Research:Sex and MS

Following our post from the weekend I thought I would have a look at studies of MS and sexual problems. The amount of information is surprisingly limited for an issue that is pretty common, as can be seen from the posts, and obviously affects quality of life. I have pulled a few papers from different countries, which lacks a UK component.. Are we Brits incapable of talking about sex, well for anyone who has read the “News of the Screws” on sunday (I know it was shut down for offensive behaviour..nothing to do with sex) surely not. So if there are issues, you can see you are not alone,so talk to you MS nurse, and neuro as there are things that can help.
Redelman MJ. Sexual difficulties for persons with multiple sclerosis in New South Wales, Australia.Int J Rehabil Res. 2009;32:337-347.

This 1992 study was conducted to ascertain the incidence of sexual difficulties in individuals diagnosed with multiple sclerosis
(MS) living in New South Wales, Australia. New South Wales is a state
lying roughly 29-36 degrees south of the equator. This is currently the
largest study conducted. The anonymous questionnaire completed by 283
respondents included questions on sexual difficulties, relationship
satisfaction and the ability to communicate about and seek help for the
sexual difficulties. In this study, 30% of respondents claimed to have
sexual difficulties attributable to MS. Sexual difficulties were
experienced by 51% of female and 74% of male respondents. For females,
the most frequently occurring sexual symptoms were difficulty with
achieving orgasm, lowered libido, dissatisfaction with sexual
performance, dissatisfaction with frequency of
intercourse, arousal difficulties and decreased vaginal lubrication. For males, by far the most common problem was decreased frequency of intercourse,
followed by dissatisfaction with sexual performance, masturbation
difficulties, difficulty with achieving vaginal orgasms, erectile
dysfunctions, retarded ejaculation and premature ejaculation. Overall,
females rated their sexual difficulties as 10th in order of importance
of disabilities from MS and males ranked sexual difficulties as fourth
in importance. For both males and females, sexual disability increased
with age, relationship unhappiness and disease disability. Communicating
about sexual difficulties was an issue for both males and females.
Fifty five percent of males and 39% of females had been able to talk
about their sexual difficulties and of these, only 29% of males and 36%
of females had been able to access help for their sexual difficulty.
Educational level did not predict ability to talk about, or ability to
access help. There was a very low satisfaction rate for the sexual help
received. The study highlights areas of need for the MS population

Dachille G et al.Sexual dysfunctions in multiple sclerosis.Minerva Urol Nefrol. 2008 Jun;60(2):77-9

AIM: The aim of this study was to analyze the sexual dysfunction in patients affected by multiple sclerosis.

January 2005 to December 2007, 221 consecutive patients, 97 women and
124 men, were included in the study. Age range was 20+/-65 years
(average 38.8). Fifty-two patients, 14 women (26.9%) and 38 men (73%),
among those who have had sexual
dysfunctions, showed their will to tackle their problem, and were thus
taken into consideration by the Department of Andrology.
activity of these patients has been estimated by self-administered
questionnaire, through the International Index of Erectile Function
(IIEF) for men and Index of Female
Arousal (IFSA) for women. All 64 patients started a domiciliary therapy
with sildenafil (Viagra) 50 mg, and in case of failure, sildenafil 100 mg.
Results have been estimated for men according to the IIEF questionnaire
and to the answers to the third and fourth question, concerning the
capacity to have and keep an adequate erection during a
sexual intercourse, and for women according to the IFSA questionnaire .

the 124 male patients, 25 (20.1%) had a serious deficiency of the
erectile function (score IIEF<10), 11 (8.8%) had a moderate
deficiency (score from 11 to 16), and 20 (16.12%) had a light deficiency
(score from 17 to 25). Twenty-five patients affected with serious
erectile deficiency, also reported a contemporaneous decrease of libido.
Among the 97 female patients, 22 (28.86%) of them reported a serious
decrease of the genital sensitivity and of the sexual
desire; 22 (22.68%) of them reported instead a serious decrease of the
vaginal lubrication; 9 (9.2%) reported a moderate decrease of the
sensitivity, and 10 (10.30%) reported a moderate decrease of the vaginal
lubrication. According to Disability Scale Expanded Score 52 male
patients showed a 2.6 mean score (range 1.5-7); 14 female patients
showed a 2.9 mean score (range 3-6). 

