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| 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.