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 has MS.

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 sexual functioning.

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 sensitivity)
• 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 treatments:

• Fatigue can suppress sexual desire
• Spasticity can interfere with sexual positioning or cause pain
• Bladder or bowel problems are closely related with sexual dysfunction because the nerve pathways are nearby or shared.
• Sensory changes can make physical contact uncomfortable.
• Pain

Tertiary sexual effects
These symptoms result from psychological or social issues that interfere with sexual feelings and/or response:

• Depression
• 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 doesn’t 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 man’s 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?
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.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/.

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