The ways in which MS can affect sexuality and expressions of intimacy are generally divided into primary, secondary and tertiary sexual dysfunction.
Primary sexual dysfunction is a direct result of neurologic changes that affect the sexual response. In both men and women, this can include a decrease or loss of sex drive, decreased or unpleasant genital sensations, and diminished capacity for orgasm.
Men may 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 and/or diminished clitoral engorgement.
Secondary sexual dysfunction stems from symptoms that do not directly involve nervous pathways to the genital system, such as bladder and bowel problems, fatigue, spasticity, muscle weakness, body or hand tremors, impairments in attention and concentration, and non-genital sensory changes.
Tertiary sexual dysfunction is the result of disability-related psychosocial and cultural issues that can interfere with one’s sexual feelings and experiences. For example, some people find it difficult to reconcile the idea of being disabled with being fully sexually expressive. Changes in self-esteem include people’s feeling about their bodies, demoralisation, depression and mood swings. These can all interfere with intimacy and sexuality.
Why does sexual dysfunction occur in MS?
Sexual response is mediated by the central nervous system (the brain and spinal cord). Many different areas of the brain are involved in 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, spinal cord and genitals throughout the sexual response cycle. Since MS lesions may appear on many of these myelinated pathways, it is not surprising that changes in sexual function are reported frequently by people with MS.
There are treatment and management options available for both men and women who experience sexual dysfunction.