ClinicSpeak: Sexual and bladder dysfunction go hand-in-hand

Sexual dysfunction in MS: how common is it? #MSBlog #MSResearch #ClinicSpeak

“The study below documents how closely related bladder and sexual dysfunction are. This should be something of a red flag for doctors and nurses seeing MSers. If an MSer complains of bladder problems we should ask about sexual problems. Why? Because we have treatments for sexual dysfunction and sexual dysfunction contributes to poor quality of life. From an anatomical perspective it is not surprising that bladder and sex go together; the neuronal pathways are both long and tend to be involved by spinal cord lesions. The following are two of the most commonly used surveys to screen men and woman for sexual dysfunction. The one for woman has been open for many months and has over 70 respondents already. It would be interesting to compare the sexes; so if  you have time could you please take a few minutes to complete one of these surveys. I am aware that these surveys are not high science, but they do highlight the how common certain problems are  in MS and the need for treatment. By completing the relevant survey you will also learn about what signs to look for and how to discuss your problems, if you have any, with your nurse of neurologist.”

For males:

For females:

Epub: Fragalà et al. Relationship between urodynamic findings and sexual function in multiple sclerosis patients with lower urinary tract dysfunction. Eur J Neurol. 2014 Nov 19. doi: 10.1111/ene.12595.

BACKGROUND AND PURPOSE: Sexual dysfunction (SD) is prevalent in MSers and affects quality of life. Furthermore, lower urinary tract dysfunction (LUTD) is common in MSers. Our aim was to determine the relationship between urodynamic findings and SD in a cohort of MSers with LUTD.

METHODS: From January 2011 to September 2013, 135 consecutive patients with MS in remission phase and LUTD underwent a first urodynamic examination, according to the International Continence Society criteria. Neurological impairment was assessed using the Expanded Disability Status Scale and SD was investigated with the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF-15). Multivariate logistic regression analysis was performed to identify predictors of female SD (FSFI < 26.55) or moderate-severe erectile dysfunction (ED) (IIEF-EF ≤ 16), after adjusting for confounding factors including urodynamic findings.

RESULTS: Subjects with maximum detrusor pressure during involuntary detrusor contraction (PdetmaxIDC) ≥20.0 cmH2 O had lower IIEF-EF, IIEF overall satisfaction (IIEF-OS), FSFI-Arousal, FSFI-Lubrication and FSFI-Orgasm. Subjects with maximum cystometric capacity (MCC) ≥135 ml had higher IIEF-EF, intercourse satisfaction (IIEF-IS), orgasmic function (IIEF-OF), sexual desire (IIEF-SD), FSFI-Arousal, FSFI-Lubrication, FSFI-Orgasm, FSFI-Satisfaction and FSFI-Pain. On multivariate logistic regression analysis, PdetmaxIDC ≥20 cmH2 O [odds ratio (OR) 6.7; P < 0.05] and MCC <135 ml (OR 6.80; P < 0.05) were predictors of moderate-severe ED. In a model including all previous variables, compliance ≤3 ml/cmH2 O was an independent predictor of moderate-severe ED (OR 14.49; P < 0.01). No relationship was found between the previous variables and FSFI <26.55.

CONCLUSIONS: Neurogenic bladder is associated with SD in MS patients. The presence of PdetmaxIDC ≥20 cmH2 O, MCC <135 ml and compliance ≤3 ml/cmH2 O may significantly predict the presence of moderate-severe ED.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


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  • The above questionnaire presupposes that you are in a relationship (I broke up with my boyfriend 6 weeks ago) and you do not have any stress or sadness in one's life, which decreases sexual desire. At least it does for me:)

  • I wouldn't feel comfortable discussing sexual fuction problems with my MS neurologist (male) or MS nurse. I would feel more comfortable speaking to someone at the Sexual Health clinic but they probably wouldn't have the MS knowledge.
    May be if the MS nurse did a clinic at the Sexual Health clinic once a month I would feel more comfortable going and discussing this.
    I am comfortable discussing bladder and bowel problems with my GP, MS nurse and MS neurologist. I'm female.

  • I once got off with a girl and went back to her place but couldn't perform. My dad went with me to the neurologist, though, when it came to discussing that part I asked him to leave for a moment. Neurologist smirked and prescribed some Viagra. I was celibate for ages after that.

    Moral of the story is things are annoyingly unpredictable. Just go with it.

  • Yes – the questionnaire assuming that you have a partner does rather make it a bit of a pointless exercise answering the questions.

    And now, diagnosed in my mid 50s, with an almost non-existent social life in part due to the impacts of my MS the chances of me ever meeting or having another partner are pretty slim. Internet "dating" sites as an option for meeting someone – not really any point – how do you deal with the issue of letting people know that you have MS when its impacts restrict what you can do? (forget about "long walks on the beach" – a trip to the supermarket leaves me exhausted) It's a double edged sword – if you note up front that you have some physical limitations any prospective "suitors" will pre-judge you (even if you don't name it up at MS), but if you don't it's akin to "false advertising", which is the situation you are placed in if your MS does put limitations on your activities. Who is going to want to take on "damaged goods", knowing that the goods are going to become even more damaged in the future? And as someone who has always been extremely capable and independent in the past, and continues to try and be that way as much as possible still, the last thing I need is someone who "needs to be needed" – that would just be a recipe for disaster.

    So, for me the issue of sexual desire or capacity to achieve orgasm is pretty academic and irrelevant. I'm just working on accepting that my future is unlikely to ever be anything other than single status, without having someone to provide emotional or moral support, an understanding hug when my MS is frustrating me, or help put the garbage bins out.

  • I am trying to address pain on penetration issue w gynae people at moment..I am female and 'ring of soreness' without visible cause is being blamed on vag att which I don't have. It takes a lot of courage to go and talk about this 🙁 Female btw…

  • I recently had review of my spms and medication with neurologist (my request & first time I had seen him). All went well, but later, my husband, who was present, asked whether any medic had asked about sexual function. On reflection (the answer was no, BTW) I think this needs to be included in the assessment routinely. The neuro. asked about bladder function which is no more intrusive really.
    Comments above refer to the lack of a partner as though this automatically means no sexual interest/activity. Well, for females surely the right vibrator is invaluable.

    • "Comments above refer to the lack of a partner as though this automatically means no sexual interest/activity. Well, for females surely the right vibrator is invaluable."
      No, they do not, my comment was stating that 1) I do not currently have a partner and 2)feeling sad because of my relationship breakup has decreased
      my sexual desire. This is a temporary situation, but given the questionnaire asks for details in last four weeks, it is impossible to answer this. Ultimately, unless the MS has dramatically -physically- changed in the last four weeks, then I have zero problems.

    • Interesting that only the male survey defines sexual activity as including masturbation. It seems a tad 'Victorian' to omit this from the female questionnaire!

    • References to masturbation (for either males or females) and the use of vibrators etc for women as a perfectly adequate substitute for sex with another real person seem to overlook one very important point – for many people sex is not always just about climax – it is often also about close contact with another human. Remember those studies done a zillion years ago which showed that babies raised in orphanages where they were well care for in relation to feeding, nappies changed etc but never cuddled failed to thrive. Close and caring contact with others is an important part of sex for many people (and many more men are admitting to this these days, especially older men), and this aspect of sexual activity should not be overlooked – it is still a human need – even if you were not raised in an orphanage in the middle of last century!

  • Lots of people with MS are single so that must reduce your sample. Also you fail to ask the male section if the person has ED and is on a prescriptive drug such as Viagra, is that relevant?

By Prof G



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