CONCLUSION: Sildenafil has been effective and safe in the treatment of sexual dysfunctions for both sexes. In all analysed patients sexual
deficiency was due to the neurological and central nervous system on
which depend different dysfunctions correlated with the extension and
the gravity of the
multiple sclerosis. There was improvement of the sexual life quality of these patients, after sildenafil therapy.


Lombardi G et al.,Treating erectile dysfunction and central neurological diseases with
oral phosphodiesterase type 5 inhibitors. Review of the literature.
J Sex Med. 2012 Apr;9(4):970-85. doi: 10.1111/j.1743-6109.2011.02615.x. Epub 2012 Feb 3.

  Erectile dysfunction (ED) is reported in a high percentage of patients
with central neurological disorders (CND). Aim.  An up-to-date review
on oral phosphodiesterase 5 inhibitors (PDE5): sildenafil, tadalafil,
and vardenafil for individuals with CND and ED.

Main Outcome Measures. 
Various questionnaires on ED, such as the International Index of
Erectile Function composed of 15 questions. Methods.  Internationally
published clinical studies evaluating the efficacy and safety of PDE5 on
subjects with CND and ED were selected.

Results.  Overall, 28 articles
on PDE5 used to treat patients with CND and ED were included. With each
of the three PDE5 compared to placebo or erectile baseline, literature
reported significant statistical improvement (P<0.01; P<0.05)
only in patients with spinal cord injury (SCI). PDE5 efficacy was
documented for SCI patients up to 10 years. The most frequent predicable
factor for PDE5 success was the presence of upper motoneuron lesion.
Each of the three clinical sildenafil studies documented statistically
significant improvement on erectile function in Parkinson’s patients
(P<0.01; P<0.05). Two studies reported discordant results
about sildenafil’s effectiveness on
multiple sclerosis (MS) patients; one on tadalafil showed significant statistical efficacy on erection
versus baseline (P<0.01; P<0.05). The only spina bifida
article determined that sildenafil remarkably improved erectile
function. Overall, drawbacks were mostly slight-moderate, except in
subjects with
multiple system atrophy where sildenafil caused severe hypotension.

Conclusions.  PDE5 represent first line ED therapy only for SCI
patients, though treatment results through meta-analysis were not
possible. Encouraging results are reported for Parkinson’s and MS
patients. PDE5 use for other CND patients is limited for various
reasons, such as ED and concomitant libido impairment caused by
depression and/or sexual endocrinology dysfunctions, and because PDE5
may cause a worsening of neurological illness.  


Fraser C et al. Correlates of sexual dysfunction in men and women with multiple sclerosis. J Neurosci Nurs. 2008;40:312-7.

Sexual dysfunction (SD) is an often overlooked disability in multiple sclerosis
(MS). The purpose of this study was to investigate the relationship
between SD and other disabilities in men and women with MS. The sample
included 32 men and 219 women. The men ranged in age from 32 to 65 years
with a mean of 47.6 years. The women ranged in age from 22 to 77 years
with a mean of 45.4 years. Data were collected using Guy’s Neurological
Disability Scale and a demographic questionnaire. In men, a significant
positive relationship was found between SD and lower-limb and bladder
disability. No relationship was found between SD and other MS
disabilities. The most common problems for men involved
and ejaculation. For women, a significant positive relationship was
found between SD and all other MS disabilities. The strongest
correlation was between SD and fatigue. The most common problems for
women involved vaginal lubrication and orgasm. No relationship was found
between SD and number of years with MS or age in either men or women.
An open dialogue about SD may improve quality of life for people with
MS. Interventions may include symptomatic treatment, referral of the
couple for sexual counseling, and other approaches that may include
sensory body mapping to enhance communication and pleasure for the
couple living with MS.

