Management Of Multiple Sclerosis

Primary Sexual Dysfunction (Resulting From Neurologic Impairment) 

Evaluation and treatment 

COPING WITH PRIMARY sexual dysfunction can be facilitated by discussing symptoms with a health professional who is knowledgeable about MS. The first step in any kind of treatment is a thorough evaluation to diagnose the difficulty. The evaluation process may include: a physical history and examination; a review of current MS and other medications for their possible effects on sexual functioning; a detailed sexual history; and perhaps some specialized tests of sexual function. 
 

Management Of Multiple Sclerosis

The sexual history thoroughly examines the current problem and investigates both present and prior sexual relationships and behaviors. The specialist may wish to conduct a joint interview of the person who has MS and his or her sex partner in order to gain a better understanding of the problem as it is experienced by both individuals. A number of questions may be asked regarding the couple's communication, intimacy, and sensual or erotic behaviors in order to obtain a balanced view of their relationship. When this has been accomplished, treatment may begin with feedback from the assessment process, education about the effects of physical symptoms of MS, and suggestions for managing these symptoms.
 
Decreased vaginal lubrication
 
SIMILAR TO THE erectile response in men, vaginal lubrication is controlled by multiple pathways in the brain and spinal cord. Psychogenic lubrication originates in the brain and occurs through fantasy or exposure to sexually-related stimuli. Reflexogenic lubrication occurs through direct stimulation of the genitals via a reflex response in the sacral (lower) part of the spinal cord. Psychogenic lubrication can be enhanced by establishing a relaxing, romantic, and/or sexually stimulating setting for sexual activity, incorporating relaxing massage into foreplay activities, and prolonging foreplay.

Reflexogenic lubrication can sometimes be increased by manually or orally stimulating the genitals. Decreased vaginal lubrication can be dealt with easily by using generous amounts of water-soluble lubricants, such as Ky Jelly, Replens, or Astroglide. Health care professionals do not advise the use of petroleum-based jellies (e.g.,Vaseline) for vaginal lubrication, because they greatly increase the risk of bacterial infection.
 
Because women have erectile tissue in the clitoris, which functions similarly to the male erectile tissue, sildenafil (Viagra - see description under erectile function) has been studied in women, including those with MS, to see if this medication would help with lubrication and other aspects of the sexual response. The results of all trials with women, however, have been negative.

Having concluded that the female response is more complex and multi-determined than the male response, the manufacturers of Viagra recently terminated all trials in women. To find out more, you can check out Management Of Multiple Sclerosis.

Multiple Sclerosis Side Effects

SEXUALITY IS AN integral part of each of us. It is biologically woven throughout our cells, tissues, and organs, influencing the development and function of the brain and immune system. Sexuality impacts our identity and personality, the nature of our interpersonal relationships, and our life span. Sexuality is depicted in the language, art, laws, music, religion, literature, and culture of every human society. It is omnipresent and universal, yet we each experience it in very different ways. 
 

Multiple Sclerosis Side Effects

Our individualized experience of sexuality is a continuous process of change and development from birth to death. The presence of a physical illness such as multiple sclerosis (MS) has the potential to complicate the lifelong course of sexual development and the ways in which one defines and expresses one's sexuality.
 
Many of the early studies on the nature and frequency of sexual problems in MS were of questionable quality. In general, they included too few people to provide meaningful results, used groups that were not representative of the MS population as a whole, and did not involve comparisons with a non-MS control group. In addition, many of the early studies used poorly constructed surveys to gather the information, and tended to focus almost exclusively on men with MS.

In 1999, Zorzon and his colleagues published the first case control study of MS-related sexual dysfunction. In a comparison of 108 men and women with definite MS, 97 with other chronic diseases, and 110 healthy individuals, the investigators found that 73% of the people with MS reported some type of sexual dysfunction, as compared to 39% of those with other chronic diseases, and 13% of the healthy control group. Among the participants with MS, more men than women reported changes in sexual function.
 
The Nature and Frequency of Sexual Dysfunction in Women
 
IT IS IMPORTANT TO look at MS-related sexual problems within the context of society as a whole. Studies of the frequency of sexual complaints among women in the general U.S. population indicate that as many as 43% have problems that cause at least "occasional" concern. The few epidemiologic studies on sexual dysfunction in women with MS have reported a wide range of sexual concerns that seem to occur with varying frequencies. At least 50% of women in each of these studies reported problems or changes in their sexual functioning. The most common complaints were fatigue, a decrease in sexual desire, genital sensation and vaginal lubrication, and loss of orgasm. In several studies, a correlation was found between sexual difficulties and overall level of disability. In several of the most recent, methodologically-sound surveys, approximately 80% of women with MS reported at least one sexual problem, although over half of the women surveyed reported little concern about their sexual difficulties. 

