Sexual problems common in women with multiple sclerosis
There are many challenges for people living with multiple sclerosis (MS), so perhaps it’s no surprise that various physical and mental factors can get in the way of a satisfying sex life. In a recent survey of women with MS, the most common issues were feeling less desire (about 58%), decreased lubrication (48%), difficulty getting physically aroused (47%), and problems achieving an orgasm (40%) (Lew-Starowicz & Rola. Sex Disabil 2013;31:141-153).
Looking at some of the physical aspects, MS can have direct effects on sexual functioning. Demyelination of nerves in the spinal cord can leave the clitoris feeling numb (Gruenwald and colleagues. Mult Scler 2007;13:95-105). MS lesions in selected spots in the brain can interfere with orgasms (Barak and colleagues. J Psychiatry Neurosci 1996;21:255-258). Changes in sensation may mean it takes longer to get aroused so it’s easy to lose focus, get annoyed or think of something else to do.
All of these can put a damper on the mood. But sometimes the underlying problem is even more embarrassing than sexual difficulties. MS can affect the nerves that control bladder and bowel function – and worrying about having an accident in bed is a common reason for losing the mood. In fact, one study found that 75% of people who said they had sexual difficulties had a problem with bladder or bowel control (Zorzon and colleagues. Mult Scler 1999;5:418-427). It’s hard to concentrate on the moment if you’re afraid that the next moment could bring an unwelcome surprise.
Of course sex is about the home, not just the plumbing. And the psychological aspects of sexuality are probably more important than the physical ones. MS can change how you see yourself, how you view your body (is it friend or enemy?), how confident and sexy you feel. For some, MS is a secret they don’t want to reveal to a new partner. Others have seen their relationship unravel after they were diagnosed. MS is tiring and tiresome. It’s physically uncomfortable. And it can leave you feeling depressed and lonely.
One way to fight the feeling of isolation is to talk about it. Only 2% of people with MS ever mention sexual dysfunction to their family doctor, neurologist or nurse (Lew-Starowicz & Rola 2013). This isn’t surprising: people without MS are just as unlikely to mention the S word to their doctor – and you can be sure your doctor won’t bring it up. This needs to change if things are doing to improve. And health professionals – doctors, nurses, physiotherapists, psychologists – can provide medications and helpful tips to improve your sex life. For example, if you’re experiencing bladder problems, learning how to insert a catheter (it isn’t that hard) to empty the bladder beforehand can eliminate a big source of worry. It’s also important to seek help if you’re feeling depressed or anxious.
A loving relationship can help put any difficulties in perspective. After listing the various sexual problems in MS, the authors added that most of the women surveyed were married or in long-term relationships (24 years on average), most were sexually active, and over 80% perceived their relationship to be very positive (Lew-Starowicz & Rola 2013). While 42% said their sex life was affected by MS, a majority said that their sex life didn’t change after they were diagnosed with MS (and 3% said it got better).
A final note on perspective. It may seem that sexual problems are unique to the MS world – but they are common everywhere in society. The U.S. National Health and Social Life survey found that about one-third of woman said they lacked interest in sex, about 28% were unable to achieve orgasm and 1 in 4 said that sex wasn’t pleasurable (Laumann and colleagues. JAMA 1999;281:537-544). Things weren’t much better for men. One-third said they experienced premature ejaculation, and one-third had erectile dysfunction.
The first step to managing any problems you’re having with your sexual function is to tell your doctor. He/she can develop a multifaceted plan tailored to your specific needs. Visit our Pre-Visit Questionnaire, click on Sexual problems, and show your completed form to your doctor. We hope it helps get the conversation started.
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