MS, sexual problems and sexual dysfunction 1 of 7

One of the reasons for sexual difficulties being more common amongst people with MS is that sexual arousal, response and orgasm require messages to be sent between the brain and sexual organs, via the spinal cord. If there is MS related nerve damage in the parts of the brain and spinal cord that are involved, sexual function may be affected.

Sexuality – that is, how we think of and express ourselves sexually – may also be affected by MS. Physical symptoms like fatigue and spasms, and psychological factors such as low self-esteem and mood, can also affect sexual activity and desire. Other things in life unrelated to MS, such as having children and getting older, may also play a role.

As many factors may be involved, sexual problems vary a great deal between people with MS, and it may be hard to identify a single cause for a particular problem. However, understanding of MS related sexual problems has improved greatly in recent years, and various treatments are now available.

Getting accurate information and communicating openly with partners and professionals can also help to minimize problems. If difficulties have already developed, there are techniques that can improve communication and understanding, and help you to adapt to new dynamics within your relationships. Many people, both with and without MS, have successful and satisfying relationships despite experiencing sexual difficulties. 

Sexual problems, also known as 'sexual dysfunction', are common in the general population. One UK based study suggests that approximately 40 per cent of women and 22 per cent of men are affected by some form of sexual dysfunction. It has also been estimated that over half of all men aged over 40 experience some form of erectile problem, and this figure increases with age. For people with MS, the numbers affected by sexual dysfunction are greater. This is because MS can cause damage to the nerves within the brain and spinal cord that are responsible for sexual function. For both men and women, this nerve damage can cause: a decrease in, or loss of sex drive; decreased or unpleasant sensations in the genital area; and/or diminished capacity for orgasm. Men may also experience difficulty achieving or maintaining an erection and a decrease in, or loss of, ejaculatory force or frequency. Women may experience decreased vaginal lubrication, loss of vaginal muscle tone, either reduced or painfully heightened sensation in the vaginal and/or clitoral area.

Not everyone with MS will be affected by sexual dysfunction and, as with other symptoms, there is no pattern or method for predicting who may experience these problems or how long they may last. However, sexual dysfunction appears to be more common in people who have MS related nerve damage in the spinal cord, and there seems to be a link with MS related bladder and bowel problems.

There are a variety of therapies available which can help minimise problems of sexual dysfunction. There are also techniques available that can help people adapt to new sexual dynamics within intimate relationships. 

MS and sexual function in men

Erections in men can occur either in response to physical stimulation of the genital area, and/or to erotic situations or thoughts. Erections in response to genital stimulation use nerves in the lower part of the spinal cord, and messages do not need to be sent from the brain to the sexual organs via the spinal cord. On the other hand, erections in response to erotic situations and thoughts do require brain processing and therefore need the nerve pathways between the brain and the bottom of the spinal cord to be undamaged. This means that, depending on where the nerve damage is, a man with MS may find that he is able to get an erection in response to genital stimulation, but not in response to erotic situations, or vice versa. It is for this reason that a man with MS (and his partner) may find his ability to obtain and sustain an erection seems both inconsistent and puzzling.

Ejaculation and orgasm are much more complicated processes than genital arousal, and are almost impossible to achieve without intact connections between the spinal cord and brain. It has been estimated that between 35 and 50 per cent of men with MS experience problems with ejaculation.

Approximately 70 per cent of men with MS experience erectile problems, although these generally start some years after the first symptoms of MS appear. However, if you experience sexual difficulties, do not automatically assume they are directly linked to MS related nerve damage. There are various other potential causes of erectile dysfunction such as side effects of medication or an unrelated health condition. By talking to a healthcare professional, such as your doctor or MS nurse, you can ensure the causes are accurately identified, and you receive the most appropriate treatment. 

Treating erectile dysfunction successfully can have a very positive effect on quality of life. Viagra (drug name Sildenafil Citrate) is one of the more effective drug treatments available, and whilst it works for the majority of men, it is not effective for everyone. In one study of men with MS experiencing erectile problems, 95 per cent of participants showed both improved erections and levels of sexual activity after taking the drug. Not all men find pills such as Viagra effective in treating erectile dysfunction, and there are other treatments available.

However, although there are potentially effective treatments for erectile dysfunction, there is no treatment as yet that really helps with ejaculation. Being able to maintain an erection for longer can help, but ejaculation may remain a problem.

Although MS does not affect fertility itself, men who are unable to ejaculate will clearly have a problem if trying to father a child. If this is the case, you should ask to be referred to a fertility clinic for help. 

Compliments of:

UK MS Society