Erectile Dysfunction and Multiple Sclerosis
Last updated: July 2022
I am a pelvic floor physical therapist who treats men for sexual dysfunction. It is estimated that between 50-90% of men diagnosed with multiple sclerosis have some form of erectile dysfunction.1
What is erectile dysfunction?
From my experience in working with men, erectile dysfunction can be qualified by lack of morning erections, decreased rigidity of erections, erections that won’t allow for penetrative sex but WILL allow for manual sex, and an increased length of time required before climax.
The link between MS and erectile dysfunction
Why is erectile quality altered by a diagnosis of multiple sclerosis, you may be wondering?
The neurological system
Erections are controlled by two facets of the neurological system and MS is a neurological disease. Let’s explore how they work! Well, it has been well-established that MS affects the nervous systems of the people who have it. The nerve which exits the spinal canal which controls erections is known as the pudendal nerve. That nerve must be in good working order to send the signal to the pelvis to begin filling the penis and testicles with blood.2
And damage to that nerve can alter erections, and I see this in patients with or without neurological conditions. (For instance, those who lift very heavy weights for long stretches of time can injure the pudendal nerve and experience ED as a result).
The central nervous system
But erections are also controlled by the central nervous system, from the brain and leading down into the spinal cord. This is why some people with spinal cord injuries can still have erections if these pathways are intact. For those with MS lesions on the brain or spinal cord, this pathway from the brain down into the spinal cord may be disrupted. It all depends on where the lesions are located and that is distinct to the individual.2
Sexual quality of life
Now that we are aware that erections are mediated by two separate and distinct parts of the nervous system, we can piece apart how to address the ED that you might be experiencing. In a cross-sectional analysis of men with MS and ED conducted in 2017, several surveys were given to the participants. These surveys included sexual quality of life, a depression scale, a urinary incontinence scale, and one that addressed prostate health. What the analysis revealed is that there are many factors which drive satisfactory sexual function and they must be considered in a holistic approach with a diagnosis of MS.3
Here are a few factors which impact sexuality in men with MS:
1: Impact of the nervous system
Impeded flow from the nervous system (either from the pudendal nerve itself or from the brain and spinal cord) may result in less rigidity of erections. It may be helpful to use PDE-5 inhibitors (drugs like Cialis or Viagra, which must be safely prescribed by a doctor), to get the blood flow going in cases like these. This is because the nervous system doesn’t need to be involved in getting the blood into the penis. The pharmaceuticals can do that instead.
2: Weak pelvic floor muscles
The pelvic floor muscles themselves may be weak. The pelvic floor muscles ensure that blood that goes into the penis remains there until a climax occurs. A simple penis ring can do wonders for certain individuals who have insufficient erections. Just make sure that it isn’t too tight or too loose. You can purchase a set of penis rings in various sizes to see which one feels best. It should be slipped on at the beginning of arousal and kept on until climax.
3: Building the muscle
“If you don’t use it, you lose it.” This is an adage that I repeat to my patients constantly. If muscles are not used, they atrophy and no longer pump blood. They get weaker until contraction slows and ceases. If you are not partnered and want to engage in sexual activity, masturbation is extremely important to keep these muscles strong and mobile. If you lack hand dexterity, a penile pump used daily can draw blood into the penis and engage those muscles by proxy.
Don’t underestimate the role of depression. If you are experiencing depression, it will have an impact on your body’s ability to get aroused. You can try using some visual images (magazines or movies) to get excited. Also, it cannot be over-estimated how crucial it is to have a support group or therapist to grieve the perceived loss of your sexuality.
Do you ever have moments where you question your self worth because of your MS?