Multiple Sclerosis Sexual Dysfunction

BODY MAPPING EXERCISE 

The following steps explain the exercise:

1. Conduct the exercise (initially by oneself) lying down naked in a comfortable, safe, distraction-free setting (e.g., bedroom). Begin by gently touching the top of the head with the fingertips, noticing the sensations. Systematically move down the face and head, and then the body, slowly touching as much of oneself as is comfortable. Take notice of all sensations, and vary the pace and pressure of the movements with the goal of learning what feels pleasurable and what does not. Do not be overly concerned about feeling sexual, and do not attempt to reach orgasm. The purpose is to explore yourself and to develop an enhanced sensual awareness of pleasurable touch.
 

Multiple Sclerosis Sexual Dysfunction

Many people may initially experience sadness or irritability when they conduct the exercise, as they process the sense of emotional loss associated with libido changes, particularly when they stroke their genitals. Some find it helpful to conduct the exercise in front of a mirror in order to provide additional visual feedback. Conduct the exercise for 15 to 20 minutes approximately twice a week.

2. Include the partner after the first few sessions of self exploration. When libido diminishes or is absent, the sequence of communications around sexual behaviors for partners almost always needs to change as well. Conducting the body mapping exercise for the purpose of improving communication (rather than for immediate sexual gratification) allows the parthers to develop new sequences of touch that are mutually pleasing. It also allows for communicating about the emotions associated with this process. Partners should be instructed verbally (e.g., "stroke me lightly on my neck with just your fingertips") and non-verbally (e.g., taking the partner's hand and guiding it to a pleasurable place, demonstrating the pace and pressure of the desirable touch). For the first two or three times the partner is included, touching the genitals should be avoided.
 
3. Expand the body mapping exercise with the partner to include stimulating the genitals. The focus should remain on communication and the restoration of pleasure, without the goal of having intercourse or achieving orgasm.

4. If he or she is physically able, the person with MS should reciprocate by conducting a body mapping exercise on the partner. This introduces mutual communication and sensual pleasure during the process of relearning cues associated with sexual pleasure. Partners can take turns, spending 15 to 20 minutes each, as "givers" and then "receivers" of pleasure. In the role of receiver, the goal is to suspend the usual concern for the partner's pleasure and focus on communicating to the partner how he or she can provide maximal pleasure. 

Similarly, in the role of giver, the goal is to be maximally attentive and completely devoted to following the cues and feedback offered by the partner. Changing one's sexual signals or cues to initiate sexual activity can be assisted by conducting a body mapping exercise. Body mapping is typically used to help compensate for primary (genital) or secondary (nongenital) sensory changes, but it can be a useful first step in the enhancement of physical pleasure and emotional closeness, as well as sexual communication and intimacy.
 
5. If the exercise elicits significant emotional distress or couples find that they have a great deal of difficulty communicating during the exercise, professional counseling can often assist in resolving the interfering issues.
 
Women and men report that diminished libido is frequently associated with a decrease in sexual fantasies. Diminished libido on sometimes be stimulated by increasing sexual imagery and fantasy. Historically, most sexual literature, videos, and magazines have been developed to appeal to a male rather than female audience. Recently, however, some sexual videos are being marketed to appeal to couples and women. They typically include fewer close-ups of genitals during orgasm and have more emotional and romantic content and imagery. 

When libido is partially intact but difficulty sustaining arousal and/or having orgasms occurs, sharing sexual fantasies or watching sexually-oriented videos together may help sustain arousal. Similarly, introducing new kinds of sexual play into sexual behavior can help maintain arousal and trigger orgasms. To find out more, you can check out Multiple Sclerosis Sexual Dysfunction.
 

MS Sexual Dysfunction In Women

Restoring libido in the context of an intimate relationship begins by focusing on the "sensual" and the "special person" of the relationship. Sensual aspects include all physically and emotionally pleasing, non-erotic contact, such as backrubs, handholding, and gentle stroking of the face, arms, and other nongenital body zones. During periods of diminished sexual drive, sex partners often neglect these sensual, non-sexual aspects of their physical relationship. 
 

MS Sexual Dysfunction In Women

Making a date for a non-sexual but sensual evening can enable partners to enjoy each other physically and engage in enjoyable sensual exploration of each other's bodies without the pressure of working toward sexual intercourse. In essence, sexuality has to be "relearned" when the central nervous system has compromised libido. Relearning one's sensual nature is a critical first step in the process.
 
The special person aspects of a relationship include all those behaviors that one engages in to show the other person that he or she is special and important. Loving gestures from an earlier, "romantic" phase of a relationship, such as unexpected flowers, a surprising note in a lunch bag, or a spontaneous, affectionate hug, tend to be forgotten amidst the pressures of raising children, developing careers, and coping with MS symptoms and disabilities. Restoring or increasing these special acts toward one another can help set the stage for increasing intimacy which can, in turn, stimulate new libido.

For the person without a current sexual partner, exploring one's sensual and erotic body zones is an important step in restoring libido. Combining enjoyable cerebral sexual stimulation (achieved via fantasy, sexually explicit videos, books, and so forth) with masturbation or sensual, physical self-exploration is sometimes helpful. Using a vibrator or other sexual toys may complement these efforts. Although beginning to work on restoring libido may feel like an unrewarding "'chore" when there is no intrinsic sex drive, working toward rekindling this vital aspect of "self" can be an important aspect of coping with MS.

Kegel exercises are sometimes prescribed to enhance female sexual responsiveness (although these exercises have not been tested in a clinical trial to determine whether they are helpful in MS). To perform the Kegel exercise, the woman alternately tightens and releases the pubococcygeus muscle (identifiable as the muscle that starts and stops the urine flow in midstream).

Exercising this muscle several times a day is recommended in an effort to enhance muscle tone and responsiveness. The rationale for Kegel exercises is that sensation from the muscles around the vagina is an important part of erotic sensation, and female orgasm consists of contractions in several of these muscles.

Currently there are no medicines available to treat loss of libido in women with MS, although there are several medicines in preclinical and phase 1 clinical trials that are being tested to see if they will enhance libido in women without MS. These medicines work by stimulating different pathways and structures in the brain that seem to be related to sexual drive and desire. However, it will take a number of years before it is known whether they are safe and effective.

Some men and women who have sustained loss of libido report that they continue to experience sexual enjoyment and orgasm even in the absence of sexual desire. They may initiate sexual activities without feeling sexually aroused, knowing that they will begin to experience sexual pleasure with sufficient emotional and physical stimulation. This adaptation requires developing new internal and external "signals" associated with wanting to participate in sexual activity. In other words, instead of experiencing libido or physical desire as an internal "signal" to initiate sexual behaviors, one can experience the anticipation of closeness or pleasure as an internal cue that may lead to initiating sexual behaviors and the subsequent enjoyment of sexual activity. To find out more, you can check out MS Sexual Dysfunction In Women.

MS Sexual Side Effect

Sensory Changes
 
UNCOMFORTABLE GENITAL SENSORY disturbances, including burning, pain, or tingling, can sometimes be relieved with prescription medications such as carbamazepine (Tegretol) or phenytoin (Dilantin) .The application of a cold compress prior to sexual activity can sometimes suppress uncomfortable sensations.

MS Sexual Side Effect

Decreased vaginal and clitoral sensation can sometimes be overcome by more vigorous stimulation, either manually, orally, or with the use of a vibrator. Strap-on clitoral vibrators may be worn by the woman or attached to the base of the penis during intercourse, allowing for more intense clitoral stimulation. In general, AC electric plug-in vibrators have more powerful motors and are more stimulating than DC-powered battery-operated ones.
 
However, some electric vibrators are quite powerful and can irritate vaginal or clitoral tissue if they are applied too vigorously, (A large selection of vibrators and other sexual aids have become more readily available in recent years due to the proliferation of mail-order services that allow people to shop conveniently and privately at home. Some mail-order companies are sensitive to the needs of people with physical disabilities and can be good sources of information for selecting sexual aids.) 

Exploring alternative sexual touches, positions, and behaviors, while searching for those that are the most pleasurable, is often very helpful. Masturbation with a partner observing or participating can provide important information about ways to enhance sexual interactions.

Problems with orgasm
 
MS CAN INTERFERE directly or indirectly with orgasm. Primary orgasmic dysfunction stems from MS lesions in the spinal cord or brain that directly interfere with orgasm. In women and men, orgasm depends on nervous system pathways originating in the brain (the center of emotion and fantasy during masturbation or intercourse), and pathways in the upper, middle, and lower parts of the spinal cord (which control sensations from erogenous zones such as lips, nipples, penis or clitoris, and so forth). 

If these pathways are disrupted by plaques, sensation and orgasmic response can be diminished or absent. In addition, orgasm can be inhibited by secondary (indirect) symptoms, such as sensory changes, spasticity, cognitive problems, and other MS symptoms. Tertiary (psychosocial or cultural) orgasmic dysfunction stems from anxiety, depression, and loss of sexual self-confidence or sexual self-esteem, each of which can inhibit orgasm.

Treatment of orgasmic loss in MS depends on understanding the factors that are contributing to the loss. If sensation is disturbed in the genitals and lower body areas, increasing stimulation to other erogenous zones, such as breasts, ears, and lips, may enhance the orgasmic response. Conducting a sensory "body map" with one's partner, to explore the exact locations of pleasant, decreased, or altered sensations, can be both intimate and informative. 

Sometimes stimulating the edges of body zones that are experiencing numbness or diminished sensation can feel sensually or erotically pleasing. Similarly, increasing cerebral stimulation by watching sexually oriented videos, exploring fantasies, and introducing new kinds of sexual play into sexual activities can help trigger orgasms.
 
Decreased libido
 
ONE OF THE most difficult primary sexual symptoms to compensate for is loss of sexual desire (libido), which is one of the most common sexual changes among women with MS. When loss of desire is due to secondary sexual dysfunction (e.g., as a result of fatigue) or tertiary sexual dysfunction (e.g., as a result of depression), treatment of the interfering secondary or tertiary symptoms frequently restores libido. When a person's libido is diminished by MS, he or she may begin to avoid situations that were formerly associated with sex and intimacy.

Sexual avoidance serves as a source of misunderstanding and emotional distress within a relationship. The partner may feel rejected, and the person with MS may experience anxiety, guilt, and reduced self-esteem. Misunderstandings surrounding sexual avoidance frequently compound the loss of desire and diminish emotional intimacy in relationships. To find out more, you can check out MS Sexual Side Effect.
 

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.