Treatment of orgasmic loss in MS depends on developing an understanding of what factors are contributing to the loss. If sensation is disturbed in the genitals or lower body areas, increasing stimulation to other erogenous zones, such as breasts, ears, and lips may sometimes enhance the orgasmic response. Sometimes stimulating the edges of body zones that are experiencing numbness or diminished sensation can feel sensually or erotically pleasing. Similarly, increasing cerebral stimulation by watching sexually oriented videos, exploring fantasies, and introducing new kinds of sexual play into sexual activities can help trigger orgasms.

When diminished or changed genital sensations occur, it is essential to develop a sensory "body map" to explore the exact locations of pleasant, decreased, or altered sensations. Developing a "body map" requires one to begin by systematically touching the body from head to toe (or all those places one can comfortably reach). Vary the rate, rhythm, and pressure of your touch, allowing approximately 15-20 minutes for the exercise. Note areas of sensual pleasure, discomfort, or sensory change. Alter your pattern of touch to maximize the pleasure you feel. Initially, conduct the exercise privately, without wearing clothing, in a setting where you feel comfortable. Next, inform your partner [if you have one] of your "body map" information and instruct him/her in touching you in similar fashion. This information can set the stage to rediscover sensual and erotic pleasure. When including your partner in the exercise, it is important to avoid intercourse or other former sexual activities for the first few weeks. This removes "performance pressure" and keeps the focus on rediscovering one's body, enhancing intimacy and providing updated information regarding sensual and sexual pleasure zones. As with the treatment of all sexual symptoms in MS, experimentation and communication are the keys to maximizing sexual response and/or pleasure.

Increase genital stimulation through vigorous oral stimulation or via mechanical vibrators, which are available by mail order. Strap-on clitoral vibrators do not interfere with intercourse and require little manipulation once in place. Vibrators that attach to the base of the penis can help stimulate erections in men, and provide direct clitoral stimulation during intercourse. Plug-in electrical vibrators provide stronger stimulation than battery operated ones, but caution is sometimes needed to avoid irritating sensitive genital tissues. See resources at the end of the article for mail-order companies.

When diminished capacity for orgasm occurs, a trial of Viagra® (sildenafil citrate) may be helpful for women in MS. The scientific rationale for trying sildenafil citrate with women stems from the biology of clitoral tissue. The clitoris is comprised in part of erectile tissue that becomes engorged with blood when a woman is sexually excited. The biochemical reactions that lead to clitoral engorgement are highly similar to those which lead to erections in men. Clinical trials of Viagraâ have been completed for both men and women with MS. Although not yet published, the findings indicate this medication is helpful for enhancing the sexual response in women (personal communication, Scott Litweiler, MD June 2000). Viagra® may be more helpful for women with MS than women with sexual problems who do not have MS, although more data is needed to reach a definitive conclusion. In the study of women with MS, sexual partners of women independently rated sexual function as improved, which corresponded to the women's' reports. For additional information about Viagra®, see "Coping with Erectile Problems."

A relatively new product on the market that is designed to enhance female sexual response consists of a small vacuum device that is applied to the clitoris that causes clitoral engorgement (Uprima®). Since increased blood flow to the clitoris and labia occurs during the sexual response, it is reasoned that enhancing blood flow via the vacuum device will enhance sexual pleasure. Although women without MS have reported enhanced sexual responsiveness with a vacuum device, it has not yet been tested in MS and it is not yet known whether this will be helpful.

Painful or irritating genital or body sensations can sometimes be treated with medication. Amitriptyline (Elavil®), carbamazepine (Tegretol®) and phenytoin (Dilantin®) are sometimes prescribed to help manage this difficult symptom.