Tepavcevic DK et al.The impact of sexual dysfunction on the quality of life measured by MSQoL-54 in patients with multiple sclerosis. Mult Scler. 2008 Sep;14(8):1131-6. Epub 2008 Jul 16

OBJECTIVE: Sexual dysfunction (SD) is a common but often overlooked symptom in multiple sclerosis (MS). The aim of this study was to estimate the frequency, type, and intensity of SD in our patients with MS and to investigate its influence on all the domains of quality of life.

METHODS: The study population comprised a cohort of 109 patients with MS (McDonald’s criteria, 2001). SD was quantified by a Szasz sexual functioning scale. Health-related quality of life was measured by a disease-specific instrument MSQoL-54 (Serbian version).
RESULTS: The presence of at least one symptom of SD was found in about 84% of the men and in 85% of the women. The main complaints in women were reduced libido, difficulties in achieving orgasm, and decreased vaginal lubrication; in men, the main complaints were reduced libido, incomplete erections, and premature ejaculation. In women, statistically significant negative correlations between the presence and level of SD and quality of life domains were reached for all subscales (P < 0.01), except for the Pain subscale (P = 0.112). In men, negative correlations were also observed for all domains, but they were statistically significant for physical health, physical role limitations, social function, health distress, sexual function, and sexual function satisfaction (P < 0.01). We found that the presence of all the analyzed types of sexual problems statistically significantly lowered scores on the sexual function and the sexual function satisfaction subscales in both men and women (P < 0.01). The most prominent impact on both domains was observed for the total loss of erection in men and for anorgasmia in women.
CONCLUSIONS: Our results reveal that frequent occurrence of SD in MS patients prominently affects all aspects of their quality of life.

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  • Apologies as I haven't had time to read every word of these studies on SD. But I am left wondering how different these experiences are from the non-MS population? The difficulties sound like they could be prevalent in the population at large…

  • They are, but just more common at a younger age in MSers, because many issues are due to nerve conduction and this is affected in MSers, where it would not be in the general population.

    However because it occurs widely in the general population there are more people looking for solutions.

  • I'd raher scientists look for a solution to improve walking in PwMS rather than them getting their groove back on.

    Oh, but wait, so far scientists have failed to do either… so much hot air coming from the world of MS research and not enough tangible results.

    My goodness, talk about a lack of progress. I am not a troll, though I suspect it's easier for researchers to label me as one. I'm just a dude with MS and am not best pleased with how little there is to offer someone like me.

    Let's focus on curing MS and fixing the damage caused by the disease.

    What's more important: Getting an errection or being able to walk to work?

  • Yes it would be great to have everyone walking and getting an erection (in the right circumstance that is) but we cannot all work on the same thing.

    (a) If we did it would be taylor made for disaster, because if we got it wrong there would be nowhere to go, execpt back to the drawing board

    Autoimmunity was thought to be the answer but it clearly is not the whole picture,some of you say no picture. If e just did autoimmunity there would be no CCSVI, no stem cells no symptomatic control agents….nothing except DMT.

    (b) The subject area is too broad to be expert in everything, you have to focus. Lack of focus is definite reason why grants get turned down and that will end you researching on MS, so there will be nothing.

    If that is no your interest, you won't put in that extra mile to try and do something positive

    (c) You do not know where the break through will come.
    Viagra was not made to give men erections, it was for a completely different reason it was made. The erection aspect was a side-effect. However that side effect has been turned round to advantage.

    The new DMT may be the answer for people newly diagnosed..lets hope so
    Many of the best discoveries cut across different areas of biology, some of it is great thinking and some of it is just luck.

    (d) If you could tell me what the cure is there would indeed be lots of people chasing that dream, but as we don't really know what the cure is we just have to keep different approaches going and find small benefits along the way that make a greater good.

    I can go on but I know progress is too slow and it is frustrating but scientists are doing what they can bit by little bit.

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