Sex for Women With MS
Most people are aware of decreasing libido after menopause in women. But in reality, many women notice the loss of libido while raising children and working full time, and yet are supposedly at their sexual peak in their late thirties and forties. I am a pelvic floor physical therapist who treats women throughout their lifespan, and I’ve observed some trends in sex for both women after menopause and women with multiple sclerosis.
Don't give up on sex
While it seems tempting to give up on sex while in an MS exacerbation or when your hormones plummet during menopause and thereafter, this isn’t a great idea. Let’s start with the muscles of the pelvic floor to explain why. These muscles open up with three activities: voiding urine, voiding poo and having sex. The muscles must be pliable and able to move with ease; vaginal secretions allow for this when we are younger and are aroused by our partners during sex.1
Challenges with sex after menopause
There are receptors for estrogen on our vulvas. This means that when estrogen is freely circulating in the blood, it will enter the tissues of the vulva and keep everything supple and primed for sex. When estrogen levels drop off, which occurs in menopause and times of heightened stress, the vulvar tissues get starved for the hormone that once fed them so profusely. The result is often vaginal dryness, atrophy, cracking of the skin of the perineum, and lack of mobility to the tissues themselves.1,2
What can we do about it?
Two things can help to prevent this lack of mobility of the vaginal tissues. The first is the use of topical estrogen, applied to the vulva twice weekly. A study performed in India involved women after menopause with vaginal dryness, frequent urinary tract infections, and pain with sex, and found that the application of an estrogen cream decreased these symptoms, perhaps because their vulvas were now plump and mobile once more.3 The second thing that helps with vulvar mobility is...to move the tissues yourself or have a partner help you!
The benefits of masturbation
Yes, we are talking about masturbation. The longer that I work in my field of asking people about sex, the more I find myself encouraging everybody to masturbate more. Some people aren’t motivated by the sensation of orgasm, but they will still benefit by touching themselves to stretch and massage the tissues in question. This can lead to improved bladder and bowel voiding patterns because these same tissues must move, open and stretch to allow the evacuation of urine and stool.
As for people who enjoy the sensation of orgasm, they do quite well using a vibrator on the clitoris to allow blood to pool into the pelvic floor and remain there for excellent muscle lengthening. If trying this is painful at first, which may be the case for those who self-cath, there is a new type of vibrator that uses air pulse stimulation and has no direct contact to the pelvic floor itself. I like this type of vibrator for anyone who has ever had pain during sex or with masturbation as a good starting point.
Tips for sex for women with MS
Some of my patients are still having penetrative sex in their eighties, with advanced MS or with various other things which might have prevented it, and I want to give a shout out to them! From the perspective of a diagnosis of MS, having spasms of the inner thighs (adductors) can make having sex as a woman in the missionary position uncomfortable. An alternate position would be with the woman in sidelying in the fetal position with a pillow between her knees. When she is penetrated from behind in this position, her pelvic floor will be in the most lengthened position (allowing better entry), without fighting against the adductor spasticity of spreading her legs.
May your sex life live on
There are many ways to continue having a sex life whether you have MS or not, whether you are partnered or not, or whether or not you believe that orgasms are necessary for life as we know it. In summary, women during or after menopause can have vaginal dryness, atrophy, and pain with sex. Topical estrogen cream has been shown to help decrease these symptoms. Something else that can help to maintain mobility of the pelvic floor would be to masturbate or use a vibrator. This can improve bladder and bowel emptying. And that’s wonderful. But even more delightful is the sensation of climax – a reminder that we are worthy of joy as human beings.
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