Sex and Multiple Sclerosis

Laurie Saloman

Reviewed by QualityHealth's Medical Advisory Board

The effects of multiple sclerosis can be wide ranging, and sexual issues are no exception. The great news is that thanks to improving therapies, fewer and fewer people with MS are so incapacitated that they are completely unable to perform sexually. The bad news is that anywhere from 50 percent to 90 percent of all people with MS still find their sex lives are impacted by the disease to at least some degree. Here are some of the typical sexual problems MS patients face, and how they’re often treated:

1. Erectile Dysfunction

For men with multiple sclerosis, the inability to achieve or sustain an erection due to changes in the brain and spinal cord is the most common problem they face in the bedroom. The first line of treatment is usually oral medications like sildenafil (Viagra) or tadalafil (Cialis), which work by preventing the release of an enzyme that causes the penis to become soft.

But if drugs don’t work, or the patient is unable to take them due to coexisting conditions, there are other options. "Sometimes [patients] need to proceed to things like cavernosum injections," says Michael Racke, MD, a professor of neurology at The Ohio State University in Columbus who specializes in the treatment of MS. These are self-administered injections into the base of the penis. The cavernosum causes additional blood flow into the organ, and "This works for almost anyone." Another possibility is using a balloon pump, also self administered, after having a surgical procedure.

2. Loss of Sensation

"With women, the major issue is mostly sensitivity," Racke says. While many healthy women have trouble achieving sexual arousal and orgasm, the issue may be particularly pronounced in women with MS because of the disease’s effect on the central nervous system. The typical recommendation? Get a vibrator to directly increase stimulation. According to the Multiple Sclerosis Foundation, some women with MS may find that watching sexually explicit films or having a partner stimulate non-genital erogenous zones such as breasts and ears also can increase sexual arousal enough to cause orgasm.

3. Bladder/Bowel Problems

An unfortunate side effect of MS for some people is difficulty with the bladder and/or bowels. If constipation (a common problem) makes sex uncomfortable, a healthier, more fiber-rich diet can help. Urinary issues can take the form of an inability to completely empty the bladder while in the bathroom or a sudden, uncontrollable urge to go, which can be terribly embarrassing during sex.

According to Racke, the problem is solvable for most people. One option is to take medication that helps control bladder spasms. Another is to rely on self-catheterization before sex to ensure that the bladder is empty. In extreme cases, a patient may opt to have Botox injected into the bladder wall to curb incontinence.

4. Depression/Fatigue

MS is a disease that causes high levels of both depression and fatigue—neither of which do much for a patient’s sex drive. Emotionally, it can be tough for people to deal with the realities of MS. "An MS patient doesn’t know when they’re going to have the next relapse," Racke says. "It’s a cloud hanging over their head." Depression can also result from certain MS medications.

The fatigue that 80 percent of people with MS experience can have many causes, including depression. It also may result from interrupted sleep due to numerous nighttime bathroom trips.

Although it can be difficult for patients (and many doctors) to discuss the sexual impact of MS, Racke stresses that with newer and better treatments available all the time, there’s no reason for anyone with MS to see their intimate life suffer.

Michael Racke, MD, reviewed this article.