Sexual dysfunction in patients with multiple sclerosis

Multiple sclerosis (MS) can affect patients' sexuality and sexual relationships in many ways. Sexual dysfunctions (SDs) are highly prevalent in MS patients and include diminished desire, arousal/erectile dysfunction, and orgasmic/ejaculatory dysfunction. SDs can be caused by damage to the brain, to the spinal cord areas, and to the peripheral neurons engaged in sexual response; by specific MS symptoms (e.g., spasticity, fatigue, incontinence) that interfere with sexual functioning, and finally by the psychosocial impact of the chronic illness (especially mood disorders, cognitive impairment, and couple issues). SDs are highly underdiagnosed in MS patients and have a negative influence on their quality of life. Talking with patients about their sexual issues may bring considerable benefits and reinforce the therapeutic alliance. Many interventions such as education and some coping strategies can be implemented by all healthcare providers. Whenever possible, patients should be referred to a specialist for more specific treatments or counseling. Other important interventions include diagnosing and treating mood disorders, as well as tailoring other MS treatments so that they interfere as little as possible with sexual functioning.