Sexual Health and Multiple Sclerosis
Sexual dysfunction is a common symptom of multiple sclerosis (MS), affecting more than 75 percent of people living with the disease - a rate higher than in most other chronic conditions. Despite how common it is, sexual health is often overlooked and left undiscussed during medical visits. Yet sexuality is an important part of health and well-being, and sexual concerns deserve the same attention as any other MS symptom.
How MS Affects Sexual Function
Sexual arousal begins in the brain, which sends signals to the sexual organs through nerve pathways in the spinal cord. MS-related damage to these pathways can affect sexual response in several ways. Sexual dysfunction in MS is often described in three categories:
Primary sexual dysfunction is caused directly by nerve damage from MS. This can include decreased or lost sex drive, uncomfortable genital sensations (such as burning, tingling, or numbness), and changes in orgasmic response. Women may experience vaginal dryness and decreased lubrication. Men may have difficulty achieving or maintaining an erection or experience changes in ejaculation.
Secondary sexual dysfunction results from other MS symptoms that get in the way of sexual activity. These include fatigue, spasticity, muscle weakness, bladder and bowel problems, tremor, cognitive changes, and sensory issues. Non-MS health conditions like diabetes, high blood pressure, depression, and obesity can also contribute. Some medications used to treat MS symptoms - as well as medications for other conditions - may further affect sexual function.
Tertiary sexual dysfunction involves the psychological, social, and emotional effects of living with MS that can affect sexual response. These may include anxiety, low self-esteem, changes in body image, shifting roles within a relationship, and fear of rejection by a partner.
Impact on Relationships and Well-Being
Sexual dysfunction does not just affect physical intimacy - it can contribute to relationship conflict, depression, isolation, performance anxiety, and avoidance of intimate relationships. Studies have found relationship problems in a significant number of people with sexual dysfunction. Recognizing and addressing sexual concerns can help people with MS understand the problem, find treatment, build healthier relationships, and improve overall quality of life.
Practical Tips for Managing Sexual Challenges
Manage other MS symptoms first. Treating symptoms that interfere with intimacy can make a big difference. If spasticity is a problem, consider timing sexual activity one to four hours after taking baclofen. If fatigue is an issue, take advantage of the time of day when your energy is highest - for many people, this is the morning. If weakness is a factor, try different positions to conserve energy and use supports like pillows or wedges to reduce strain. If bladder or bowel control is a concern, use the bathroom right before sex.
Talk to your health care provider. The first and most important step is bringing up your concerns. Your provider can help determine what is contributing to the problem and connect you with the right resources. Physical therapists can help with positioning techniques. Occupational therapists can recommend devices that enhance comfort and pleasure. Psychologists or counselors can work with individuals or couples on communication and emotional barriers.
Treatment options may include oral medications for erectile dysfunction (such as sildenafil, tadalafil, or vardenafil), topical hormones, lubricants, genital stimulators to help with decreased sensitivity, sex therapy including body mapping, counseling, and in some cases injectable medications or surgical options for erectile dysfunction. Men should talk to their provider before using over-the-counter performance supplements, as some - like yohimbine - may interact with MS medications or other health conditions.
Nurture intimacy. Intimacy is about more than sex - it involves trust, emotional closeness, and physical affection. Have open, honest conversations with your partner about your concerns and fears. Focus on the experience rather than the outcome. Plan time together, hold hands, make eye contact, and explore what feels good through touch and closeness. Have realistic expectations and be open to making changes.
When to Seek Help
You are a sexual being, and having love and intimacy is a basic human need. If sexual dysfunction is affecting your quality of life or your relationships, talk to your MS care team. They can refer you to specialists and resources that can help. Women Veterans are encouraged to contact VA Women Veterans Health Centers for more information and services.
Based on articles by Barbara Severson, MSN, MSCN, ARNP and Heidi Maloni, PhD, NP, MSCN.
