Sexual Problems

Sexual problems are often experienced by people with MS, but they are very common in the general population as well. Sexual arousal begins in the central nervous system, as the brain sends messages to the sexual organs along nerves running through the spinal cord. If MS damages these nerve pathways, sexual response — including arousal and orgasm — can be directly affected. Sexual problems also stem from MS symptoms such as fatigue or spasticity, as well as from psychological factors relating to self-esteem and mood changes.

In a study of people with MS, 63 percent reported that their sexual activity had declined since their diagnosis. Other surveys of persons with MS suggest that as many as 91 percent of men and 72 percent of women may be affected by sexual problems. Ignoring these problems can lead to major losses in quality of life. Yet both individuals and healthcare professionals are often slow to bring up the subject.

The emotional factors relating to changes in sexual function are quite complex. They may involve loss of self-esteem, depression, anxiety, anger and/or the stress of living with a chronic illness. Counseling — for you and your partner — by a mental health professional or trained sexual therapist can address both physiologic and psychological issues.

Both men and women with MS may experience difficulty achieving orgasm or loss of libido. You and your partner can benefit from instruction in alternative means of sexual stimulation to overcome slow arousal and impaired sensation. Abnormal sensations and spasms can often be controlled through use of medication. Techniques such as intermittent catheterization or medication can control urinary leakage during intercourse.

Men may additionally have difficulty achieving or maintaining an erection (by far the most common problem), reduced sensation in the penis and difficulty achieving ejaculation. Erectile dysfunction may be addressed through:

• Oral medications
• Injectable medications
• Small suppositories that are inserted into the penis
• Inflatable devices or implants.

Women may experience reduced sensation in the vaginal/clitoral area, painfully heightened sensation and vaginal dryness. Management strategies could include:

• Use of a vibrator to increase stimulation and arousal
• Use of liquid or jellied, water-soluble personal lubricants for vaginal dryness. (Hint: you cannot use too much of these products; specialists advise using them generously.) Petroleum jelly (Vaseline®) should not be used because it is not water-soluble and may cause infection.

MS does not affect the basic fertility of either men or women, although sexual problems may interfere with the ability of a man with MS to father a baby. "Dry orgasms" that impair fertility, have been reported by men with MS in several studies. These problems have been successfully treated with medication or through techniques to harvest sperm for insemination. Men who are concerned about fertility issues should consult a urologist experienced in this area.

Women and men with MS are also advised that they must make the same decisions and take the same precautions regarding birth control and sexually transmitted diseases as anyone else.

• Sex Ed for Grownups – Intimacy in MS webinar