IN MULTIPLE SCLEROSIS (MS), the incidence of fatigue, muscle tightness or spasms, bladder and bowel dysfunction, and pain, burning, or other discomfort can have adverse effects on the experience of sexual activity. The interference of these symptoms with sexual function can often be alleviated by taking an aggressive approach to symptom management. A significant part of managing secondary sexual dysfunction is to become well educated about the nature, causes, and treatments of those MS symptoms that affect sexual functioning.
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| Secondary Sexual Dysfunction In MS |
Fatigue
ONE OF THE most common secondary sexual symptoms in MS is fatigue. Fatigue greatly interferes with sexual desire and the physical ability to initiate and sustain sexual activity. Fatigue can be managed in a number of ways. It is often helpful to set aside time in the morning for sexual activity, since this is usually when MS fatigue is at its lowest ebb. Energy conservation techniques (e.g., taking naps and using a motorized scooter or other ambulation aids) can preserve the energy needed for sexual activities.
Choosing sexual activities and positions that are less physically demanding or weight-bearing for the partner with MS may minimize fatigue during sex. In addition, a physician can prescribe a medication such as modafinil (Provigil) or amantadine to help minimize fatigue. As you try to initiate some of these changes in your sexual life, be aware that they require open communication and a willingness to engage in some trial-and-error exploration. If you or your sexual partner find it difficult to communicate about alternatives, counseling may be helpful.
Bladder and bowel symptoms
PHARMACOLOGIC INTERVENTIONS HAVE also been used to manage bladder and bowel symptoms in MS. Some common symptoms of bladder dysfunction include incontinence, urgency, and frequent urination. Anticholinergic medications help manage incontinence by reducing spasms of the bladder and the urethra. One side effect of bladder medications, however, is dryness of the vagina. As previously mentioned, vaginal dryness can be alleviated with generous amounts of a water-soluble lubricant (e,g,, K-Y Jelly). A physician may be able to help modify daily medication schedules to maximize benefit and minimize negative side effects at the time of planned sexual activity.
Sexual interest is frequently inhibited by fear of bladder or bowel accidents during sexual activity. It is important for partners to openly discuss their concerns about incontinence with one another. Most partners are willing to "take the chance" after they have been informed of the issues and educated about the measures that are being taken to manage the problem. By strategizing together, and with the healthcare team, couples can minimize the risk of incontinence during sexual activity, thereby increasing their relaxation and pleasure.
The partner who has MS may need to tailor his or her symptomatic management strategies to allow for anticipated sexual activity. If, for example, a person is taking anticholinergic medications for bladder storage dysfunction, it may be advisable to take the medication 30 minutes before anticipated sexual activity in order to minimize bladder contractions. Because these medicines increase vaginal dryness, a woman may need to compensate by using a water-soluble lubricant. Restricting fluid intake for an hour or two before sex and conducting intermittent catheterization just before sexual activity will also minimize incontinence. For men who are concerned about small amounts of urinary leakage, wearing a condom during sex is advised.
If an indwelling catheter is used, healthcare providers may be able to offer tips for handling or temporarily removing catheters. If a woman needs to keep the catheter in place, she can move it out of the way by folding it over and taping it to her stomach with paper tape. It is a good idea to experiment with different sexual positions and activities to find those that feel the most comfortable with the catheter in place. The book Choices: A Guide to Sex Counseling with Physically Disabled Adults offers illustrations of positions for sexual intercourse that are most beneficial for managing catheters and a wide range of physical limitations. Many people put a plastic mattress pad on the bed and keep towels handy to wipe up any leaks or accidents.
The fear of losing bladder or bowel control during sexual activity, or feeling that one is unattractive because of MS-related equipment or physical symptoms, can inhibit sexual desire and increase feelings of vulnerability and anxiety. Having frank and open discussions with a sexual partner about bladder or bowel dysfunction before engaging in sexual activity may remove some of the fear about losing control and allow for a more enjoyable sexual experience. To find out more, you can check out Secondary Sexual Dysfunction In MS.