Sexual dysfunction (SD) is a common problem among people with MS. Older studies from the 90s indicate a frequency (prevalence) between 40 and 90%, although the studies are difficult to compare due to different definitions of SD. According to the World Health Organization (WHO), SD is a syndrome that includes lack or loss of sexual desire, erectile/lubrication disorders, orgasm difficulties, premature ejaculation and pain during intercourse.The causes of SD in MS can be varied. A primary SD can be directly caused by inflammatory lesions leading to symptoms such as erectile dysfunction, anorgasmia and reduced sensation in the genital area. Secondary SD can occur when MS has led to changes in body function that indirectly affect sexuality, e.g., fatigue, spasticity or disturbances in bladder and bowel function. Finally, tertiary sexual dysfunctions can be triggered by psychosocial factors that include body image, emotional challenges and cultural influences. It is also important to remember the impact of depression, including the side effects of antidepressant medications on sexual function – a constellation that is often encountered in MS.
Accordingly, sexual dysfunctions are not only of great importance for young adults with MS due to the variety of disorders and the associated effects on mental health, quality of life and interpersonal relationships. However, despite its known high importance, discussing sexual dysfunctions is not standard practice during consultations with neurologists or other medical professionals, which often results in patients feeling alone with their problems.
Against this background, the results of a recently published study (Marck et al. BMC Neurol 2016;16(1):210) are of interest. In total, 2062 MS patients were surveyed via the Internet about specific sexual functions. The MSQOL-54 quality of life questionnaire’s sexual function scale was used, as well as a question about sexual satisfaction within the last 4 weeks. The surveyed patients were 81% female and averaged 45 years old. More than half of the surveyed patients (54.5%) reported at least one feature of a sexual dysfunction (49%,7% of men and 55.6% of women). Reported issues included sexual disinterest in 39.6%, erectile/lubrication disorders in 32.8%, orgasm difficulties in 34.9% and more than every fifth (21.5%) reported having problems satisfying their partner sexually.
Sexual satisfaction in the last 4 weeks was reported by only 43.7% of respondents. A statistical analysis showed an independent association between sexual function/satisfaction and a number of demographic factors such as age, risk of depression, use of antidepressants and fatigue. Interestingly, the authors were also able to show that a healthier diet is associated with fewer sexual disorders and that physical activity/exercise goes hand in hand with higher sexual satisfaction.
Ultimately, this current study is a call to both us neurologists and our patients to refocus on the issue of sexual dysfunction, because the study impressively shows that sexual problems exist in the majority of MS patients and have a significant impact on quality of life.
However, it also becomes apparent that, due to the complex interrelationships and chains of symptoms on completely different levels, there is no universal solution for sexual dysfunction. Therefore, a comprehensive, holistic approach is of great importance in treating sexual disorders, which – and this study makes this very clear – particularly includes the modification of so-called lifestyle factors. The authors see preventative potential in a healthy diet and physical activity and encourage a more intense focus on these connections.
