Multiple Sclerosis Presents Challenges to Sexual Health
When Matt Cavallo was first diagnosed with multiple sclerosis (MS) in 2005, he was nonfunctional from the waist down. For about 90 days, Cavallo, now 46 years old, could not get an erection.
"I was devastated at the time because I had been married for only three years and I thought my dreams of becoming a dad were over," the Phoenix resident said. "Luckily for me, everything went back to normal after those 90 days, and I was able to get an erection again. Two years later, my oldest son was born."
Though his erectile dysfunction (ED) resolved, Cavallo started experiencing a lack of sexual desire.
"Whether it was from the MS fatigue or because I was just not feeling great, sex was something that I lost interest in," said Cavallo, an advisory panel member of the Multiple Sclerosis Foundation, also known as MS Focus. "I also lost confidence. I think when you are not feeling confident and you feel sick or lethargic each day, it is tough to get in the mood for sex."
While sexual complications are common in people with MS, Cavallo believes men with MS can still have fulfilling sex lives.
"Communication is the key," he said. "Your partner does not understand that there is a problem unless you tell them about it. If you cannot talk to your neurologist or doctor about your sexual dysfunction, then you probably have the wrong doctor. Your doctors can provide guidance and prescribe medication if needed."
A multiple sclerosis explainer
MS is a potentially disabling chronic disease that affects the central nervous system. The disease occurs when the immune system attacks myelin—the protective sheath of fatty substance that surrounds nerve fibers—in the brain and spinal cord. This causes communication problems between the brain and the rest of the body and can lead to permanent damage to the nerves.
The disease can cause issues with balance, muscle control, vision and other everyday bodily functions. The effects vary widely; some patients may have mild symptoms and not even need treatment, while others may have difficulty moving and completing basic tasks.
A complex interaction of genetics and environmental factors leads to multiple sclerosis, according to Ben Thrower, M.D., the medical director of the MS Institute at Shepherd Center in Atlanta and a senior medical advisor to MS Focus.
"While genetics contribute to the development of MS, it is not a strongly hereditary disease," Thrower explained. "Most people with MS cannot identify any family members with MS. Environmental factors include common viral infections, especially EBV [Epstein-Barr virus] and low vitamin D levels."
How MS impacts sexual function
MS is three to four times more common in women than in men, but men who have it are likely to experience sexual issues. In addition to ED, men with multiple sclerosis may experience delayed orgasm and a decrease in libido.
"Sexual dysfunction may result from many different issues in a man with MS," Thrower said. "The disruption of electrical pathways from MS demyelination can affect both erections and orgasms. The problem is much more complex, however. Psychological factors, including depression, changes in relationship roles and vocational changes, may all contribute as well."
As if the disease's effects aren't bad enough, medications to treat it may also have side effects that influence sexual function. These medications can be divided into three categories:
- Those that treat acute relapses
- Those that manage symptoms
- Those that prevent future disease activity
"In my experience, the highest risk for sexual side effects is seen with some of our symptomatic therapies," Thrower said. "Some antidepressants may result in delayed orgasm or erectile dysfunction. Many symptomatic medications can cause drowsiness that may interfere with sex."
Thrower noted that a diagnosis of MS does not automatically mean a man will have problems with sex, and many men with MS do not have any sexual complications.
"MS varies tremendously from person to person, and we have far more treatment options now than we did in the past," he said.
MS symptoms can make sex challenging
While sexual complications can be linked to MS, the symptoms of the disease may also cause trouble with the act of sex itself. Common symptoms such as fatigue, spasticity, abnormal sensations, pain, and bladder and bowel dysfunction can all negatively impact a man's sex life.
"Someone with abnormal sensations like numbness may find it more challenging to feel aroused," said Julie Fiol, a registered nurse in Bel Air, Maryland, and the associate vice president of clinical innovation and strategy for the National MS Society in New York City. She added that arousal could be challenging or impossible for someone with chronic pain. "Sex also requires vulnerability and confidence. Someone who experiences bladder and bowel dysfunction might be focused or worried about an untimely accident and unable to feel relaxed enough for arousal or orgasm."
Cavallo has not been affected by spasticity or abnormal sensations that restrict his ability to have sex. However, in times when he suffered severe MS relapses that affected his mobility, he was focused more on improving his symptoms than on intercourse.
But fatigue is the most bothersome symptom for many men with MS, according to Thrower.
"Fatigue can sometimes be worsened with exertion or overheating, both of which can be a normal result of sexual activity," he said.
Treatment and guidance for men with MS
Managing sexual issues requires a comprehensive and integrated approach for men with MS, Thrower explained. While PDE5 inhibitors such as sildenafil and tadalafil may help with ED, the problem is sometimes more complex and requires more treatment options.
"Through a good history, we try to sort out both the physical and psychological contributors to the problem and address each," he said. "Urologists have medications and even surgical options beyond our first-line medications. We also emphasize that sex is bigger than just the physical act and that intimacy is vital as well."
Fiol said it's important that men with multiple sclerosis and sexual complications realize they are not alone. Those issues are common among the general population, and even more so among people with MS.
"Learn about factors that can worsen sexual problems, like specific MS symptoms and medications," Fiol advised. "Work with your healthcare provider to manage your symptoms and learn how to safely adjust your medications if they are contributing to your sexual problems."
Cavallo stressed the importance of communication—both with your sexual partner and your medical provider.
"While it is hard to talk about this kind of sexual dysfunction with your partner, you'll find that once you do, it will strengthen your relationship and your partner's understanding of what you are going through with your MS journey," he concluded.
Taking that first step toward talking with someone, whether that's your partner or a healthcare professional, can be difficult. Telehealth makes it easier to find a professional who will listen, either on a phone call or a video appointment, which physicians and therapists have added as a service. Giddy telehealth makes it convenient to get connected to a qualified healthcare professional who can help with a variety of conditions.