UNDERSTANDING HOW MS CAN AFFECT SEXUAL FUNCTION

Sexual dysfunction is a common and very distressing symptom that affects up to 70 percent of men and women living with multiple sclerosis.  MS can affect sexuality, sexual functions, and expressions of intimacy both directly (referred to as primary sexual effects) and indirectly (referred to as secondary and tertiary sexual effects).  The prevalence of sexual dysfunction is higher in MS than in other chronic diseases, and almost five times higher than in the general population.  In this series of posts, we will be exploring sexual dysfunction in men and women, sexuality, intimacy, coping skills, and sex tips and toys.

Primary Sexual Effects

The central nervous system (CNS) makes sexual arousal possible; the brain, sexual organs, and other parts of the body send messages to each other along nerves that run through the spinal cord. MS-related damage to these nerve fibers can directly impair sexual feelings or sexual responses in the same way that damage in the CNS can affect a person’s ability to walk or see. And, just as with other aspects of MS, sexual problems can arise at any time, without any clear cause.

The primary sexual effects, which occur as a direct result of demyelination in the spinal cord or brain, include:
§ Decreased or absent sex drive.
§ Altered genital sensations such as numbness, pain, or hypersensitivity.
§ Decreased or absent genital sensations.
§ Decreased vaginal muscle tone.
§ Difficulty or inability to get an erection.
§ Decreased vaginal lubrication and clitoral engorgement.
§ Difficulty with or inability to ejaculate.
§ Decreased frequency and/or intensity of orgasms.

Secondary Sexual Effects

In addition to the changes caused directly by damage to the nerve fibers in the CNS, secondary problems can arise as a result of other MS symptoms or the medications used to treat those symptoms. The most troublesome symptoms include fatigue, spasticity, bladder or bowel problems, sensory changes, decreased non-genital muscle tone, cognitive impairments, tremor, and pain.

§ Fatigue, a very common MS symptom, can suppress desire or make sexual activity feel overwhelmingly exhausting and interfere with spontaneity.
§ Spasticity can interfere with sexual positioning or cause pain.
§ Bladder and bowel disturbances create anxiety and fears that other symptoms do not. The thought of having a bladder or bowel accident during sex can stifle interest.
§ Sensory changes (for example, numbness, pins-and-needles, and pain of various kinds) can make activities that used to feel good begin to feel very uncomfortable. Because physical contact is such an important part of intimate communication and simple pleasure, the loss can be devastating.
§ Decreased non-genital muscle tone. Muscle tension in the body helps build sexual excitement and contributes to orgasm in both men and women. The decrease in muscle tone sometimes caused by MS can interfere with both.