The No-Blush Guide to Sex and MS

When you aren't feeling well, you probably won't want sex. That's also known as being normal. For MSers, spasticity—when your legs spasm—may make it difficult to position yourself well for maximum enjoyment. Cory Martin, 40, of Venice Beach, CA, didn't want sex when she was diagnosed with MS at age 28. "I had spasticity that constantly served as a reminder that one day my body could fail me completely," Martin says. Doctors sometimes suggest having sex when you’re on your anti-spacticity meds. Otherwise, if they aren't severe, use the spasms to your advantage—they can be helpful for stimulating a partner with a tighter squeeze.

Erectile dysfunction is a top complaint among men with MS...but also among men without MS. If you need medication-related assistance, talk to your doctor, no matter your age. "There's no age limit on Viagra, young or old," Hendin says. "From talking to my patients, it's the younger men who ask more often. It's because sexual performance, sexual functioning, and the centrality of sexuality is so great in young adults." Oral medications (Viagra, Levitra, Cialis) can help men maintain erections. Vacuum erection devices (VEDs), implants and suppositories can help guys initiate erections when they don't happen on their own.

"Genital numbness is a very common symptom in men and women with MS, and it's caused by lesions in the spinal cord," says Frederick Foley, Ph.D., director of neuropsychology and psychosocial research at the Holy Name Medical Center Multiple Sclerosis Center in Teaneck, NJ. The numbness may relapse in some people or remain constant in others. The solution? If you have some sensation, increasing direct stimulation may help you experience pleasure. "Use vibrators that are more stimulating than intercourse [alone] would be," Foley says. One to try: We-Vibe (we-vibe.com), which comes with nine vibration settings and can be used alone or during sex.

"It's a very common symptom for women to have reduced vaginal lubrication and reduced clitoral engorgement," Foley says. With decreased sensation, your lubrication-producing cells don't get the message that you're ready to get busy. But you can maintain an amazing sex life, even with less lubrication. Using generous amounts of water-based lubricants (like gyno-recommended Lola Lube, mylola.com) can help, Foley says.

Difficulty achieving an orgasm is common among both men and women with MS. It may be caused by MS lesions, reduced sensation, or side effects of medications. Antidepressants are often the culprit. "Depression is more common in MS than in any other central nervous system disease, and antidepressant use is very widespread in MS," says Foley. "So, we'll look at that, and we'll see if we can switch them to a different antidepressant." There are some like Wellbutrin (bupropion) and Remeron (mirtazapine) that have lower rates of sexual side effects.

With MS, brain messages that say "Hold it in!" can get scrambled, contributing to leaks during sex. It may only be a few drops, and your partner may not even notice, but you may be tempted to avoid sex if you're worried about a recurrence. "The biggest issues probably are the embarrassment and inhibition that it causes," Dr. Hendin says. Don't let your fear of a little pee derail your sex life! There are many things to try, including cutting back on liquids an hour or two before having sex, using the bathroom ahead of time, or taking medication for overactive bladder.

Sometimes, a man may experience the pleasurable sensation of orgasm without ejaculation, which is known as dry orgasm. This may occur in some men with MS, although it isn't very common. If you're satisfied with the sex, there's no need to see a urologist to determine the cause or seek a solution. "Unless you're trying to get your partner pregnant, it need not be an issue," Hendin says. "It's not dangerous." If you're ready to start a family, ask your doctor about assisted-reproductive technology, which is a kind of infertility treatment for men.

The short answer is yes. "Pre-diagnosis, I was totally healthy and enjoyed intimacy," Martin says. Decreased libido may be caused by vaginal dryness, an inability to maintain erections, or a power shift in your relationship, especially if you feel guilty or uncomfortable that your partner has become your caregiver.

"[The person with MS] may not feel sexy anymore, or they may feel that they are not the man or woman that they used to be," Foley says. You can help boost libido naturally by exercising or even experimenting with role-playing fantasies with your S.O. And if those changing dynamics are getting in the way, reach out to a therapist to work through them.

Some people with MS develop a negative self-image, either because they don't like how they look, they miss what they can't do anymore, or they feel like a burden on their partners. Like a domino effect, that bottomed-out self-esteem knocks your sex life down with it. Concentrating on what your body can do, and the pleasure that you can still experience, may help. Foley recommends "body-mapping" exercises, in which partners take turns touching each other from head to toe. The practice empowers partners by shining light on what feels good and what doesn’t—knowing these things is a huge confidence boost.