Written by Amy Perrin Ross, APN, MSN, CNRN, MSCN
Advanced Practice Nurse
Loyola University Medical Center
Sexuality and intimacy have an important impact on the quality of life for nearly everyone, including those with a chronic disease such as multiple sclerosis (MS). In MS, sexual dysfunction may be one of the less talked-about symptoms of the disease. It is important to recognize and understand this symptom in order to adequately address it.
Intimacy may be defined as anything that makes one feel closer to another, particularly in a personal and private way. Intimacy plays an important role in the sexual lives of people with MS and their partners.
Males and females may experience sexual dysfunction. Some studies suggest it affects between 40 and 80 percent of women, and 50 to 90 percent of men.2 Other studies suggest sexual dysfunction increases over time in people with MS and may be associated with some of the other physical symptoms of the disease, including limited mobility, spasticity, and bowel and bladder dysfunction.
People are at times reluctant to discuss sexual dysfunction with their MS care team as they may feel awkward discussing things that seem so personal. In order to address these problems, like others, it first must be recognized and discussed.
The causes of sexual dysfunction may be divided into three categories: primary, secondary and tertiary.
Primary sexual dysfunction is the result of damage to the central nervous system caused by MS. Motor and sensory pathways may be disrupted by damage to the neurons. This can result in a slowing of the impulses sent from the brain to the body and back. Symptoms that result can manifest as decreased sexual sensation, decreased vaginal lubrication, or erectile dysfunction.
Secondary sexual dysfunction can be the result of other symptoms of the disease. Limited mobility may result in the inability of the person with MS to maintain certain positions to engage in sexual activity. Fatigue is also a major contributor to sexual dysfunction. Often the demands of daily life combined with fatigue in MS result in a decreased libido and a decreased willingness to attempt to engage in physical sexual activity.
Spasticity may limit the types and number of positions a person with MS can maintain during sexual activity. A sudden onset of painful spasms can certainly interrupt attempts at sexual activity. Bowel and bladder dysfunction are also known to contribute to sexual dysfunction. People with MS who have difficulty controlling their bowels or bladder often avoid intimate contact fearing an embarrassing accident.
Depression has also been found to have a significant effect on sexuality. Many of the medications used by people with MS can also contribute to sexual dysfunction, including antispasticity and antidepressant drugs.
Tertiary sexual dysfunction results from primary and secondary causes and includes psychological disturbances, cognitive dysfunction, and depression. People with MS often focus a significant amount of time and energy on the other physical symptoms of the disease. This may leave them simply too tired to consider sexual activity. They may also be embarrassed by the use of other devices such as urinary catheters or extremity splints.
Some people with MS experience a loss of self-esteem or an altered body image. For example, a man who is no longer able to work and needs physical care from his partner may not imagine himself to be a sexual being and will thus avoid sexual contact. This may be true for care partners also.
Providing intimate physical care for a person with MS such as catheterization and then engaging in sexual activity with that person may be overwhelming. Concerns about the possibility of pregnancy and having a child with MS can also impact sexual function.
There may be other possible causes that have nothing to do with MS yet should be considered. These problems may be associated with a normal aging process. Vaginal dryness and decreased libido may be the result of menopause in women. Lack of erectile function in men may be associated with aging or vascular disease, or medications such as anti-hypertension drugs.
Common symptoms of sexual dysfunction may include:
- decreased libido
- decreased sensation
- orgasmic dysfunction
- painful intercourse
- decreased vaginal lubrication
- erectile dysfunction
- ejaculatory dysfunction
The first step to managing sexual dysfunction is to recognize and discuss it with your partner and MS team or a sexual counselor. MS presents many physical challenges that can be recognized and managed, resulting in a more satisfying sexual life.
Another important first step is to review medications. Many impact sexual performance. A discussion of these with your healthcare team may result in some changes that can improve sexual function. Doses may be changed or medications may be switched if necessary.
Other simple measures can include avoiding beverages such as caffeinated drinks (coffee, tea, carbonated sodas) and spicy foods immediately prior to sexual intimacy, which can reduce the possibility of a bladder or bowel accident. Emptying the bladder and bowels immediately prior to a sexual encounter may also reduce the risk of elimination dysfunction during intimacy. Timing a sexual encounter is also important. Fatigue often worsens as the day progresses, so setting aside time early in the day may enhance the sexual experience.
Pelvic floor exercises taught by a physiotherapist can serve to strengthen the muscles used in many sexual encounters. Hot or cold therapy, biofeedback, and electrical stimulation may also help with mobility limitations or spasticity. Timing sexual encounters at least 30 minutes after a dose of antispasticity medications is important. Personal lubricants may be useful for women with vaginal dryness.
There are several medications available by prescription for erectile dysfunction. Men should discuss these and all medications with the MS team. It is important to remember that sexual function is more than just a physical action. In the next issue of The Motivator, the topic of emotional and psychological symptom management, including sexuality, will be addressed.
As noted at the beginning of this section, sexuality and intimacy have an important impact on the quality of life for nearly everyone, including those with a chronic disease such as MS. There are many ways to manage sexual dysfunction in MS. The first step is recognizing and discussing sexual function with your MS healthcare team.
The following medications may be used to treat sexual dysfunction (as listed on MSAA’s website at mymsaa.org under Symptoms). Please see MSAA’s website for more information about these drugs, such as prescribing information and side effects.
For erectile dysfunction:
- Viagra® (sildenafil)
- Levitra® (vardenafil)
- Cialis® (tadalafil)
For vaginal dryness:
- Lubrication agents
- Estrogen-containing vaginal preparations
- Topical creams
- Krawchuk LR Rediscovering Intimacy. The Motivator Fall 2004
- Orton SM, Herrera BM, Yee IM, et al. Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lance Neurol. 2006;5:932-936.
- Association of Reproductive Health Professionals. “Sex Therapy for Non-Sex Therapists.” Accessed August 31, 2013 at www.arhp.org/Publications-and-Resources/Clinical-Fact-Sheets/SHF-Therapy