Doniraj
Physical Symptoms of Sexual
Dysfunction
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. 1 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 xMS 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.
