Intimacy and Multiple Sclerosis
Intimacy and Multiple Sclerosis
From:Inside MS. Wntr-Spring 1996; 14(1)
By:Joyce Hendley

When you first learned about having MS, your doctor probably explained that some days would be better than others. But chances are you weren't prepared for one of the most troubling aspects of MS - its effects on your sex life.
In a recent study from the University of Rochester School of Medicine and Dentistry, 63 percent of people with MS reported their sexual activity had declined since their diagnosis. Other surveys suggest that as many as 91 percent of men and 72 percent of women with MS may be affected by sexual problems.
"There are primary effects, directly caused by MS lesions, and secondary effects - physical symptoms that occur in response to MS, such as fatigue or pain," said Frederick Foley, Ph.D., a psychologist at the St. Agnes Hospital MS Center in White Plains, New York. "Both kinds can affect intimacy."
The primary effects start with the nervous system, where sexual arousal begins, as the brain sends messages to the sexual organs along nerves running through the spinal cord. If MS damages these nerve fibers, sexual response can be affected, too. And just as with other aspects of MS, sexual problems can arise at any time, without any clear cause.
In Women, Direct Symptoms Include:
Changes in sensations in the vaginal area - becoming either less or more sensitive
Trouble reaching orgasm
Vaginal dryness or reduced vaginal lubrication
In Men, Direct Symptoms Include:
Difficulty or inability to, get an erection (by far the most common problem)
Less sensation in the penis
Difficulty or inability to ejaculate
In both sexes, secondary effects arise as a consequence of other MS symptoms. Spasticity, for example, might cause cramping - or adductor spasms can pull the thighs together and make them difficult to separate. Pain syndromes can make response unpredictable, suddenly making what once felt stimulating feel painful. Embarrassment caused by bladder or bowel incontinence, or the presence of an indwelling catheter, can stifle sexual interest. Weakness and fatigue can be additional barriers.

The Mind-Body Connection
Less easy to document, but every bit as devastating, are psychosexual problems. Stress, depression, or grieving can cause anyone to have a reduced interest in sex - and who with MS has not experienced these feelings at some time?
Sarah, who underwent several abdominal surgeries for uterine fibroids shortly after her MS was diagnosed, found that the stress of surgery compounded by depression and fears about the future of her MS - conspired to push thoughts about sex to the back burner: "I just stopped thinking sexually," she said. Likewise, Bill, her husband, began to feel more like a caretaker than a sexual partner.

The pressures of work - or of not being able to work - can also take their toll on sex life. Steve, a lawyer, lost his job when he became unable to walk - and with it, his role as a breadwinner: "I'm not contributing much to the household," he claims. Sexual relations between him and his wife have been "basically zero" since that time, he said.
"A disability shatters our image of ourselves," said Sandra Cole, Ph.D., Director of the Sexuality Training Center at the University if Michigan Medical Center in Ann Arbor. "Changes in how the body looks, loss of independence, diminishment of a traditional role - all of these can impact on our image of ourselves as sexual beings."
Also at work are "asexual stereotypes" - the ones that characterize people with disabilities as being incapable of and uninterested in sex, according to Margaret Nosek, Ph.D., an Associate Professor at Baylor College of Medicine in Houston. Dr. Nosek is studying the impact of physical disability on sexuality in women. She has found that doctors may perpetuate these perceptions.

"I've interviewed many women who reported that they were treated by their doctors as if they had no interest in sex, no potential for marriage," Nosek said.
Copyright © 1996 National Multiple Sclerosis Society. Copyight © 1996 Information Access Company