Symptom Management

Sexual Dysfunction

Sexual problems are often experienced by people with MS, but they are also very common in the general population.

Sexual arousal begins in the CNS, as the brain sends messages to the sexual organs along nerves running through the spinal cord. If MS damages these nerve pathways, sexual response can be directly affected.

Sexual problems also stem from MS symptoms such as fatigue or spasticity. Psychological factors contribute to sexual problems in MS, as well.

In women, symptoms include:

• reduced sensation in the vaginal/clitoral area,
• or uncomfortably increased sensation
• vaginal dryness
• trouble reaching orgasm
• loss of libido

In men, symptoms include:

• difficulty or inability to get or maintain an
• erection (by far the most common problem)
• reduced sensation in the penis
• difficulty or inability to ejaculate
• loss of libido

Other MS symptoms cause problems in both sexes:
Spasticity can cause cramping or uncontrollable spasms in the legs pulling them together or making them difficult to separate

• Pain can interfere with pleasure
• Embarrassment can be caused by bowel or bladder incontinence
• Weakness and fatigue interfere with libido and function

Therapies Are Available to Treat Sexual Dysfunction of MS
There are a variety of therapies to treat sexual dysfunction. For men, erectile dysfunction may be addressed through use of implants, inflatable devices, injectable medications that increase blood flow in the penis, the MUSE® system which involves inserting a small suppository into the penis, and use of the oral drugs.

For women, vaginal dryness can be relieved by using liquid or jellied, water soluble personal lubricants that can be purchased over-the-counter. It is a common mistake to use too little of these products. Specialists advise using them generously. Petroleum jelly (Vaseline®) should not be used because it is not water soluble and may cause infection.

Both men and women with MS and their partners often benefit in alternative means of sexual stimulation, such as the use of a vibrator, to overcome slow arousal and impaired sensation. Abnormal sensations and spasms can often be controlled through use of medication. Techniques such as intermittent catheterization or medication can control urinary leakage during intercourse.

Fertility, Conception, and Sexually Transmitted Diseases

MS does not affect the basic fertility of either men or women, although sexual problems may interfere with the ability of a man with MS to father a baby. “Dry orgasms” which impair fertility have been reported by men with MS in several studies. These problems have been successfully treated with medication or through techniques to harvest sperm for insemination. Men who are concerned about fertility issues should consult a urologist experienced in this area.

Women and men with MS are also advised that they must make the same decisions and take the same precautions regarding birth control and sexually transmitted diseases as anyone else.

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