Research:Sex and MS

Following our post from the weekend I thought I would have a look at studies of MS and sexual problems. The amount of information is surprisingly limited for an issue that is pretty common, as can be seen from the posts, and obviously affects quality of life. I have pulled a few papers from different countries, which lacks a UK component.. Are we Brits incapable of talking about sex, well for anyone who has read the "News of the Screws" on sunday (I know it was shut down for offensive behaviour..nothing to do with sex) surely not. So if there are issues, you can see you are not alone,so talk to you MS nurse, and neuro as there are things that can help.

Redelman MJ. Sexual difficulties for persons with multiple sclerosis in New South Wales, Australia.Int J Rehabil Res. 2009;32:337-347.

This 1992 study was conducted to ascertain the incidence of sexual difficulties in individuals diagnosed with multiple sclerosis (MS) living in New South Wales, Australia. New South Wales is a state lying roughly 29-36 degrees south of the equator. This is currently the largest study conducted. The anonymous questionnaire completed by 283 respondents included questions on sexual difficulties, relationship satisfaction and the ability to communicate about and seek help for the sexual difficulties. In this study, 30% of respondents claimed to have sexual difficulties attributable to MS. Sexual difficulties were experienced by 51% of female and 74% of male respondents. For females, the most frequently occurring sexual symptoms were difficulty with achieving orgasm, lowered libido, dissatisfaction with sexual performance, dissatisfaction with frequency of intercourse, arousal difficulties and decreased vaginal lubrication. For males, by far the most common problem was decreased frequency of intercourse, followed by dissatisfaction with sexual performance, masturbation difficulties, difficulty with achieving vaginal orgasms, erectile dysfunctions, retarded ejaculation and premature ejaculation. Overall, females rated their sexual difficulties as 10th in order of importance of disabilities from MS and males ranked sexual difficulties as fourth in importance. For both males and females, sexual disability increased with age, relationship unhappiness and disease disability. Communicating about sexual difficulties was an issue for both males and females. Fifty five percent of males and 39% of females had been able to talk about their sexual difficulties and of these, only 29% of males and 36% of females had been able to access help for their sexual difficulty. Educational level did not predict ability to talk about, or ability to access help. There was a very low satisfaction rate for the sexual help received. The study highlights areas of need for the MS population

Dachille G et al.Sexual dysfunctions in multiple sclerosis.Minerva Urol Nefrol. 2008 Jun;60(2):77-9

AIM: The aim of this study was to analyze the sexual dysfunction in patients affected by multiple sclerosis.

METHODS: From January 2005 to December 2007, 221 consecutive patients, 97 women and 124 men, were included in the study. Age range was 20+/-65 years (average 38.8). Fifty-two patients, 14 women (26.9%) and 38 men (73%), among those who have had sexual dysfunctions, showed their will to tackle their problem, and were thus taken into consideration by the Department of Andrology. Sexual activity of these patients has been estimated by self-administered questionnaire, through the International Index of Erectile Function (IIEF) for men and Index of Female Sexual Arousal (IFSA) for women. All 64 patients started a domiciliary therapy with sildenafil (Viagra) 50 mg, and in case of failure, sildenafil 100 mg. Results have been estimated for men according to the IIEF questionnaire and to the answers to the third and fourth question, concerning the capacity to have and keep an adequate erection during a sexual intercourse, and for women according to the IFSA questionnaire .

RESULTS: Among the 124 male patients, 25 (20.1%) had a serious deficiency of the erectile function (score IIEF<10), 11 (8.8%) had a moderate deficiency (score from 11 to 16), and 20 (16.12%) had a light deficiency (score from 17 to 25). Twenty-five patients affected with serious erectile deficiency, also reported a contemporaneous decrease of libido. Among the 97 female patients, 22 (28.86%) of them reported a serious decrease of the genital sensitivity and of the sexual desire; 22 (22.68%) of them reported instead a serious decrease of the vaginal lubrication; 9 (9.2%) reported a moderate decrease of the sensitivity, and 10 (10.30%) reported a moderate decrease of the vaginal lubrication. According to Disability Scale Expanded Score 52 male patients showed a 2.6 mean score (range 1.5-7); 14 female patients showed a 2.9 mean score (range 3-6). 

CONCLUSION: Sildenafil has been effective and safe in the treatment of sexual dysfunctions for both sexes. In all analysed patients sexual deficiency was due to the neurological and central nervous system on which depend different dysfunctions correlated with the extension and the gravity of the multiple sclerosis. There was improvement of the sexual life quality of these patients, after sildenafil therapy.


Lombardi G et al.,Treating erectile dysfunction and central neurological diseases with oral phosphodiesterase type 5 inhibitors. Review of the literature. J Sex Med. 2012 Apr;9(4):970-85. doi: 10.1111/j.1743-6109.2011.02615.x. Epub 2012 Feb 3.

