Christopherson JM, Moore K, Foley FW, Warren KG. A comparison of written materials vs. materials and counselling for women with sexual dysfunction and multiple sclerosis. J Clin Nurs. 2006;15:742-50.
AIM: Evaluate whether symptoms of vaginal dryness, low libido, less intense or delayed orgasm could be improved in women with multiple sclerosis who took part in an education or education plus counselling programme.
BACKGROUND: Sexual dysfunction, a prevalent symptom in women with multiple sclerosis, can negatively affect quality-of-life.
METHODS: Women attending a large multiple sclerosis
clinic were invited and 62 were randomized into one of two groups.
Group 1 received written materials on primary, secondary and tertiary
sexual dysfunction in multiple sclerosis
as well as additional resources (books, websites, list of local
psychologists specializing in sexual counselling). Group 2 received the
same written materials as well as three counselling sessions from the
clinic nurse, the latter two by telephone. The primary outcome measures
were the expanded disability status scale and the multiple sclerosis
intimacy and sexuality questionnaire-19. Repeated-measures analysis of
variance was used to evaluate sexual dysfunction score over time and to
compare two groups.
RESULTS:At baseline, total expanded
disability status scale scores were not correlated with primary,
secondary or tertiary sexual dysfunction. Total multiple sclerosis
intimacy and sexuality questionnaire-19 score was correlated with use
of anti-cholinergic medications [r (54) = 0.28, P < 0.05], but no
other medications, alcohol or tobacco use. Both groups had equivalent
and significant reductions in primary sexual dysfunction [F (1) = 14.79,
P < 0.001] postintervention. There was a trend towards an
interaction effect for tertiary sexual dysfunction [F (1) = 2.88, P =
0.096], in the direction of group 2 (education and counselling).
Subjectively, women welcomed the opportunity to discuss sexual concerns
and noted that the written information allowed a framework for
initiating discussion with their spouses.
straightforward interventions provided by a clinic nurse may help women
cope with the symptoms of sexual dysfunction associated with multiple sclerosis. Women who do not benefit from basic interventions could then be referred to an expert sexual dysfunction practitioner.
RELEVANCE TO CLINICAL PRACTICE: Women with multiple sclerosis
experience many disease-related physical and emotional challenges of
which sexuality is only one. Sensitivity to sexual dysfunction and being
willing to approach the topic is appreciated by women with multiple sclerosis.
Nurses do not require in-depth expertise to offer some basic
suggestions which may significantly improve life quality and assist the
woman with multiple sclerosis to talk about or cope with sexuality issues.
OBJECTIVE:Genitourinary dysfunction is common in women with multiple sclerosis
(MS), yet few studies have evaluated the association between bladder
and sexual dysfunction in these women. The aim of this study was to
determine factors, including demographic and bladder function,
associated with sexual dysfunction in a sample of women with MS.
hundred and thirty-three women with MS completed questionnaires related
to overall heath status, bladder function and sexual function. Response
frequencies and percentages were calculated for questionnaire
responses. Multivariate logistic regression analyses were performed to
determine predictors of sexual dysfunction.
per cent of the sample indicated that they had a problem with bladder
control. Forty-seven per cent of respondents indicated that their
neurological problems interfered with their sex life. Over 70% of the
sample reported that they enjoyed, felt aroused and experienced orgasm
during sexual activity. Not having a sexual partner and the indication
of bothersome neurological problems were the best predictors of sexual
dysfunction. Interestingly, patients bothered by their urge incontinence
had higher levels of orgasm compared to women not bothered by urge incontinence.
CONCLUSIONS:Although over half of the women reported voiding symptoms, most still enjoyed, felt aroused and could experience orgasm.
Neurological symptoms and lacking a sexual partner emerged as the best
predictors of sexual dysfunction. Urge incontinence may not be a risk
factor for an orgasm. Our findings elucidate the complex nature of sexual dysfunction in women with MS.
Zorzon M et al. Sexual dysfunction in multiple sclerosis: a case-control study. I. Frequency and comparison of groups.Mult Scler. 1999;5:418-27
Sexual dysfunction is a very important but often overlooked symptom of multiple sclerosis. To investigate the type and frequency of symptoms of sexual dysfunction in patients suffering from multiple sclerosis, we performed a case-control study comparing 108 unselected patients with definite multiple sclerosis,
97 patients with chronic disease and 110 healthy individuals with
regard to sexual function, sphincteric function, physical disorders
impeding sexual activity and the impact of sexual dysfunction on social
life. Information has been collected from a face-to-face structured
interview performed by a doctor of the same gender as the patient. The
disability, the cognitive performances, the psychiatric conditions and
the psychological profile of patients and controls have been assessed.
Sexual dysfunction was present in 73.1% of cases, in 39.2% of chronic
disease controls and in 12.7% of healthy controls (P<0.0001). Male
cases reported symptoms of sexual dysfunction more frequently than
female cases (P<0.002). Symptoms of sexual dysfunction more commonly
reported in patients with multiple sclerosis
were anorgasmia or hyporgasmia (37.1%), decreased vaginal lubrication
(35.7%) and reduced libido (31.4%) in women, and impotence or erectile
dysfunction (63.2%), ejaculatory dysfunction and/or orgasmic dysfunction
(50%) and reduced libido (39.5%) in men. Seventy-five per cent of
cases, 51.5% of chronic disease controls and 28.2% of healthy controls
(P<0.0001) experienced symptoms of sphincteric dysfunction. In
conclusion, a substantial part of our sample of patients with multiple sclerosis
reported symptoms of sexual and sphincteric dysfunction. Both sexual
and sphincteric dysfunction were significantly more common in patients
with multiple sclerosis
than in either control group. Our findings suggest that a peculiar
damage of the structures involved in sexual function is responsible for
the dysfunction in patients with multiple sclerosis,
but the highly significant lower frequency of symptoms of depression
and anxiety in healthy controls may also imply a possible causative role
of psychological factors.
What is tertiary sexual dysfunction ?
The ways in which MS can affect sexuality and expressions of intimacy have been divided into primary, secondary, and tertiary sexual dysfunction (Foley & Werner, 2000).
"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" results from 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-including the way one feels about one's body, demoralization, depression, or mood swings-can all interfere with intimacy and sexuality. The sexual partnership can be severely challenged by changes within a relationship, such as one person becoming the other's caregiver. Similarly, changes in employment status or role performance within the household are often associated with emotional adjustments that can temporarily interfere with sexual expression. The strain of coping with MS challenges a couple's efforts to communicate openly about their respective experiences and their changing needs for sexual expression and fulfillment.