Why You Should Talk to Your Doctor About Your Sex Lifeby Lisa Emrich Patient Advocate
During a routine visit with your neurologist, there is much material to cover. Your doctor will ask about symptoms, watch you walk, and conduct a neurological exam. He or she may also ask about your family life, work life, relapses, or treatment concerns.
To facilitate the discussion and to help assess your MS, many neurologists might ask you to complete a questionnaire before each appointment. My own doctor has a form that requires each patient to self-assess a variety of symptoms or body functions. It covers such topics as vision problems, numbness, weakness, or lack of coordination in arms or legs, balance problems, bladder or bowel problems, sexual problems, cognitive problems, and depression and anxiety. Each symptom is rated on a scale of 0 (none) to 5 (severe).
There are times when my responses on the questionnaire will prompt a discussion regarding a particular symptom. If I rate depression or anxiety with high scores, my MS nurse usually asks about it. High scores for bladder or bowel problems often precipitate more discussion. But I can’t think of a single time my doctor pursued the subject when I’ve marked higher scores on the sexual dysfunction item.
It turns out that doctors may be uncomfortable with the topic.
In a survey of 42 neurologists, members of the Consortium of Multiple Sclerosis Centers, more than 80 percent of respondents report routinely assessing for depression, anxiety, sleep, and pain—but only half ask about sexual dysfunction; 18 did not routinely assess sexual function; 24 did.
Regarding reasons why survey participants did not routinely assess sexual function, here is text from the paper: "In terms of why participants do not routinely ask about sexual dysfunction, the most common reason was that they wait until their patients bring up having a problem. Only one provider reported discomfort regarding the topic. Other barriers endorsed were not enough time with the patient and not feeling confident enough in his or her knowledge of the treatment options."
The takeaway? Don’t wait for your doctor to ask about sexual issues you may be having. Bring up the topic yourself. That’s the only way you can get the help you may need.
How does MS affect sexual function?
Multiple sclerosis (MS) can affect sexual function in women and men with MS, thus impacting quality of life. Symptoms of sexual dysfunction can include sensory changes, decreased lubrication, erectile dysfunction, decreased libido, or problems with orgasm. In some patients, spinal cord lesions can be associated with bladder, bowel, and/or sexual dysfunction.
Sexual dysfunction (SD) is a common symptom of MS that may be under-diagnosed, particularly in women with the disease. A survey of 86 women with relapsing-remitting MS revealed that 27 percent of respondents experienced SD. Persons with other forms of the disease may be more likely to have sexual dysfunction.
Frequently, SD doesn’t occur alone; it can be associated with other symptoms. In patients with more severe MS, SD may be associated with bladder and bowel dysfunctions; however, in the current survey, this association was not observed in women with RRMS.
Researchers found that sexual dysfunction in women with relapsing-remitting MS, who are not severely disabled, is mostly associated with psychosocial factors, not directly with MS symptoms and signs. Female patients with RRMS who are more depressed, have difficulty with speech, are less educated, and live in smaller towns, should be considered high-risk for sexual dysfunction. Authors suggest that more attention should be focused on the sexual lives of patients matching these characteristics.
Once SD is recognized in women with MS, sex therapy may be used to significantly improve quality of life. In a study of 30 women with MS, half participated in a 12-week sex therapy program focused on psychological issues to treat sexual dysfunction. The results revealed that women in the treatment group reported enhancements in their desire, arousal, lubrication, orgasm, satisfaction, and decrease in pain during sex. Participants in the treatment group reported more satisfaction with sexual function, better quality of life, more energy, better cognitive function, and improved sexual and social functions compared to the control group.
Bartnik P, Wielgoś A, Kacperczyk J, et al. Sexual dysfunction in female patients with relapsing-remitting multiple sclerosis. Brain Behav. 2017;7(6):e00699. doi: 10.1002/brb3.699. eCollection 2017 Jun.
Gromisch ES, Schairer LC, Pasternak E, et al. Assessment and Treatment of Psychiatric Distress, Sexual Dysfunction, Sleep Disturbances, and Pain in Multiple Sclerosis: A Survey of Members of the Consortium of Multiple Sclerosis Centers. Int J MS Care. 2016;18(6):291-297. doi:10.7224/1537-2073.2016-007.
Zamani M, Tavoli A, Yazd Khasti B, et al. Sexual Therapy for Women with Multiple Sclerosis and Its Impact on Quality of Life. Iran J Psychiatry. 2017;12(1):58-65.