Introduction.   Erectile dysfunction (ED) is reported in a high percentage of patients with central neurological disorders (CND). Aim.  An up-to-date review on oral phosphodiesterase 5 inhibitors (PDE5): sildenafil, tadalafil, and vardenafil for individuals with CND and ED.

Main Outcome Measures.  Various questionnaires on ED, such as the International Index of Erectile Function composed of 15 questions. Methods.  Internationally published clinical studies evaluating the efficacy and safety of PDE5 on subjects with CND and ED were selected.

Results.  Overall, 28 articles on PDE5 used to treat patients with CND and ED were included. With each of the three PDE5 compared to placebo or erectile baseline, literature reported significant statistical improvement (P<0.01; P<0.05) only in patients with spinal cord injury (SCI). PDE5 efficacy was documented for SCI patients up to 10 years. The most frequent predicable factor for PDE5 success was the presence of upper motoneuron lesion. Each of the three clinical sildenafil studies documented statistically significant improvement on erectile function in Parkinson's patients (P<0.01; P<0.05). Two studies reported discordant results about sildenafil's effectiveness on multiple sclerosis (MS) patients; one on tadalafil showed significant statistical efficacy on erection versus baseline (P<0.01; P<0.05). The only spina bifida article determined that sildenafil remarkably improved erectile function. Overall, drawbacks were mostly slight-moderate, except in subjects with multiple system atrophy where sildenafil caused severe hypotension.

Conclusions.  PDE5 represent first line ED therapy only for SCI patients, though treatment results through meta-analysis were not possible. Encouraging results are reported for Parkinson's and MS patients. PDE5 use for other CND patients is limited for various reasons, such as ED and concomitant libido impairment caused by depression and/or sexual endocrinology dysfunctions, and because PDE5 may cause a worsening of neurological illness.  


Fraser C et al. Correlates of sexual dysfunction in men and women with multiple sclerosis. J Neurosci Nurs. 2008;40:312-7.

Sexual dysfunction (SD) is an often overlooked disability in multiple sclerosis (MS). The purpose of this study was to investigate the relationship between SD and other disabilities in men and women with MS. The sample included 32 men and 219 women. The men ranged in age from 32 to 65 years with a mean of 47.6 years. The women ranged in age from 22 to 77 years with a mean of 45.4 years. Data were collected using Guy's Neurological Disability Scale and a demographic questionnaire. In men, a significant positive relationship was found between SD and lower-limb and bladder disability. No relationship was found between SD and other MS disabilities. The most common problems for men involved erection and ejaculation. For women, a significant positive relationship was found between SD and all other MS disabilities. The strongest correlation was between SD and fatigue. The most common problems for women involved vaginal lubrication and orgasm. No relationship was found between SD and number of years with MS or age in either men or women. An open dialogue about SD may improve quality of life for people with MS. Interventions may include symptomatic treatment, referral of the couple for sexual counseling, and other approaches that may include sensory body mapping to enhance communication and pleasure for the couple living with MS.
Tepavcevic DK et al.The impact of sexual dysfunction on the quality of life measured by MSQoL-54 in patients with multiple sclerosis. Mult Scler. 2008 Sep;14(8):1131-6. Epub 2008 Jul 16

OBJECTIVE: Sexual dysfunction (SD) is a common but often overlooked symptom in multiple sclerosis (MS). The aim of this study was to estimate the frequency, type, and intensity of SD in our patients with MS and to investigate its influence on all the domains of quality of life.
METHODS: The study population comprised a cohort of 109 patients with MS (McDonald's criteria, 2001). SD was quantified by a Szasz sexual functioning scale. Health-related quality of life was measured by a disease-specific instrument MSQoL-54 (Serbian version).
RESULTS: The presence of at least one symptom of SD was found in about 84% of the men and in 85% of the women. The main complaints in women were reduced libido, difficulties in achieving orgasm, and decreased vaginal lubrication; in men, the main complaints were reduced libido, incomplete erections, and premature ejaculation. In women, statistically significant negative correlations between the presence and level of SD and quality of life domains were reached for all subscales (P < 0.01), except for the Pain subscale (P = 0.112). In men, negative correlations were also observed for all domains, but they were statistically significant for physical health, physical role limitations, social function, health distress, sexual function, and sexual function satisfaction (P < 0.01). We found that the presence of all the analyzed types of sexual problems statistically significantly lowered scores on the sexual function and the sexual function satisfaction subscales in both men and women (P < 0.01). The most prominent impact on both domains was observed for the total loss of erection in men and for anorgasmia in women.
CONCLUSIONS: Our results reveal that frequent occurrence of SD in MS patients prominently affects all aspects of their quality of life.