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.
§ Cognitive impairments, such as changes in attention and concentration, can also interfere with the buildup and progression of sexual excitement and feeling. Changes in attention or concentration can disrupt the emotional and behavioral interactions of sexual activity, producing a sudden loss of interest.
§ Tremor in the hands or other parts of the body can interfere with physical and emotional communication between people.
§ Side effects of various medications can interfere with sex drive or function. Anti-seizure medications used to control pain or tremor, as well as antispasticity medications, produced significant fatigue. Medications for bladder dysfunction reduce vaginal lubrication. Antidepressants can inhibit libido and orgasm.
§ Managing indwelling catheters can pose additional difficulties.
Tertiary Sexual Effects
The tertiary effects on sexual feelings and responses result from psychological, social, and cultural attitudes and issues. In many ways, they raise the most difficult barriers to contentment in intimate and sexual relationships. And they can affect both the person with MS and his or her partner. Tertiary effects include performance anxiety and changes in self-esteem; depression, demoralization, and guilt; and family and social role changes or role conflict.
§ Changes in body image can affect both the person with MS and the well partner. Changes in physical appearance may damage people’s image of themselves or their partner as a sexual being. Our society doesn’t offer up many images of sexiness that include a cane or wheelchair.
§ MS symptoms that come and go unpredictably, and make a person feel out of control of his or her own body, can have a negative impact on self-image and self-esteem. It is hard to feel sexy when you experiencing a lot of fatigue and discomfort in your body.
§ Grief, demoralization, anxiety, and depression frequently accompany MS. These emotions affect both partners. They may cause feelings of isolation, interfere with desire, and lead both partners to stop thinking sexually.
§ MS may change a person’s roles in work, in running a household, in parenting, in the activities of daily living. Sometimes these changes affect the person’s ability to feel like an equal partner in the relationship. Th ese changes can also be difficult for well partners, especially if caregiving activities leave the well partner feeling more like a caretaker than a sexual partner.
§ Cultural values and expectations get in the way of intimacy and sexuality. Many ideas about “proper” or “normal” sexuality prevent people from exploring new ways of giving and receiving pleasure. Our society puts great emphasis on ejaculation and orgasm as the sources of sexual satisfaction. This goal-oriented approach to sex may make the pursuit of satisfaction a frustrating experience.
Intimacy and Sexuality in MS by Rosalind C. Kalb, Ph.D. © 2008 National Multiple Sclerosis Society.
Talking about Sexual Dysfunction by Frederick Foley, Ph.D. Talking with Your MS Patients about Difficult Subjects. © 2008 National Multiple Sclerosis Society.
For Further Information:
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]
CH Polman, AJ Thompson, TJ Murray, AC Bowling, and JH Noseworthy. [Multiple Sclerosis: the Guide to Treatment and Management, 6th edition](https://www.amazon.com/Multiple-Sclerosis-Guide-Treatment-Management/dp/1932603514. 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