Intimacy and Multiple Sclerosis
Intimacy with a loved one is an important component of a healthy, contended
life. It does not have to disappear from the lives of couples when one partner
MS can affect the experience of intimacy in a variety of ways. Some people
report changes in sexual function or feel disinterested in sexual contact. Some
women report a lack of sensation or loss of sexual desire, some men report
erectile dysfunction as being the most common problem with sexual function.
These changes in sexual function can be either a direct result of the neurologic
changes, symptomatic (spasticity or bladder problems) or can be a result of
psychosocial problems (not feeling sexually attractive due to a disability).
Sexual arousal begins in the central nervous system, as the brain sends
messages to the sexual organs along the nerve pathway in the spinal cord.
MS-related changes to these nerve pathways can directly or indirectly impair
Primary sexual effects
These symptoms can occur as a direct result of myelin breakdown in the spinal
cord or brain:
- Decreased sex drive
- Altered genital sensations (numbness, pain, increased
- Difficulty or inability to maintain erection
- Decreased vaginal lubrication
- Decreased vaginal muscle tone
- Difficulty to ejaculate
- Problems having an orgasm
Secondary sexual effects
These symptoms can arise as a consequence of MS, physical changes or
- Fatigue can suppress sexual desire
- Spasticity can interfere with sexual positioning or
- Bladder or bowel problems are closely related with
sexual dysfunction because the nerve pathways are nearby or shared.
- Sensory changes can make physical contact
Tertiary sexual effects
These symptoms result from psychological or social issues that interfere with
sexual feelings and/or response:
- Performance anxiety
- Changes in self-image or body image
Communication is key
Most of these symptoms can be identified and medications or other therapies
may be helpful. The most important way of dealing with sexual difficulties is to
discuss your feelings with your loved one. Talk is the main way we come to feel
close to another person. When MS problems begin affecting your sexual desire,
then avoiding talking can easily lead to avoiding sex. Sensory changes can make
things that used to bring pleasure can now bring pain and discomfort. Telling
your partner what feels good and what doesnít is essential for an intimate
relationship. Confiding in your partner deepens intimacy and may help resolving
fears of sexual intimacy.
Talking with your health care professional
You can make intimacy a part of your health care visit either with your
primary care physician or your MS specialist. If you have symptoms that are
interfering with sexual function, tell your health care team. If you are
uncomfortable with talking about your sexual symptoms, then write them down and
give the list to your physician or nurse. Many problems associated with
neurologic changes or symptomatic problems of MS can be medically managed.
Will MS affect my sexual desire?
As MS progresses, you may notice a decrease in sexual desire due to lack of
sensation or painful sensation, changes in bladder or bowel function, excessive
fatigue or changes in self-image.
MS can affect a manís ability to achieve or maintain an erection suitable
for intercourse and women may experience impaired sensation, numbness or
tingling in the genital area. Medications have been proven helpful for these
symptoms. If you have concerns about changes in your sexual desire, please
discuss them with your health care provider.
I am having some problems achieving an orgasm, can this be associated with
MS can interfere either directly or indirectly with orgasm. "Primary
orgasmic dysfunction" is caused from lesions in the spinal cord or brain
that directly interferes with having an orgasm. Sensation and orgasmic response
can be diminished if lesions disrupt the pathway. Indirect symptoms such as
sensory numbness or pain can also interfere with achieving an orgasm.
Treatment of orgasmic loss depends on an understanding of the factors that
are contributing to the loss. If you are having some problems achieving an
orgasm, please discuss them with your health care provider.
Copyright 1995-2005 The Cleveland Clinic Foundation. All rights reserved