Sexual Dysfunction

Sexual dysfunction is a common symptom of multiple sclerosis (MS). Sexual dysfunction includes problems that affect how you enjoy your sexuality. It can affect your overall sexual health. And that may have a larger impact on your life than other MS symptoms.^1,2

Common sexual problems include low sexual desire and difficulty achieving orgasm. MS can directly cause these problems. Fatigue and other indirect causes also lead to issues. Talk to your doctor about ways to improve your sexual health.¹

What is sexual health?

Sexual health is the ability to enjoy your sexuality throughout your life. It is a state of physical, emotional, and social well-being. Sexual health is more than just the absence of disease or dysfunction. But having sexual dysfunction does not mean sexual health is impossible.^3,4

All cultures and people have different perspectives of sexual health. Gender norms and power dynamics affect sexual health. Social and economic contexts also influence sexual health. In general, key elements of sexual health include:^3,4

• Knowing that sexuality is natural and involves more than just sex
• Respecting everyone’s sexual rights
• Having access to sexual health information and education
• Taking steps to prevent sexually transmitted infections (STIs) and unplanned pregnancy
• Seeking care and treatment for STIs
• Experiencing sexual pleasure and intimacy when desired
• Talking about sexual health with sexual partners and doctors

Sexual health is a critical part of your overall health and well-being. Issues that interfere with sexual health range widely. They can include infections, dysfunction, violence, and unplanned pregnancy.^3,4

How does multiple sclerosis affect sexual health?

Sexual dysfunction is a common symptom of MS. This refers to problems that prevent you from enjoying sexual activities. Certain problems affect your sexual desire or ability to get aroused or orgasm. Other problems can cause pain during sex.^1,5

MS can lead to sexual dysfunction in different ways. Experts classify these causes as:^1,2

• Primary causes – when MS lesions (damage to the body) or medicines lead to sexual problems
• Secondary causes – when physical changes, such as fatigue, lead to sexual problems
• Tertiary causes – when emotional or social issues interfere with sexual health

What are common sexual dysfunction problems in multiple sclerosis?

Between 40 and 80 percent of women with MS experience sexual dysfunction. The most common sexual problems for women with MS include:^1,6

• Difficulty achieving orgasm
• Low sexual desire (libido)
• Vaginal dryness
• Genital numbness

Between 50 and 90 percent of men with MS experience sexual dysfunction. The most common problems for men with MS include:^1,2

• Difficulty achieving or maintaining erection (erectile dysfunction)
• Loss of sexual confidence
• Difficulty achieving orgasm
• Genital numbness

How is sexual dysfunction treated?

Treatment depends on your symptoms and possible causes. Many people have a combination of symptoms and overlapping causes. You may need a mixture of treatment approaches.²

Erectile dysfunction (ED)

Many medicines are available to treat ED. These work by increasing blood flow to the penis. One example is Viagra® (sildenafil). Your doctor may suggest changing other medicines you take that could be causing ED. Other ways to treat ED include:^1,2

• Inflatable devices
• Implants
• Therapy

Vaginal dryness

Over-the-counter lubricant products may help. These include Astroglide, Replens, or K-Y Jelly. These lubricants are water-based. They can contain menthol or other ingredients that improve sensation.^1,2

Genital numbness

Different techniques increase sexual stimulation and sensation. A sex therapist can suggest possible techniques, including:^1,2

• Vibrators
• Sexual aids
• Other ways to manage numbness or burning

Difficulty achieving orgasm

Treatment involves changing medicines that may cause orgasm issues. Your doctor will try to understand and manage all contributing factors.^1,2

Low libido

Therapy may help improve beliefs about sexual functioning. Your doctor may change medicines that may be contributing. For women, your doctor may suggest taking Addyi® (flibanserin).^1,2

Weakness or fatigue

Treatments for fatigue can help. Talk to a sex therapist about ways to manage the effects of fatigue. Possible strategies include:^1,2

• Planning sexual activity for when you are less tired
• Taking naps
• Using aids to save your energy

Bladder and bowel problems

Medicines may control bladder and bowel issues during sex. Some other techniques include:^1,7

• Decreasing fluid intake before sex
• Planning bowel movements twice a day and before sex
• Using condoms for concerns of urinary leakage
• Pelvic floor exercises

Spasticity

Medicines and other therapies can reduce cramping or spasms. Physical therapy can focus on improving range of motion. Certain sex positions may be more comfortable or less painful.¹

Emotional causes

Depression, anxiety, and low self-esteem can all lead to issues. Treatment may involve:¹

• Counseling
• Sex therapy
• Medicine

Talk to your doctor about sexual health

Talking to your doctor about sexual health can help you get the best information and treatment. Many doctors do not ask about sexual health. It may feel awkward to bring up the topic yourself. Talking about sex can be even harder for people who are lesbian, gay, bisexual, transgender, or queer (LGBTQ).⁸

Some tips for talking to your doctor about sexual health include:^8,9

• Rehearsing how you want to start the conversation
• Writing down your questions
• Keeping track of symptoms
• Asking for a referral to a urologist or gynecologist (doctors who specialize in the urinary and reproductive systems)
• Bringing your partner or someone who brings you comfort