’ll determine whether your symptoms were due to primary, secondary, tertiary causes, or a combination. If you choose to treat them, the doctor will recommend different options based on the specific causes of your sexual dysfunction. They’ll decide which experts should be involved in your care. This may include neurologists, urologists, nurses, or psychologists.
For primary causes, your doctor may provide tips to treat:
Orgasmic dysfunction or premature/delayed ejaculation. Doctors can review current medications that could be affecting you. These may include:
- Antipsychotics
- Selective serotonin reuptake inhibitors (SSRIs)
- Tricyclic antidepressants (TCAs)
They’ll also want to learn more about the different factors that could affect sexual dysfunction (like other secondary or tertiary symptoms) and focus on proper symptom management.
Lack of vaginal lubrication. You can use water-soluble lubricants before and during sex. Other options include lubricants that have menthol or other agents that can improve your sensation (examples include K-Y Jelly, Replens, or Astroglide).
Lower libido. Your doctor may suggest cognitive behavioral therapy (CBT) to address certain beliefs about sexual functioning and sexuality. You could also try:
- Couples therapy/counseling
- Changing your medications
- Discussing the use of medications to help with sex drive
- Try body mapping exercises
Lack of genital sensation or a “pins and needles” feeling. You can improve your genital sensation with more intense genital stimulation or with vibrators. Your doctor may also suggest CBT or couples therapy/counseling.
Erectile dysfunction. To combat this symptom, experts may suggest:
- PDE-5 (phosphodiesterase-type5) inhibitors
- Injectable medications such as prostaglandin
- Changing your SSRIs and other medications
- Bupropion as an antidepressant
- A vacuum assistive device (but only for less than 30 minutes)
- CBT
To treat secondary causes of sexual dysfunction, your doctor may suggest that you address:
Fatigue. You can use energy conservation strategies like planning to have sex when your MS-related fatigue is low, taking naps, or using walking aids.
Bladder and bowel issues. You can limit the amount you drink before sex. You can also try:
- Self-catheterization (using a catheter to empty your bladder) just before sex
- Planned bowel movements twice a day and before you have sex
- Using condoms to protect from leakage
You could also use anticholinergic medications, but they may lower vaginal lubrication. You can combat this with a water-soluble lubricant.
Spasticity. You may be referred to a physical therapist who can show you range-of-motion exercises to help with this symptom. You can also take antispasticity medication a half hour before sex.
You and your partner can also try different sexual positions to figure out which ones are most comfortable and ease pain from your spasticity.
Cognitive changes. You need to have good concentration for pleasurable sex. To keep your mind focused, you should minimize nonsexual distractions and emphasize sensual and sexual stimuli. You can also try cognitive rehabilitation to combat this symptom.
Your doctor may address tertiary causes like:
Body image. You can help address any body image issues with CBT, couples counseling, or sex therapy.
Role reversal. If your sexual partner is also your caregiver, you might want to ask other family members to help with your care as well. This can lower the “role conflict” you and your partner may have. You can also try individual or couples counseling to help with this.
Depression. CBT can help treat depression. You might also want to ask your doctor about taking SNRIs instead of SSRIs antidepressants.
