Multiple sclerosis can cause changes that affect one’s usual ways of expressing sexuality. Everyone with MS retains the capacity to give and receive love and pleasure, although creative problem-solving is sometimes necessary to find avenues for intimate expression. Understanding how MS symptoms might affect intimacy and sexuality represents a crucial step towards overcoming obstacles effectively. Whether one is newly diagnosed, physically disabled, young, mature, single or in a committed relationship, MS does not diminish the universal human need to give and receive love and intimate pleasure.
Sexual changes in MS: frequency and characteristics
Studies have been completed on the prevalence of sexual and relationship problems in MS in a number of countries. Although normal sexual function changes throughout the lifespan, MS can affect an individual’s sexual experience in a variety of ways. Studies on the prevalence of sexual problems in MS indicate that 40-80 per cent of women and 50-90 per cent of men have sexual complaints or concerns. The most frequently reported changes in men are a diminished capacity to attain or maintain an erection, and difficulty having an orgasm. The most frequent changes that women report are a partial or total loss of libido (sexual desire), vaginal dryness/irritation, diminished orgasm, and uncomfortable sensory changes in the genitals.
Sexual changes in MS can best be characterised as primary, secondary, or tertiary in nature. Primary sexual dysfunction stems from changes to the nervous system that directly impair the sexual response and/or sexual feelings. Primary disturbances can include partial or total loss of libido (sexual desire), unpleasant or decreased sensations in the genitals, decreased vaginal lubrication or erectile capacity, and decreased frequency and/or intensity of orgasm. Secondary sexual dysfunction refers to MS-related physical changes that indirectly affect the sexual response. Bladder and/or bowel dysfunction, fatigue, spasticity, muscle weakness, problems with attention and concentration, hand tremors, and non-genital
| changes in sensation are amongst the most common MS symptoms that can cause secondary sexual dysfunction. Tertiary sexual dysfunction results from psychosocial and culturalissues that can interfere with sexual feelings and sexual response. Depression, performance anxiety, changes in family roles, lowered self-esteem, bodyimage concerns, loss of confidence, and internalised beliefs and expectations about what defines a “sexual man” or a “sexual woman” in the context of having a disability, can all be expressions of, or contribute to, tertiary sexual dysfunction.
The central nervous system and sexual response
Sexual response is mediated by the central nervous system – the brain and spinal cord. There is no single sexual centre in the central nervous system. Many different areas of the brain are involved in various aspects of sexual functioning, including sex drive, perception of sexual stimuli and pleasure, movement, sensation, cognition, and attention.
Sexual messages are communicated between various sections of the brain, thoracic (upper), lumbar (middle) and sacral (lower) spinal cord and genitals throughout the sexual response cycle. Since MS can result in randomly distributed lesions along many of these myelinated pathways, it is not surprising that changes in sexual function are reported so frequently. The good news is that there are likely to be neurologic pathways that mediate aspects of sexual feelings and response that are widely distributed and therefore unaffected by MS lesions.
The subsequent articles in this issue of MS in focus will discuss in greater detail the important aspects of sexual functioning as related to MS, including strategies for enhancing sexual desire, communicating with a sexual partner and managing other symptoms of the disease that can inhibit sexual expression.
Unfortunately, healthcare providers rarely bring up the subject of sexuality, because of personal discomfort, lack of professional training in this area, or fears of being overly intrusive. It is critical to discuss changes in sexual feelings and strategies and treatments that are available to enhance sexuality.
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