Sexual dysfunction is a common symptom in MS, affecting as many as 85% of men and 50% to 75% of women living with MS. In one recent study, about 70% of people with MS report one or more sexual problems that got in the way of sexual performance or pleasure much of the time.
What causes sexual dysfunction in MS?
Feelings of sexual arousal begin with messages sent along nerve pathways of the CNS as the brain communicates with sexual organs via nerves located in the spinal cord. Sexual response, including arousal and orgasm, may be affected if nerves serving sexual organs are damaged by MS-related inflammation. Other MS-related symptoms, from spasticity and fatigue to emotional changes, may also impact normal sexual functioning.
Types of sexual problems by gender
- Decreased sensation or painfully heightened sensation in vaginal/clitoral area
- Difficulty achieving orgasm
- Dryness in vagina
- Loss of libido
- Erectile dysfunction (difficulty achieving or maintaining erection)
- Decreased sensation in penis
- Difficulty achieving orgasm and/or ejaculation
- Loss of libido
- Weakness or fatigue can decrease interest in sex or ability to engage in sex
- Spasticity can result in leg cramping or spasms (causing legs to pull together or making them difficult to separate) and making physical positioning during sex uncomfortable and/or difficult
- Pain can decrease desire for and ability to engage in sex
- Bladder and bowel problems can cause embarrassment that may impact desire to engage in sex
- Emotional problems, including depression, anxiety, loss of self-esteem, can impact desire for sexual intercourse and the ability to perform sexually
How is sexual dysfunction managed in people with MS?
Treatment approaches vary according the specific type of sexual dysfunction and the gender of the patient living with MS.
Erectile dysfunction. A number of drug options are available for erectile dysfunction (ED) to increase blood flow to the penis. These include oral medications called PDE-5 inhibitors, such as Viagra® (sildenafil), Levitra® (vardenafil), and Cialis® (tadalafil) and injectable PDE-5 inhibitor medications such as papaverine and phentolamine.
Other options for ED include the MUSE® system, short for medicated urethral system for erections, which involves inserting a small pellet version of the PDE-5 inhibitor alprostadil inside the opening at the end of the penis with a thin applicator tube. Other approaches include inflatable devices and implants.
Vaginal dryness. For women who experience vaginal dryness, over-the-counter lubricant products, such as Astroglide, Replens, or K-Y Jelly, can be helpful. These lubricant products are water-based and safe for use. Non-water soluble products like Petroleum jelly (Vaseline®) should not be used due to the risk of causing infection.
Impaired sensation. Women and men with MS who experience a decrease in sensation in sexual organs may benefit from instruction or counseling in alternate techniques for sexual stimulation, including use of a vibrator or other sexual aids. Your doctor should be able to refer you to a sexual therapist who has experience providing instruction to patients with chronic diseases that affect sexual performance.
MS symptoms that impact sexual performance. Medications are available to control abnormal sensations and spasms that may interfere with the ability to engage in sex. Bladder and bowel dysfunction can be managed using medications and other techniques to control symptoms during sexual intercourse.
Emotional issues. Emotional problems, including depression, anxiety, loss of self-esteem, anger, and stress, can have a profound effect on the ability to perform sexually and the desire for sexual intercourse. If you think that your sexual dysfunction may be related to emotional issues, ask your doctor for a referral to a mental health professional who has experience in counseling patients who have chronic illnesses such as MS. Additionally, a trained sexual therapist may be able to help you with psychological and physiologic issues that impact sexual performance.
Will MS affect my fertility or ability to have children?
While MS does not necessarily affect fertility in men or women, sexual dysfunction in a man with MS may interfere with his ability father a child. Men with MS sometimes experience difficulty with ejaculation or a problem called dry orgasm, which can negatively impact their ability to impregnate their partner. Medications and other techniques, including the collection or harvesting of sperm for insemination, can be used to address this problem. If you are concerned about fertility and have decided to attempt to have a child, speak with your doctor. He or she will be able to refer you to a specialist who can evaluate your problem and offer solutions.
Birth control and sexually transmitted diseases. People with MS must take the same precautions for birth control and prevention of sexually transmitted diseases as do people without MS. If you have any questions about birth control or methods to prevent sexually transmitted diseases, talk to your doctor or visit the Centers for Disease Control and Prevention at www.cdc.gov or call 1-800-CDC-INFO (1-800-232-4636).