The Nature and Frequency of Sexual Dysfunction in Men
 
IN SURVEYS OF the general U.S. population, between 5 and 30% of men under 40 report sexual problems. Studies of men over 40 have yielded more frequent complaints, with 15-52% reporting sexual problems. Chronic disease, as well as alcohol, illegal drugs, and nicotine use, are factors that are associated with an increased risk of sexual problems.
 
As with women, surveys on the prevalence of sexual dysfunction in men with MS vary widely in their findings. Difficulty acquiring or maintaining satisfactory erections seems to be the most common male complaint in MS, with frequencies ranging from 25-80% of those surveyed. These observations are noteworthy in comparison to a 5% occurrence rate of erectile dysfunction in healthy 40-year-old men in the general population, and a 15-25% occurrence rate after age 65. The combined findings of numerous studies on the causes of erectile dysfunction in MS suggest both a physical and a psychogenic (emotional) role in MS related erectile dysfunction.
 
In addition to erectile problems, surveys of men with MS have identified decreased genital sensation, fatigue, difficulties with ejaculation, and decreased interest or arousal as fairly common complaints. In the study by Zorzon and his colleagues, one of the most comprehensive and methodologically sound surveys to date, only 35% of men reported no sexual problems, and many reported multiple problems. This study also found that the majority of men who experienced sexual problems believed that these problems had a noticeable impact on their intimate relationship.
 
Primary, Secondary, and Tertiary Sexual Dysfunction
 
THE WAYS IN which MS can affect sexuality and expressions of intimacy have been divided into primary, secondary, and tertiary sexual dysfunction. Primary sexual dysfunction is a direct result of neurologic changes that affect the sexual response. In both men and women, this can include a decrease in, or loss of, sex drive, decreased or unpleasant genital sensations, and diminished capacity for orgasm. Men may experience difficulty achieving or maintaining an erection, and a decrease in, or loss of, ejaculatory force or frequency. Women may experience decreased or absent vaginal lubrication.

Secondary sexual dysfunction stems from nonsexual MS symptoms that can also affect the sexual response (e.g., bladder and bowel problems, fatigue, spasticity, muscle weakness, body or hand tremors, impairments in attention and concentration, and non-genital sensory changes).
 
Tertiary sexual dysfunction is the result of disability-related psychosocial and cultural issues that can interfere with one's sexual feelings and experiences. For example, some people find it difficult to reconcile the idea of being disabled with the idea of being fully sexually expressive. Changes in self-esteem and self-perceived body image, demoralization, depression, or mood swings can all interfere with intimacy and sexuality. Partnership changes within a relationship (i.e., one person becoming the other's caregiver) can severely challenge the sexual relationship.
 

Similarly, changes in employment status or role performance within the household are often associated with emotional adjustments that can temporarily interfere with sexual expression. The strain of coping with MS challenges most partners' efforts to communicate openly about their respective experiences and their changing needs for sexual expression and fulfillment. To find out more, you can check out Multiple Sclerosis Side Effects.

What Is The Treatment For Multiple Sclerosis

CONSIDERING THE IMMUNE-MODULATING THERAPIES

• Because MS is likely to progress without treatment, and irreparable damage can occur even early in the disease course, treatment should be considered for any person with relapsing MS even if a person is relatively symptom-free and "feeling fine."
• Early treatment improves a person's chances of reducing the attack rate and slowing disease progression over the long term.
• All of the approved treatments are beneficial; the evidence indicates that some may be stronger than others; together, your physician and you can determine the best treatment option for you. 
• While every treatment may have side effects, 90% of people can learn how to manage the treatments comfortably. If you are having difficulty with your immune-modulating medication (or any other that has been prescribed for you), do not stop taking it without talking to your physician; most problems with treatment can be successfully resolved. 

What Is The Treatment For Multiple Sclerosis

Many people with MS use various types of alternative treatments in an effort to manage their symptoms - sometimes instead of mainstream medicine, but more commonly as an adjunct to the treatments prescribed by their physicians. Alternative therapies include a broad range of treatments (i.e., dietary supplements, homeopathy, chiropractic, and many others). It is extremely important that you let your physician know about any treatments you are using, including over-the-counter medications and nutritional supplements, so that he or she can alert you to potential drug interactions or other risk factors.
 
Bringing a family member or friend to your doctor's visits can often be quite helpful. People sometimes feel anxious while talking to the doctor and find that they have difficulty focusing on what is said, and even more difficulty remembering it afterward. You might ask your relative or friend to jot down notes for you during the appointment so that you can go over them again later. This person might also be able to remind you of problems or symptoms that have sipped your mind. A family member may have questions of his or her own pertaining to your symptoms or to family issues relating to the illness. In addition to, or instead of, bringing someone with you to the appointment, you might want to tape record the conversation for later review or to share with family members.

