SPASTICITY CAN MAKE straightening the legs, or changing leg positions for sexual activity, quite painful. Active symptomatic management of spasticity will minimize its impact on sexuality. Range of motion and other physical therapy exercises are commonly employed, as well as antispasticity medications, such as baclofen and tizanidine (Zanaflex.) Exploring alternative sexual positions for intercourse is helpful when spasticity is a problem. Women who have spasticity of the adductor muscles may find it difficult or painful to separate their legs. Changing positions (e.g., lying on one side with the partner approaching from behind) to accommodate this symptom may be important. Taking an antispasticity medication 30 minutes before anticipated sexual activity can be helpful. Be sure, however, to discuss any medication changes with your physician.
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| Does MS Cause Sexual Problems |
Weakness
WEAKNESS IS A common MS symptom that frequently necessitates finding new positions for satisfactory sexual activities. Reclining (non-weight-bearing) positions do not place as much strain on muscles and are therefore less tiring. Pillows can be used to improve positioning and reduce muscle strain. Inflatable wedge-shaped pillows (available by mail order) are specifically designed to provide back support during sexual activity. Oral sex requires less movement than intercourse, and using a hand-held or strap-on vibrator can help compensate for hand weakness while providing sexual stimulation.
Pain and other discomforts
OTHER SECONDARY SEXUAL symptoms may include pain, tingling or burning sensations, and positional discomfort. These symptoms can interfere with intimacy and sexuality by making it difficult to enjoy sexual activities or find comfortable sexual positions. Tingling and burning sensations can sometimes be relieved by an antiepileptic drug such as gabapentin (Neuronton), carbamazepine (Tegretol), or divalproex sodium (Depakote), or by an antidepressant such as amitriptyline (Elavil). Anxieties about hurting a sex partner are fairly common when there are significant changes in physical functioning. Education and discussion about MS symptoms will enable partners to air concerns while planning for sexual encounters. Conducting a "positioning exercise" before sex is attempted will help determine if the new positions are comfortable and feasible without introducing anxiety during sexual activity.
Distractibility
SUSTAINED ATTENTION AND myotonia (increasing muscle tension) are usually required for sexual feelings to build progressively toward orgasm. MS can cause impairment of attention and concentration that may interfere with maintaining sexual desire during sexual activities. This may, in turn, lead to feelings of rejection or inadequacy in the partner and guilt in the person with MS. Accepting distractibility as a valid MS symptom and discussing ways to help compensate for it are crucial steps toward finding a solution.
Attention and/or concentration problems tend to be worse when a person is fatigued, so evaluating the person's fatigue level and compensating accordingly are vitally important. The main strategy to deal with distractibility is to minimize nonsexual stimuli and maximize sensual and sexual stimuli. Creating a romantic mood and setting, using sensual music and lighting, talking in sexy ways, and engaging in erotic touching provide multisensory stimuli that minimize "cognitive drift" during sex. Introducing humor at those moments when the person "loses attention" allows mutual acceptance of this frustrating symptom and helps minimize its impact.
In summary, there are several approaches to managing secondary sexual problems in MS. First, it is important to become familiar with the MS symptoms and treatments that affect sexual functioning. Information can be obtained directly from physicians, nurses, or other health professionals who are involved in the care of people with MS, or from MS literature.
In addition, a wealth of knowledge can be found by speaking casually with others via MS chat rooms and bulletin boards on the Internet or through local support groups and other activities run by and for individuals who have MS. Information about support groups, the Internet, and other MS-related information can be found by contacting your chapter of the Multiple Sclerosis Society in the United States or Canada or the office of the International Federation of Multiple Sclerosis Societies in London, England.
Second, it may be helpful to utilize various pharmacologic approaches in managing secondary sexual dysfunction. A physician who is competent in the care of individuals with MS may be able to prescribe medications to alleviate the symptoms that hinder sexual enjoyment. In addition, a physician can help modify treatment regimens to best accommodate sexual needs.
Last, planning for intimacy and modifying sexual activities can be quite beneficial. Although planning for sexual activity may initially take away some of the romance and spontaneity, it will eventually lead to a more positive, satisfying sexual experience.
Planning for intimate activity and altering familiar sexual behaviors can sometimes be emotionally frightening or uncomfortable. It is easier to adapt to these modifications by having open communication and flexibility within the relationship. Counseling can be helpful in maintaining intimacy by assisting couples to discuss these issues with one another and encouraging the exploration of new approaches to intimate and sexual communication. To find out more, you can check out Does MS Cause Sexual Problems.