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.
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 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.
Weakness is a common MS symptom, and it frequently necessitates finding new positions for satisfactory sexual activities. Reclining (non-weight-bearing) positions do not place as much strain on muscles and are therefore less tiring. Pillows can be used to improve positioning and reduce muscle strain. Inflatable wedge-shaped pillows are specifically designed to provide back support during sexual activity. Oral sex requires less movement than intercourse, and using a hand-held or strap-on vibrator can help compensate for hand weakness while providing sexual stimulation.
Sustained attention and myotonia (increasing muscle tension) are usually required for sexual feelings to build progressively toward orgasm. MS can cause impairment of attention and concentration that may interfere with maintaining sexual desire during sexual activities. The main strategy to deal with distractibility is to minimize nonsexual stimuli and maximize sensual and sexual stimuli. Creating a romantic mood and setting, using sensual music and lighting, talking in sexy ways, and engaging in erotic touching provide multi-sensory stimuli that minimize "cognitive drift" during sex. Introducing humor at those moments when the person "loses attention" allows mutual acceptance of this frustrating symptom and helps minimize its impact.
In Short, Managing Secondary Sexual Problems
Many sexual problems produced by MS symptoms or MS treatments can be managed with the help of your medical team.
** §** Pain can be controlled with medications.** §** Spasticity can be reduced with medication, cold packs, and stretching or massage.** §** Fatigue can be alleviated through energy conservation and, in some cases, with medication. Making love at times when the partner with MS is most energetic (usually the morning) will also help.** §** Alternative sexual positioning can help with both spasticity and weakness. Using pillows for support or trying the side positions can relieve discomfort.** §** Catheters can be secured during sex. Your doctor or nurse can show you the best way.** §** Medication side effects may be minimized by taking medications at a different time of day or by changing the timing of sexual activity. You might also consult your doctor about switching to medications with fewer sexual side effects.
Please talk to your medical team so that you can eliminate the secondary problems which interfere with your primary sexual function and quality of life.
Intimacy and Sexuality in MS by Rosalind C. Kalb, Ph.D.
© 2008 National Multiple Sclerosis Society.
Assessment and Treatment of Sexual Dysfunction in Multiple Sclerosis by Frederick W. Foley, PhD. Clinical Bulletin / Information for Health Professionals.
© 2008 National Multiple Sclerosis Society[Original publication date: 2006]
For Further Information:
Healthy Living: Good Sex in Momentum Magazine, Summer 2008.
CH Polman, AJ Thompson, TJ Murray, AC Bowling, and JH Noseworthy. Multiple Sclerosis: the Guide to Treatment and Management, 6th edition. New York: Demos Medical Publishing, 2006. (updated online, 2008).
How to Manage MS-Related Sexual Dysfunction Series: Part One: Understanding How MS Can Affect Sexual Function Part Two: Primary Sexual Dysfunction in Men with MS Part Three: Primary Sexual Dysfunction in Women with MS Part Four: Secondary Sexual Dysfunction in Men and Women Part Five: Sexuality, Intimacy, and Multiple Sclerosis Part Six: Multiple Sclerosis: Sex Toys, Tips, and Tools
Lisa Emrich is a patient advocate, accomplished speaker, author of the award-winning blog Brass and Ivory: Life with MS and RA, and founder of the Carnival of MS Bloggers. Lisa uses her experience to educate patients, raise disease awareness, encourage self-advocacy, and support patient-centered research. Lisa frequently works with non-profit organizations and has brought the patient voice to health care conferences and meetings worldwide. Follow Lisa on Facebook, Twitter, and Pinterest.