You may hear or read about a treatment that seems relevant to your MS or to a particular symptom you are having. It is appropriate to ask your doctor whether this treatment might be helpful for you. If your doctor is not familiar with the particular treatment, it is reasonable for you to ask that he or she look into it further and give you an opinion about it. Doctors who are not MS specialists should be willing to investigate possible MS treatments or make a referral to a specialist who might be more familiar with them.
 

No matter which topics are covered in a particular visit to the doctor, you should leave feeling that you have conveyed and received whatever information is needed for you to continue managing your MS symptoms and day-to-day activities as comfortably and effectively as possible. If, at the end of your visits, you wonder what has been accomplished, it is time to think about what needs to change in order for those visits to be more productive. If every visit to the doctor is a search for "the cure," the visit is not likely to be a fruitful one. If, however, you are working with your doctor to keep your life comfortable, active, and productive, you have a much higher likelihood of success. To find out more, you can check out What Is The Treatment For Multiple Sclerosis.

Multiple Sclerosis Clinics

Taking Responsibility for Optimizing Your Medical Care
 
Choosing Your Physician And Healthcare Team

WHETHER OR NOT your choice of physician is restricted by your health plan, the most important factors in your selection should be (1) your comfort level in working and communicating with this doctor, and (2) the physician's knowledge and experience in MS. Centers that specialize in MS care are often in a position to offer a wider range of medical and psychosocial interventions. However, even the most sophisticated MS center will not meet your needs if you do not feel able to communicate and work comfortably with the healthcare team.

Multiple Sclerosis Clinics

If your healthcare plan requires you to select a primary care physician (most likely an internist, or a general or family practitioner) to act as gatekeeper for your medical care, look for a physician who currently treats other MS patients and is familiar with the complexities of the disease. He or she should be willing and able to help you manage your symptoms and knowledgeable about existing treatment options. The primary care physician should also be willing and able to refer you to a specialist when the need arises. If you are unable to find a physician within your network who is experienced in the care of MS patients, your next best option may be to find one who is willing to learn.
 
Staying Informed
 
PEOPLE WITH MS and their family members need to educate themselves about the disease and existing treatment options. In particular, those patients whose care is provided by non-MS specialists need to take responsibility for staying informed and up-to-date about MS management. This is the most effective way to ensure that you are receiving optimal care. Today, more than ever, there are numerous avenues for obtaining this kind of information, including books, newsletters, information lines sponsored by pharmaceutical companies, the Internet, and the vast array of publications offered by the MS societies. Keep in mind, however, that some sources are more authoritative than others, and that you cannot believe everything you hear. This educational process will enable you to be an active and informed participant in your own care.

TIPS FOR MAKING THE MOST OF DOCTOR VISITS

• Make a list of questions and concerns before the visit.
• Prioritize the list and discuss your most important issues first.
• Make sure that your doctor has a complete list of all the medications you are taking, including any that have been prescribed by another physician for non-MS-related conditions, and any over-the-counter drugs or supplements. 
• Bring up all your concerns - even the ones that may be difficult to talk about (e.g., bladder and bowel problems, sexual changes, cognitive changes). 
• Discuss any medication side effects you are experiencing. 
• Ask for a referral if' you would like a second opinion on any aspect of your disease or its management. 
• Consider bringing a family member or friend to your visit if you feel the need for a "second pair of ears"; consider tape recording the visit for later review. 
• Ask for more time or another appointment if you have not addressed your issues fully. 

Use Your Visits to the Doctor Effectively
 
THE DOCTOR-PATIENT collaboration is at its most active during the office visit. This is the time to give your physician the information he or she needs in order to help you manage your MS. Be prepared for your visits.
 
Because most people find it difficult to remember all the things they want to talk about, particularly when they are trying to listen to what the doctor is saying, it is a good idea to bring a list of topics and questions. Let the doctor know how current medications are working for you and what, if any, problems or side effects you are having with them. This is particularly true in relation to the approved immune-modulating therapies - the interferons (Avonex, Betaseron, and Rebif), glatiramer acetate (Copaxone), and mitoxantrone (Novantrone). 

An effective collaboration between you and your healthcare team will help to ensure that you initiate treatment at the time that you and they feel is most appropriate, and that you can continue comfortably with the treatment for the foreseeable future. 

Describe your symptoms, taking care to let the doctor know which of them are causing you the greatest difficulty. Patients are sometimes hesitant to bring up certain issues that they find embarrassing. Unfortunately, some physicians may be reluctant to bring up the very same topics. People living with MS need to know that bladder and bowel symptoms, sexual difficulties, and cognitive and emotional changes can all be significant problems related to their disease. Do not hesitate to talk about them, and do not hesitate to think about looking for another physician if you feel that you are not getting adequate help with these important problems. To find out more, you can check out Multiple Sclerosis Clinics.