Sexual Dysfunction Impacts in Multiple Sclerosis

Sexual dysfunction affects up to two thirds of people with multiple sclerosis (MS), spanning both genders and all disease courses. Symptoms arise from demyelinating lesions in central pathways (primary factors), secondary complications such as spasticity, pain and bladder dysfunction, and tertiary influences including depression, fatigue and relationship stress. Common manifestations include diminished libido, arousal difficulties, orgasmic disorders, erectile dysfunction and dyspareunia, all of which significantly reduce quality of life and intimate satisfaction. Underreporting is widespread, owing to communication barriers, stigmatisation and lack of clinician awareness. Disability level, mood disturbances and fatigue severity correlate strongly with sexual health outcomes, suggesting bidirectional interactions. Management demands a multidisciplinary approach, integrating neurological assessment, urological or gynaecological evaluation, psychological support and tailored rehabilitation. Pharmacological remedies, particularly phosphodiesterase-5 inhibitors in men and hormone therapy in women, show promise alongside pelvic floor training and cognitive–behavioural interventions. Despite growing recognition, gaps persist in understanding the long-term effects of disease-modifying therapies on sexual function and in establishing routine screening protocols. Enhanced clinical guidelines and patient education are essential to mitigate the global burden of sexual dysfunction in MS.

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Sexual Dysfunction Impacts in Multiple Sclerosis publication trend

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Technical terms

Expanded Disability Status Scale (EDSS): A quantitative scale from 0 (normal) to 10 (death) assessing neurological impairment and ambulation in MS.

Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19): A self-reported measure of primary, secondary and tertiary factors affecting sexual function in MS.

Female Sexual Function Index (FSFI): A validated questionnaire evaluating female sexual function across six domains: desire, arousal, lubrication, orgasm, satisfaction and pain.

Disease-Modifying Therapies (DMTs): Treatments designed to alter the natural history of MS by reducing relapse frequency and slowing disability progression.

Phosphodiesterase-5 (PDE5) Inhibitors: Medications that enhance erectile function by increasing penile blood flow through cyclic GMP preservation.

References

1. Male sexual and reproductive health in multiple sclerosis: a scoping review. Journal of Neurology (2024).
2. Prevalence and risk of developing sexual dysfunction in women with multiple sclerosis (MS): a systematic review and meta-analysis. BMC Women's Health (2023).
3. Assessment of sexual dysfunction in patients with multiple sclerosis: a perspective from neurologist. BMC Neurology (2022).