Sexual disorders in men with multiple sclerosis: evaluation and management

Area of Science:

• Neurology
• Urology
• Reproductive Medicine

Background:

• Sexual dysfunction (SD) is highly prevalent in men with multiple sclerosis (MS), affecting 50-90% of patients.
• SD often goes unrecognized due to patient and physician reluctance to discuss these sensitive issues.
• Symptoms include erectile, ejaculatory, and orgasmic dysfunction, alongside reduced libido, occurring at any disease stage.

Purpose of the Study:

• To highlight the commonality and impact of sexual dysfunction in men with MS.
• To outline the multifactorial causes of SD in MS, including neurological, physical, and psychosocial aspects.
• To review current and potential treatment strategies for SD and fertility issues in MS patients.

Main Methods:

• Review of existing literature on sexual dysfunction in multiple sclerosis.
• Analysis of contributing factors: neurological pathways, physical symptoms (fatigue, spasticity, pain), and psychosocial elements (depression, anxiety).
• Evaluation of treatment options for erectile dysfunction, ejaculatory dysfunction, and fertility concerns.

Main Results:

• Erectile dysfunction is linked to spinal cord pathway impairment, fatigue, spasticity, bladder/bowel dysfunction, and pain.
• Psychosocial factors like depression and anxiety significantly contribute to SD.
• Pharmacological treatments (PDE inhibitors, intracavernous injections) and penile vibratory stimulation show efficacy for specific dysfunctions.
• Immunosuppressive therapies may negatively impact semen quality, necessitating assisted reproduction for fertility.

Conclusions:

• A comprehensive assessment addressing neurological, physical, and psychosocial factors is crucial for managing SD in men with MS.
• Effective treatments exist for various sexual dysfunctions and fertility issues.
• Increased physician awareness is vital for timely intervention and improved patient quality of life.