MS, sexual problems and sexual dysfunction 2 of 7

Viagra works by enhancing blood flow into the penis, and increasing any erectile response that can naturally occur – either through genital stimulation, or erotic thoughts and situations. It takes between 30 minutes and two hours to take effect and lasts for up to four hours. Viagra does not cause spontaneous erections, and sexual stimulation is still necessary.

Other drugs that work in a similar way to Viagra are now also available. Cialis (Tadalafil) acts within 30 minutes and its effect lasts more than 24 hours. Levitra (Vardenafil) acts after 25 to 60 minutes and its effect lasts for four to five hours. The shorter response time and longer duration clearly have advantages in that less 'planning' is required and sexual activity can be a more spontaneous event. Research has shown Cialis and Levitra to help in 80 per cent of men experiencing erectile problems.

Uprima (Apomorphine Hydrochloride) is another drug used to treat erectile dysfunction but may be less effective for men with MS as it relies on messages being sent along the spinal cord, where there may be MS related nerve damage. 

The National Institute for Health and Clinical Excellence (NICE) [in the UK] guideline, that outlines best practice for the treatment and management of MS in the NHS, recommends Viagra as the first line of treatment for erectile dysfunction. The NHS has also put MS on the list of conditions for which treatment of erectile dysfunction is free. So, your GP can prescribe you one of these pro-erectile treatments. Prescriptions will generally be limited to one dose per week, and it is normally recommended that you only take one dose in a 24 hour period. Viagra is not always appropriate for men with heart conditions or hypertension (high blood pressure).

Even though there are all sorts of drugs for sale on the internet, medications for sexual dysfunction do need to be prescribed by your doctor who knows your medical history, other medicines you take (and any possible interactions), and can discuss any potential side effects.  

Prostaglandins are a hormone-like substance naturally produced in the body. Synthetic versions of prostaglandins can be used to treat erectile dysfunction, as they have the effect of enhancing blood flow into the penis. There are two different methods for using prostaglandins. The first option is by self-injecting prostglandins (drug name Caverject) into the penis, this can result in an erection five to 20 minutes after injection. The second option is to insert a small pellet of prostaglandin (drug name MUSE) into the urethra – the tube through the penis from the bladder through which urine passes. However, MUSE does not work for men who have a permanent urethral catheter or who intermittently self catheterise. This treatment is also not appropriate for men with heart conditions.

Vacuum devices

Vacuum devices can also be helpful. They work by fitting a plastic tube over the penis and use a hand pump to create vacuum pressure that results in blood flow into the penis. A ring is then placed around the base of the penis to maintain the erection created. The ring is removed after intercourse. Unfortunately, whilst this can help with erection, it will not bring back sensation.

MS and sexual function in women

Like male sexual response – female sexual response depends on good spinal cord connections and undamaged nerve pathways between the brain and the base of the spinal cord. It is estimated that 50 to 70 per cent of women with MS will experience some degree of sexual dysfunction at some stage during the course of their MS. Like other MS symptoms problems may initially relapse and remit, or may become permanent.

The types of problems that can occur include: decreased vaginal lubrication; loss of libido or sex drive; loss of vaginal muscle tone; reduced or painfully heightened sensation in the vaginal and/or clitoral area; and loss of ability to achieve orgasm. Unfortunately, there are currently no specific medications available to treat these symptoms, but there are a variety of strategies that can help to minimise their impact. 

Vaginal lubrication is the aspect of female sexual response that corresponds most closely to erection in men, and there are ways of treating decreased vaginal lubrication. Some women find water-soluble lubricants like KY-Jelly or Sensilube help with lubrication. Both these lubricants are available over the counter and will need to be applied liberally. A small research study on women with MS has found that Viagra helps with lubrication, but has no significant effect on orgasm. However, because of its limited effect it is not currently prescribed for women. 

The main complaint of women with MS is loss of orgasmic capacity. There is currently no medication available to treat orgasmic loss, although research continues. In the meantime, vibrating stimulators may help as some women find they can still reach orgasm, but it takes longer, and requires more stimulation. Most women achieve orgasm through direct stimulation of the clitoris. This stimulation increases the blood supply to the clitoris causing it to enlarge and stimulate the vagina to produce lubrication. Because of this, women often say the most effective vibrators are those that include an externally vibratory feature. 

Compliments of:

UK MS Society