Addressing Sexual Health in Relapsing MS Care

Key Takeaways:

• Sexual health and intimacy was the most negatively affected life domain measured in the 2026 Multiple Sclerosis In America survey, with 39.4 percent rating it at the top of a 1 to 7 scale where 7 is significant negative impact – above employment, independence, mental health, and finances.
• Almost no respondents raised it unprompted in more than 3,600 open-ended responses about quality of life and daily challenges.
• The gap between rated impact and volunteered mention means the topic reaches the visit only if the clinician opens it.

Asked to rate how negatively multiple sclerosis (MS) affects each area of life on a 1 to 7 scale where 7 is significant negative impact, 39.4 percent of respondents with relapsing forms in the 2026 Multiple Sclerosis In America survey placed sexual health and intimacy at the top of the scale. That was the highest proportion recorded for any domain measured – higher than employment, independence, mental health, finances, or relationships.¹ Across more than 3,600 open-ended responses from the same respondents about quality of life and daily challenges, the subject appears almost never.

What the impact ratings show

The survey base is not a young or newly diagnosed population: mean age is 58.8 years and mean time since diagnosis is 19.9 years.¹ The rating is therefore not a description of a recent adjustment. It is a settled assessment of a domain that has been affected for a long time.

The published prevalence estimates are consistent with a burden of that size. A meta-analysis of 56 studies covering 8,980 women with MS estimated sexual dysfunction at 61 percent (95 percent confidence interval 56 to 67), with 3.05 times (1.74 to 5.35) the odds compared with healthy controls.² A separate meta-analysis of 29 studies covering 3,349 men with MS estimated sexual dysfunction at 66 percent (64 to 69) and erectile dysfunction at 49 percent (47 to 50).³ These come from different reviews using different instruments and pooling methods and should be read as 2 independent signals of high prevalence, not as a comparison between groups.

What patients volunteer instead

When respondents describe their own lives in open text, sexual health surfaces almost exclusively as a downstream consequence of something else. A respondent 5 years past diagnosis who described needing a catheter in order to urinate added, without elaboration, that her "sex life has been massively compromised." Another, 14 years post-diagnosis, listed it inside a sequence of fatigue effects: "Fatigue means I cannot clean as well my home, I have no libido whatsoever, sleeping is always a challenge, and cognition is hit or miss."¹ The framing in both is incidental – it appears as an item in a list, not as a concern being raised.

Mechanisms behind the symptom

That framing is diagnostically informative rather than merely stylistic. Sexual dysfunction in MS is conventionally divided into primary dysfunction arising from the disease process itself, secondary dysfunction arising from other symptoms such as fatigue, bladder dysfunction, and spasticity, and tertiary dysfunction arising from psychological and relational factors.² The patients above are describing secondary dysfunction and attributing it, correctly, to its proximate cause – which is also why it does not get raised as its own problem.

The compounding burden is documented in the 2026 Multiple Sclerosis In America survey population: 64.4 percent reported bladder problems in the past month, and 47.2 percent reported depression.¹ Notably, the disease-modifying class tested most extensively for this outcome did not help: in a systematic review of 41 intervention studies, interferon therapy showed no improvement in sexual function.⁴ There are limited or no studies on oral disease-modifying therapies or newer infusion or injectable disease-modifying therapies and their effects on sexual function.

Opening a conversation patients will not start

What the intervention evidence does support is treatment once the subject is on the table. Psychoeducational interventions were effective in 10 of 12 studies and medical interventions in 8 of 11, with structured counseling models tested as treatment in their own right; phosphodiesterase type 5 inhibitors improved erectile function in all 4 male trials.⁴

The limiting step is disclosure. Every dysfunction study in that review required identified dysfunction as an entry criterion, which means the evidence base begins after the conversation has already happened. Nothing in the data suggests patients will initiate it. A direct question, asked as a routine part of symptom review alongside bladder and fatigue rather than set apart from them, is what converts a rated impact into a treatable problem.