Multiple Sclerosis Centers of Excellence
That Part of You That is Sexual
Heidi Maloni, PhD, NP, MSCN
Sexual arousal begins in the brain. The brain sends messages to the sexual organs along the nerve pathway in the spinal cord. MS-related damage to these nerve pathways can directly or indirectly impair sexual functioning. Nerve damage can contribute to diminished sexual response and feelings. MS symptoms can get in the way of sexual initiation or satisfaction. Symptoms of fatigue can be the biggest culprit or spasms that seem to be worse at night or when lying down. Weakness contributes to exhaustion and may be a limiting factor in initiating sexual activity.
Sexual dysfunction is a common symptom that affects more than 75% of people living with MS, more often than in people with other chronic diseases. Sexual dysfunction can present in many ways, limiting your ability to be sexual with your partner, to behave as a sexual being, and benefit from this way of expressing love and intimacy. The ability to be a sexual person is not lost because you live with MS, although you may need to learn new ways to be sexual and accept things that are not in your control. Intimacy is a feeling of belonging to another, involves trust, and is both an emotional and physical sharing of one’s most personal nature. Your MS does not need to interfere with your ability to be intimate.
Recognition of sexual dysfunction can help people with MS understand the problem, find treatment, build healthier relationships, enhance self-esteem, reduce depression, and improve quality of life.
For women, low desire or no desire is usually the first and foremost problem. Physical changes include lack of lubrication (dryness), genital numbness, decreased vaginal tone, and pain during intercourse. Body image is important to women as are acceptance and personal security. Women rate affection and emotional communication as more important than orgasm. For women, a sexual partner who is tender and romantic, with touching, kissing, caressing, and extended foreplay is often ideal. Communication, honesty, warmth, and understanding are important for women.
For men, sexual problems may occur with erections and ejaculation. Men often desire sexual partners who do not make demands and appreciate partners who are reassuring and supportive, without pressure regarding erections or performance. Men also want to feel secure in the relationship and share affection.
The first step in managing sexual dysfunction in MS is accepting that it is a common symptom that should, and can, be addressed. Sexual dysfunction not only impacts quality of life but can contribute to relationship conflict, depression, isolation, performance anxiety, and fear of intimate relationships and sexual encounters. Talk to your provider about your symptoms and what can be done to help. Physical and occupational therapists can help with positioning, techniques, and “tools” while a mental health professional can help you address emotional issues that may be hindering intimacy.
Men who experience erectile dysfunction should talk to their provider about the many medications in both pill and injectable form that can help. Before buying “Men’s Performance Supplements” you should discuss the ingredients with your provider so they can advise you if they are safe with your other medicines and any other medical conditions you may have. For example, yohimbine, a herbal supplement advertised to promote sexual function, may be dangerous to your liver, especially when taking some MS disease modifying treatments.
Manage other MS symptoms that might get in the way of sexual satisfaction. If spasticity is a problem, time sexual activity between one and four hours after taking baclofen. If fatigue is a problem, take advantage of morning sex, which may be your time of peak energy. If you experience weakness, consider different positions to conserve energy and consider using supports (wedge, pillow, support chair) to reduce strain or pressure on your body. Lack of bladder or bowel control can be addressed by using the lavatory immediately before sex. Genital stimulators can help compensate for decreased sensitivity. Know that alcohol, nicotine, some medications, and even some foods may diminish your sexual response.
Intimacy and closeness is important to your life satisfaction. Intimacy can be scary, even more so with fears around performance, rejection, failing to satisfy, and fear that MS symptoms will spoil a sexual encounter. Having an open and honest conversation with your partner about your fears is a good start to fueling greater intimacy. Have realistic expectations. Focus on the process rather than the goal. Plan a date night. Enjoy intimate times, such as holding hands and making eye contact. Create romance. Light candles, play music from your most romantic days, bring out that scent you wore in high school, and touch yourself and your partner all over to discover what body mapping is all about. Engage in activities that have nothing to do with MS.
You are a sexual being. Having love and intimacy is a basic human need. Sex is an important aspect of love and intimacy. Be open to making changes to improve your sexual functioning. Talk to your provider and MS team about your sexual concerns. They can refer you to resources that will help.