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Issues to do with sexual function and sexuality are common in the general population, but research shows that, at some stage, sexual problems affect more than half of people living with multiple sclerosis (MS). For many people with MS, there can be several contributing factors, not just MS itself. Slightly more men living with MS are affected than women, as with the general population. Starting a conversation about problems with sexual function and sexuality can be scary and overwhelming. However, the benefit that can be gained from sharing the problem with your healthcare professional and seeking the right help, can work wonders for both you and your relationships.
With the right information and support, sexual function can be managed effectively to maintain a healthy and active lifestyle.
Sexuality is core to our life as human beings and an important way to express feelings and receive love and nurturing. Sometimes, things get in the way of this when living with MS, and these can occur directly and indirectly from MS. For men, they can have difficulty achieving and maintaining an erection, experience sensation issues and difficulty achieving orgasm. Women may experience a loss of sexual desire, reduced lubrication, reduced sensation of orgasm and a loss of sensation to the genital area. For both men and women, there can be many additional issues to deal with including extreme fatigue, lack of energy, incontinence issues, pain and spasticity, and feelings of unworthiness.
Sexual issues in MS can be related back to primary, secondary and tertiary causes. Primary sexual issues are caused directly by the MS lesions causing havoc with the nerves – for example a lesion on the spinal cord controlling nerves to the genital area and affecting the ability to have an erection for men, or sensation to the genital area for women. Secondary issues might be related to other MS symptoms, for example, depression, spasms preventing positioning, pain in limbs or significant fatigue. Tertiary issues are more indirectly related to MS but can also have a big impact on sexuality. An example of this would be feeling unattractive and experiencing low self-esteem, as can happen after an MS diagnosis.
The first thing to do is to share your story with your neurologist, MS Nurse or GP. Sexual issues are common in MS and your trusted healthcare advisor will be able to answer your questions and put you in touch with the right professionals to help you. Sometimes, just talking about the issues and finding practical and simple ways to adapt can be most helpful. For others, referrals to an occupational therapist, physiotherapist, psychologist, or sex therapist can lead to strategies to help manage sexual issues. The important thing to remember is that there’s help available: discussing your concerns is the first step to finding strategies and solutions to manage.
Sometimes, managing bladder and bowel issues can help with sexual issues as well [see link here to bladder and bowel issues], as incontinence and constipation can both affect sexual health. For many people living with MS, adaptions to sexual positioning can make sex more comfortable, as can open and honest communication with your partner. There are also many psychological interventions that can teach you to adapt your thinking around sexuality and MS, to alter your sexual perception of yourself to fit your new reality. Psychologists can be very helpful in this area. Sometimes, your medications for other conditions may also be affecting your sexual symptoms, so reviewing these with your GP can be beneficial.
Some issues with sexual health can be treated medically, as with the general population. This may include treatment for erectile dysfunction in men and reduced lubrication in women. Other treatments for secondary issues include treating depression, spasms and pain, which can help improve other MS symptoms which may be having an impact on sexuality.
There is support available to help you manage your MS.
Your neurologist, MS Nurse or GP should be the first contact for any new and/or persistent sexual concerns, so they can perform a detailed assessment and tailor a management plan or referrals if needed.
Contact your state or territory MS organisation to access services such as MS nurses, peer support and other resources.
The following support services may be able to provide advice on sexual issues, wellbeing and other lifestyle factors:
