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.
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| 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.