By Amy Perrin Ross, APN, MSN, MSCN, CNRN
Neuroscience Program Coordinator
Loyola University Chicago MS Center
Member, MSAA Healthcare Advisory Council
Sexual Dysfunction: A Less-Discussed Symptom of MS
Sexuality and intimacy have a significant 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 more invisible symptoms of the disease. It is important to recognize and understand the factors that contribute to sexual dysfunction in order to adequately address it.
Both men and women may experience sexual dysfunction. Some studies suggest it affects between 40 to 80 percent of women and 50 to 90 percent of men.1 Other studies suggest that sexual dysfunction increases over time in people with MS and may be associated with some of the emotional and psychological problems that they may also experience.
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 as one would address other symptoms, they first must be recognized and discussed.
How Cognitive Problems Affect Sexual Function
Cognitive impairment is common in MS, affecting as many as 50 percent of individuals with MS, and is not necessarily associated with advanced stages of disease.2 The onset of cognitive impairment in MS is usually not easy to pinpoint. Some people notice distinct changes in their mental functioning that can be attributed to the disease, while others are unaware of how their cognitive limitations may be affecting relationships.
Some of the cognitive functions typically affected in people with MS include: information processing; perceiving; attending/responding to incoming information; information-processing speed; cognitive flexibility, such as attending to multiple stimuli at the same time (“multi-tasking”); problems with storage, manipulation, and retrieval of information; and executive function, which includes planning, working memory, attention, and problem-solving.
Cognitive impairment may affect sexual function and relationships in many ways. Partners may become frustrated if the person with MS becomes easily distracted during intimacy. Distractions such as children in the home, music, and television may interrupt intimate moments if the person with MS is not able to filter out these distractions and remain focused on his or her partner.
Planning for sexual activity may be complex and overwhelming to the person with MS, and he or she may choose to avoid it all together. Verbal fluency and word finding may also be a problem leading to a partner who feels he or she is not wanted or respected. Fatigue may worsen both cognitive function and the quality of sexual relations as well.
Once cognitive impairment has been identified in a person with MS, what can be done to treat this condition? First, people with relapsing forms of MS should be encouraged to begin or remain on an effective disease-modifying therapy (DMT), if advised by his or her doctor. Based on these agents’ ability to inhibit inflammation and the accumulation of brain lesions, it is likely that they exert some degree of neuroprotection that may limit the progression of cognitive impairment.
Evidence suggests that exercise training in people with MS has the potential to improve many aspects of cognitive performance. Exercise has been proposed to have positive effects in reducing inflammation and neurologic damage in people with MS.3 Counseling is vital to assist the couple dealing with cognitive challenges affecting sexual function. Patients can be referred to an occupational therapist to assist with adaptation of certain skills or to a psychosocial therapist for assistance with coping and stress reduction.
How Depression and Anxiety Affect Sexual Function
Depression is another psychological disorder seen frequently in people with MS that often impacts sexual function. People with MS who are depressed may have a decreased libido, difficulty with certain sexual positions, and fear of developing relationships. Men may also experience erectile dysfunction. The best treatment for depression is usually psychotherapy along with medication and exercise. Seeking strength in spiritual beliefs can also help. Depression can also affect care partners and may increase as disability increases. Care partners need to recognize and treat depression to effectively participate in intimate relations.
Anxiety can affect sexual function as well, and care partners are also at risk. When anxiety impacts sexual function, both of these symptoms can worsen.
Intimacy may be defined as anything that makes one feel closer to another, particularly in a personal and private way.4 People with MS who are experiencing emotional or psychological difficulties may find intimacy particularly challenging. Depression, anxiety, and cognitive dysfunction are all likely to interfere with attempts at intimacy. Recognizing and treating the underlying cause is the best way to enhance intimacy.
Emotional and psychological impairment affects quality of life, which includes intimate and sexual relationships. Recognizing these impairments in people with MS and their care partners is the first step to a healthy sexual relationship. Quality of life can be impacted and treatment for many of the underlying emotional and psychological causes of sexual dysfunction should be investigated. With early recognition and treatment, a healthy and satisfying sexual relationship is certainly possible.
- Orton SM, Herrera BM, Yee IM, et al. Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurol. 2006;5:932-936.
- Chiaravalloti ND, DeLuca J. Cognitive impairment in multiple sclerosis. Lancet Neurol. 2008;7:1139-1151.
- Comi G. Effects of disease modifying treatments on cognitive dysfunction in multiple sclerosis. Neurol Sci. 2010;31:S261-264.
- Krawchuk LR. Rediscovering Intimacy. The Motivator. Fall 2004.