Sexual dysfunction is common in people with MS and is important to assess because patients may be relunctant to self-report
The Psychosocial Implications for sexual dysfunction symptoms are:
Individual:
-
Significant impact on gratification, self-esteem, self-confidence; difficult/embarrassing to discuss with healthcare providers
Interpersonal:
-
Significant impact on all intimate relationships:
-
Sexual activity can be difficult, exhausting, painful, and unsatisfying
-
Lack of arousal can be misunderstood and resented by partner
-
Learning new ways to be intimate can be frightening and difficult
-
Caregivers may become disinterested in, or uncomfortable with, their disabled partner
-
Person with MS may be reluctant to become intimate with new partner
Symptom: Primary (result of neurologic impairment)
Impaired arousal; sensory changes; reduced vaginal lubrication; erectile dysfunction; inability to achieve orgasm
Treatment
- Education; evaluation; counseling; sexual aids to enhance stimulation
- Men:
- Oral medications: sildenafil, vardenafil, tadalafil;
- Injectable or insertable medication: alprostadil
- Prosthetic devices
- Women:
- Lubricating substances; enhanced stimulation
- Oral medication: flibanserin
Symptom: Secondary (resulting from other MS symptoms)
Fatigue; spasticity; bladder/bowel problems; sensory changes interfere with sexual activity.
Note: Impaired arousal, erectile dysfunction, and inability to orgasm can also result from medications taken to relieve other symptoms, most notably antidepressants.
Treatment
Interventions:
- Evaluation of medications that might be interfering with sexual function
- Effective management of other MS symptoms to reduce impact on sexual function
Symptom: Tertiary (resulting from disability-related attitudes/feelings)
Feeling unattractive; unable to attract a partner; believing that sexuality is incompatible with disability
Treatment
- Individual and couple’s counseling and education