Western cultural expectations about sex include the notion that sex should be spontaneous and passionate. If enculturated visions of what sex "should be" are not met, lovers can feel so disappointed that they withdraw from the sexual relationship, and fail to explore and enjoy other sexual possibilities.

Gay and lesbian persons with MS face a cultural "double jeopardy." MS tends to marginalize persons in society, which MS societies and other organizations combat through education, outreach, and advocacy programs. Persons with MS who are gay or lesbian may find it extremely difficult to combat societal isolation, since it may be difficult for them to speak openly about their concerns with intimacy and sexuality with health care providers, MS society staff, and/or family members. The reality of dealing with one's own vulnerability on a sensitive topic in the face of being stigmatized or rejected by persons from whom you are seeking help is an added burden.

In Western societies, women are particularly susceptible to having a negative body image, which MS related disabilities may exacerbate. Similarly, men with MS may view themselves as failing to live up to some internalized role such as "breadwinner" or having physical prowess, or being the sexual initiator. Sometimes the struggle with internalized role expectations for oneself and one's partner may result in a gradual loss of seeing each other as sexy. This process may become accelerated if a "well" partner provides extensive caregiving assistance to the "sick" or "disabled" partner. When caregiving becomes an extensive part of a relationship, it is difficult to relax and have sexual fun. Accompanying these role changes may be an increasing sense of isolation in the relationship and less understanding of the partner's concerns. The diminishing capacity to understand and work through these issues creates greater isolation and misunderstanding, and resentments towards each other may g row.

The solutions to loss of intimacy that stem from role changes and culturally associated self-image conflicts are not simple. Developing a language to comfortably talk about sexuality and intimacy can help, although there are cultural barriers to discussing the nuances of one's sexual and intimate feelings. Obtaining educational and resource materials can facilitate such discussions, and are available through the MS society in your country. In addition, there are many self-help books available at bookstores that are designed to enhance sexual and intimate communication. Read them together with your partner, and set aside time each week to talk about what you are reading, and whether or not it applies to your relationship.

Another approach involves setting aside time each week on a regular basis to devote exclusively to restoring intimacy and talking about sexuality. This can set the stage for a couple to slowly develop greater ease in talking about their sensual, sexual, and intimate desires and differences. A helpful but more difficult adjunct to this is to make regular "dates" in which you are free from caregiving, child rearing, or work tasks. Dates that focus on "discovering each other" characterize the early romantic phase of most long-term intimate relationships, but all-too-often get swept away by the burdens of career, parenting, and coping with MS tasks. The MS situation requires that couples "rediscover" each other, since roles and expectations need to be updated or reconciled with the changing MS situation.