SECONDARY SEXUAL DYSFUNCTION IN MEN AND WOMEN WITH MS

In multiple sclerosis, the incidence of fatigue, muscle tightness or spasms, bladder and bowel dysfunction, and pain, burning, or other discomfort can have adverse effects on the experience of sexual activity. The interference of these symptoms with sexual function can often be alleviated by taking an aggressive approach to symptom management.

Fatigue

One of the most common secondary sexual symptoms in MS is fatigue. Fatigue greatly interferes with sexual desire and the physical ability to initiate and sustain sexual activity. Fatigue can be managed in a number of ways, see How to Manage MS-Related Fatigue.  Consider setting aside some time in the morning for sexual activity because this is often when MS fatigue is at its lowest ebb. Energy conservation techniques, such as taking naps and using ambulation aids, can preserve the energy needed for sexual activities. Choosing sexual activities and positions that are less physically demanding or weight-bearing for the partner with MS may minimize fatigue during sex.

Bladder and Bowel Symptoms

The thought of bladder or bowel problems during sex creates fear in many MS patients.  Some common symptoms of bladder dysfunction include incontinence and urinary urgency and frequency, see How to Manage MS-Related Bladder Dysfunction and How to Manage MS-Related Bowel Dysfunction.  However some of these medications can cause vaginal dryness which then can be alleviated by using generous amounts of a water-soluble lubricant, such as K-Y Jelly®. A physician may be able to help modify daily medication schedules to allow for maximum effectiveness at the time of planned sexual activity.

Restricting fluid intake for an hour or two before sex and conducting self catheterization just before sexual activity will also minimize incontinence. For men who are concerned about small amounts of urinary leakage, wearing a condom during sex is advised.  If an indwelling catheter is used, healthcare providers may be able to offer tips for handling or temporarily removing catheters. If a woman needs to keep the catheter in place, she can move it out of the way by folding it over and taping it to her stomach with paper tape. It is a good idea to experiment with different sexual positions and activities to find those that feel the most comfortable with the catheter in place.

Spasticity

Spasticity can make straightening the legs, or changing leg positions for sexual activity, quite painful. Active symptomatic management of spasticity will minimize its impact on sexuality, see How to Manage MS-Related Spasticity.  Exploring alternative sexual positions for intercourse is helpful when spasticity is a problem. Women who have spasticity of the inner thighs may find it difficult or painful to separate their legs. Changing positions (e.g., lying on one side with the partner approaching from behind) to accommodate this symptom may be important. Taking an anti-spasticity medication 30 minutes before anticipated sexual activity can also be helpful.