A fulfilling sex life is a basic need of every individual. Sexual problems relating to MS can lead to reduced self-esteem and well-being, so it is important for both partners in a sexual relationship to be trusting and open with each other about any sexual issues that may arise.
Sexual problems are attributable to various causes
In MS, the causes of sexual problems are often organic. Inflammatory changes in the brain and spinal cord can lead to disorders of sexual sensitivity. In certain circumstances, symptoms of MS, such as fatigue, spasticity in the legs, or urinary incontinence may lead to disturbances of sensitivity. Psychological problems often suppress sexual desire.
Primary, Secondary & Tertiary Sexual Dysfunction
MS can affect sex and physical intimacy in one of three ways; these have been divided into the categories of primary, secondary, and tertiary sexual dysfunction1.
Primary sexual dysfunction
Primary sexual dysfunctions result directly from neurological changes that affect sexual responses. In both men and women, this can include a decrease or loss of sex drive, a change in genital sensations, and diminished capacity for orgasm.
Women may experience the following symptoms:
- Reduced sensitivity in the vaginal and clitoral region;
- Vaginal dryness;
- Difficulty reaching orgasm;
- Occasional failure of sensation in the vaginal and clitoral region; and
- Loss of libido.
The following symptoms may occur in men:
- A disturbance or loss of erectile capacity;
- Reduced sensitivity in the penis;
- A disturbance or loss of ejaculatory capacity; and
- Loss of libido.
Secondary sexual dysfunction
Secondary sexual problems stem from symptoms not directly involving the genitals, such as bladder and bowel impairments, spasticity, muscle weakness, limb tremors, an inability to concentrate on activities, non-genital sensory changes and fatigue due to MS.
Tertiary sexual dysfunction
This results from disability-related changes in social and psychological realms. For example, self-esteem can be affected, including self-perception of the body, demoralisation, depression, and mood swings, which can interfere with intimacy and sexuality.
Talk to an expert
If you do experience repeated sexual problems, it is important to discuss things with your partner, and to resolve these issues, where possible. It is also advisable to consult a doctor, whether it be your General Physician, a neurologist, a specialist in women’s medicine, or a urologist.
There are ways of treating sexual problems. Urologists can treat men with erection difficulties by prescribing mechanical aids and special drugs. The use of a vaginal gel or cream can help women experiencing vaginal dryness. Failures of sensation and spasticity can often be reduced by medicines. It is sometimes helpful to plan intimacy after a refreshing cool bath, or in the morning, when you are not so tired.
MS and contraception
Women with MS usually have normal ovulation cycles, unless they are using a form of contraception, of which all forms are acceptable: the pill, coils, occlusive or Dutch caps, contraceptive creams and sterilisation.
Men with MS can use condoms, or opt for a vasectomy should they decide they do not want (any more) children.
There are no indications that fertility is affected in any way in women with MS. However, some men with MS can suffer from a limited degree of infertility as a result of erectile or ejaculatory problems.
Some male MS patients can suffer from a limited degree of infertility as a result of erectile or ejaculatory problems.
