Unique Considerations About Sex for Men With MS
Last updated: September 2022
Being a man who has been diagnosed with multiple sclerosis can lead to questions about changes in sexual activity. Maybe you are newly diagnosed or don’t notice much of a difference in your erections. Perhaps you require assistance to stand up and walk, and you wonder how you will be able to achieve climax. Or, you may have a high libido despite physical limitations and aren’t partnered with another person who does.
Your pelvic floor's role in sexuality
I am a physical therapist of the pelvic floor muscles – those small saddle muscles upon which you sit that play a vital role in sexuality. They do more for you than you might know, and having MS impacts them in specific ways. When I first meet a patient in the clinic, I ask them to imagine their saddle muscles like an elevator that can move up and down within the elevator shaft.
When you are living your life and not thinking about them, your pelvic floor muscles are "at rest," but they are slightly activated to hold up your organs. The "at rest" position of the muscles is like an elevator that is at the level of the lobby of a hotel. When you bear down to pee or poop, these same muscles must drop down and open. During the passing of urine or stool, the pelvic floor muscles descend, and the elevator is in the basement of the hotel.1
Sex for men with MS
Now, let’s talk about sex! During orgasm, the pelvic floor muscles contract vigorously and rise up into the body. Having an orgasm is similar to the elevator rising to the third floor of the hotel. This muscular contraction is like any other in the body – it strengthens the muscles and brings new blood to the area.2
The importance of orgasms
This is where things get interesting. Lots of people at a certain age or at a certain decline in perceived bodily function essentially stop having sex. This occurs for many reasons, as the depression surrounding life events or a diagnosis of MS can reduce libido. The urge to climax is often not there. But did you know that having an orgasm is a valuable tool to keep the muscles of the pelvic floor pumping and exchanging blood?
Penetrative sex is often the first thing to be affected by MS in men. The penis must be very rigid to accomplish this. But there are so many other different kinds of sex to be enjoyed! If you are a man whose erections are not as firm as they once were, it can be helpful to masturbate to achieve the sensation of climax. Climax DOES NOT require an erection at all but will have the same sensation and effect on the pelvic floor muscles.
Tips for those who use a catheter
Those who use catheters and have some tenderness along the shaft of the penis can still climax. There is a highly sensitive area of the penis called the frenulum. This is an erogenous V-shaped area located on the underside of the glans, and it is rich in sensory nerve endings.3
Using a small vibrator from an online sex store that is placed over a finger and stimulating the frenulum can result in orgasms without irritating the urethral opening where the catheter is inserted.
Don't give up on sex!
Some of you may read this and think, "This is too much trouble, and I have given up anyway. What's the use of trying to climax?" First, remember that elevator of your pelvic floor. If it goes up to the third floor of the hotel, this is a serious workout for your muscles (with the added bonus of several moments of bliss).
Second, research shows that during climax, the part of your brain that is associated with fear and withdrawal from life, known as the amygdala, is deactivated. This is a reset for your brain and you will feel rewarded with happiness rather than stifled by anxiety.3
Finally, having an orgasm does not require that you can walk or even have an erection – it just requires a little creativity and the willingness to surrender what you thought sex should look like versus what it can be.
You're worth it
Consider getting on that elevator in the hotel lobby when you are stressed and doubtful. Press the button for the third floor and watch it light up. When the elevator doors open, you'll hear the ding of the bell, and you'll be ready for a brand new trip to an amazing place. You are a sexual being and you are worth it.
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