How to Have a Healthy Sex Life When You Have Multiple Sclerosis

If you feel that multiple sclerosis (MS) has affected your sex life, you’re not alone. According to the National Multiple Sclerosis Society (NMSS), sexual response, such as arousal and orgasm, can be affected by damage to the central nervous system, as well as by other common MS symptoms such as fatigue, spasticity, abnormal sensations, and psychological factors such as depression. As a result, sexual problems are common among people who have MS.

A study published in November 2016 in BMC Neurology found that the majority of people with MS reported one or more problems with sexual function, with lack of sexual interest (42 percent of women), and difficulty with erection (40 percent of men) being the most common issues. The study also noted that sexual dysfunction was directly affected by depression and fatigue.

A more recent meta-analysis of other studies, published in Systematic Reviews in January 2021, found that sexual dysfunction is highly prevalent in men with MS (63 percent). An earlier study, published in the Journal of Research in Medical Sciences, found that 64 percent of women with MS experienced sexual dysfunction, with the most common issue being trouble with orgasm (41 percent).

All these issues can be difficult to discuss with a partner, and can therefore lead to sexual and relationship problems. But once you understand how MS leads to problems with sex, you can focus on finding ways to regain your enjoyment of sexual intimacy.

Direct Effects of MS on Sexuality

MS can directly affect your sexual response and function if it damages the nerves that carry messages from your brain to your sexual organs, says Nicholas LaRocca, PhD, a clinical psychologist who specializes in MS and is a consultant for the NMSS.

For men, this can mean difficulty attaining or maintaining an erection (the most common sexual problem related to MS), reduced sensation in the penis, and difficulty ejaculating, notes the NMSS.

For women, it can mean reduced sensation in the vagina and clitoris, painfully heightened sensation, or vaginal dryness, per the NMSS. Both men and women may have trouble with arousal and reaching orgasm.

RELATED: Pelvic Floor Physical Therapy for MS: Help for Bladder, Bowel, and Sexual Function

Indirect Effects of MS on Sexuality

MS can interfere with sexual desire or function in less direct ways and have a libido-dampening effect, per the NMSS. These include MS-related fatigue, spasticity, psychological factors relating to self-esteem and mood changes, and emotional factors including depression, anxiety, anger, and the stress of living with a chronic illness.

“Many individuals with MS no longer see themselves as sexually desirable, and this negatively impacts their sex lives,” says the MS specialist Donna Graves, MD, the specialty medical director of neurology at Atrium Health Neurosciences Institute in Charlotte, North Carolina.

Some MS symptoms may be so personal that you have a difficult time telling your partner about them and decide to simply avoid sex.

“Bladder and bowel control problems can present some fairly significant challenges,” Dr. LaRocca says. “Those kinds of symptoms are not directly related to sexual machinery, but can interfere with interest and ability to participate in sex.”

For a single person with MS who may want to have a sexual encounter, there may be some hesitation and concern with revealing the problems involved, LaRocca points out. “One of the biggest losses is that loss of spontaneity, because some of the MS symptoms require a lot more preparation.”

Regaining Your Sexual Pleasure With MS

Romance and MS don’t have to be mutually exclusive. Although you might find it embarrassing or difficult to talk about intimate concerns, communication — with both your partner and your medical team — is the first step to getting your sex life back on course.

“I often recommend to my patients that they plan a date night,” Dr. Graves says. “Sex often needs to be a planned event for individuals with MS, so plan a time with no distractions, and coordinate your medications to optimize your control of any symptoms that may interfere with sex.”

Graves also stresses the importance of working with your medical team. “In our clinic, we make a practice of asking about sexual function, as this is an often-ignored issue that can have a major impact on families,” she says.

Graves notes that several available treatments can improve sexual function and help rekindle romantic feelings. Per the NMSS, some options include:

• Medication Oral medications, injections, small suppositories that are inserted into the penis, inflatable devices, and implants may help those with MS deal with erectile dysfunction. Medication can also help with abnormal sensations and spasms caused by MS.
• Lubrication Using a liquid or jellied water-soluble personal lubricant for vaginal dryness can improve women’s sexual pleasure and alleviate discomfort.
• Vibrators Women may consider using a vibrator to boost stimulation and arousal.
• Therapy Individual or couples therapy can help both partners with physical and psychological issues. Options include both mental health professionals and sex therapists.
• Intermittent catheterization or medication These techniques can help control urinary leakage during intercourse.

Talk with your doctor about what treatment or combination of treatments would be most helpful for you. Sexual dysfunction is quite common, so chances are your doctor is more comfortable with the topic than you think, Graves says. In addition to offering their own suggestions, they may refer you to other experts such as a urologist, therapist, or others, and if they don’t, ask for a referral if you feel a specialist could give you the help you need.