Just as in anyone’s life, sex with MS can be fun, intense, routine, boring, passionate, flirty, dirty, easy, comforting, fraught with difficulties, or all of the above!
Sexuality and sensuality is an integral part of being human and, depending on the individuals involved, has varying degrees of importance at different times in a relationship.
For this article, I’m leaning heavily on an excellent publication for healthcare professionals, ‘MS, Sex, Sexuality and Intimacy’; link at the end of the article, and the fantastic work of MS Nurses Denise Middleton & Lesley Catterall.
The chance to discuss issues with sexual function is an important part of your MS Nurse appointment, and if you have a concern, always raise the subject.
Problems with sex that can affect people with MS are divided into:
Primary problems, which occur as a direct result of MS lesions, and can include numbness in the genital area, and problems with orgasm, erections, or vaginal lubrication.
First of all, both partners should understand that mutually expressing sensuality, through loving touch, with affection and humour, can still be deeply rewarding, even if sex does not necessarily end in orgasm.
Then, it’s worth checking that problems aren’t being caused by one of the commonly used in MS medications that can cause problems in libido, erection/lubrication, or achieving orgasm, which include:
Amitriptyline, Carbamazepine, Gabapentin, Pregabalin, and Baclofen as well as opiod painkillers, antidepressants, blood pressure drugs, statins, and cannabis.
This is not an exhaustive list! If therefore, you can find a way to decrease the need for these medications, that’s ideal.
For problems with erection, men with MS qualify for the medications Viagra, Cialis, including the once a day Cialis that allows for a bit more spontaneity, Levitra and Spedra on the NHS, and if they are not suitable, ask to be referred to the local erectile dysfunction clinic, where different options like implants, creams, injections, and vacuum pumps can be discussed. Pumps can also be bought privately, and work well for many men.
To help achieve orgasm, and for numbness, exploring the use of sex toys can be helpful. These include vibrators for both sexes and different sexual areas, and vibrating rings; ‘sleeves’, or artificial vaginas, which can also be during foreplay instead of hands for stimulation, and stimulant lubricants (‘play gels’) which can strengthen sensation, amongst others, and are available via tasteful online shops like lovehoney.co.uk, beecourse.com and emotionalbliss.co.uk.
There is another product, the Eros Therapy, which has been marketed as a medical device, rather than a sex toy, whose aim is to improve blood flow to the clitoris, using a little suction cup device, making orgasm more likely! In a study of (only 15) women diagnosed with sexual dysfunction, more than 80% reported increased sexual satisfaction, and 55% achieved orgasm; they also reported more genital sensation and vaginal lubrication, when using Eros.
For problems with ejaculation, there are no specifically licensed medications, however, in 158 men with spinal injuries; 65% did achieve ejaculation when taking midodrine.
The NHS choices website mentions that Baclofen can cause delayed ejaculation, and that Amantadine, bupoprion and yohimbine are suggested are suggested when this problem is caused by SSRIs. Pseudoephedrine has also shown promise but hasn’t been licensed for this use. Interestingly, Amantadine is also used for fatigue in MS.
For problems with lubrication there are a variety of products available to help , such as Replens, SYLK, Yes VM.
Secondary sexual problems describe when MS symptoms interfere with sex; for instance, bladder, pain, spasticity or fatigue.
These problems can often be got round with a bit of planning. The most common problem I hear in clinic from people with relapsing remitting MS is fatigue. When tired, libido can be the first thing to go, but where sex is important to your partner, try to plan for it: is it possible to have morning sex, at least on the weekends, a nap in the day, or a super early night together..?
With pain and spasm, timing medications to get the most relief at the right time, taking an extra (agreed with your prescriber) muscle relaxant, or using CBD oil for instance, can help.
If you have more advanced MS, with disability, thinking about positioning may be important. You may want to use pillows to raise hips or get comfy. Spokz.co.uk is a disability equipment site that includes sex products, including a gripper, for when hand function is an issue, and sex furniture – swings and swinging chairs, that sound exotic, but take the effort out of sexual moves, and can make positioning easier.
If you have a catheter, adding a flipflow valve means the bag can be removed, and this can be taped out of the way underneath nice underwear. Absorbant bed pads can be placed underneath if you’re worried about bypassing.
Remember, not all sexual difficulties are caused by MS. The NHS website gives broad pointers to other causes, and the Sexual Advice Association offers more detailed advice, your GP may be able to refer you to more specific services, and sexual and relationship counselling is available privately.
Tertiary sexual problems refers to cultural, emotional, psychological and social aspects; for example, inhibitions due to beliefs, or losing confidence.
Keeping the channels of communication open is probably the most important factor here, and has a direct effect both on successful sex, and on maintaining intimacy. After spinal injury, the important factors in maintaining a positive and satisfying sexual relationship were found to be “emotional factors such as honesty, trust, closeness, mutual respect, communication, caring and appreciation”
A fulfilling sexual relationship is about more than intercourse or orgasms, and a fulfilling relationship is about more than sex. There are many couples whose relationship does not involve sex at all, but who maintain a high level of intimacy, with warmth, and fulfilment on both sides, and many others whose sexual relationship involves creative solutions and may not culminate for both partners in orgasm, but is still a deeply enjoyable expression of love and care for each other and each other’s needs.
This document has a full list of resources for support with sexual and relationship difficulties including the excellent booklets for both sexes by the MS Trust, downloadable from www.mstrust.org.uk; sexual and relationship counselling, books, films and organisations.
By Miranda from her blog ‘MS Nurse with a holistic approach – useful things I’ve learned’