Sexual problems with multiple sclerosis
Fact-checked by Multiple sclerosis (MS) can affect regions of the brain and spinal cord involved in regulating sexual function, which means there is a close link between sexual problems and MS.
When inflammation and nerve damage interfere with the communication between the brain and sexual organs, patients may experience issues such as reduced genital sensations, decreased sexual desire, and difficulties with erection or orgasm.
Beyond direct nerve damage, sexual well-being in MS can also be impaired by other MS symptoms, medication side effects, and mental health challenges. Together, these factors make sexual dysfunction a common symptom of MS.
Research suggests that a majority of people with MS  — about 40% to 80% of women and 50% to 90% of men — experience some type of sexual problem.
While these issues can affect confidence, relationships, and overall quality of life, open communication and appropriate care can make a meaningful difference in maintaining a fulfilling sex life.
Causes of sexual dysfunction in MS
Sexual dysfunction in people with MS can arise for several reasons, which are traditionally grouped into primary, secondary, and tertiary causes.
Primary causes
Primary sexual dysfunction occurs when the disease directly disrupts neurological processes that regulate sexual function.
Sexual arousal begins in the brain and is transmitted via nerves in the spinal cord down to the sexual organs. Damage that interferes with these signaling pathways can lead to sexual problems, which can vary depending on the affected region.
For example, damage in certain brain regions may lead to diminished sexual desire (low libido) or difficulties achieving arousal or orgasm, while spinal cord damage can reduce sensation in the genitals and cause erectile dysfunction.
Hormonal changes that occur in MS may also disrupt sexual responses.
Secondary causes
Secondary sexual dysfunction arises due to other MS symptoms or medication side effects that don’t cause direct nerve damage but create physical barriers that make sexual activity more difficult.
Some MS symptoms that can interfere with sexual satisfaction include spasticity, muscle weakness, fatigue, pain, and bladder and bowel problems. Some medications used to manage MS symptoms, particularly certain antidepressants, can also affect sexual arousal and cause sexual dysfunction.
Tertiary causes
Tertiary causes involve the psychological and social effects of living with MS, which can significantly interfere with sexual desire, performance, and satisfaction.
These may include changes in body image due to MS, depression, anxiety, and reduced self-esteem, as well as fear of being rejected. Factors such as gender identity, sexuality, or cultural background could also have an impact, although research in this area remains limited.
Challenges of sexual dysfunction in MS
Because MS can disrupt both the physical and emotional parts of the sexual response cycle, patients may face a wide range of challenges. The sexual response cycle is a sequence of events that starts with desire (libido or excitement), followed by physical arousal, orgasm, and resolution, or when the body returns to its normal state.
While decreased or absent sexual desire is a common symptom reported by both men and women, other issues often vary by gender.
Common sexual challenges in men with MS may include:
- erectile dysfunction, or problems achieving or maintaining an erection
- altered genital sensations, including numbness, pain, or oversensitivity
- delay or inability to achieve orgasm or ejaculation
Common sexual issues in women with MS include:
- vaginal dryness
- difficulty achieving orgasm
- pain or discomfort during sex
- loss of genital sensations, or genital numbness
Managing sexual health
Talking about sexual problems can feel uncomfortable, but open and honest communication — both with a sexual partner and the healthcare team — is an important first step toward finding solutions.
Many strategies can help people with MS experience sexual desire, arousal, and satisfaction, depending on the underlying cause of the problem.
Approaches that may help include:
- medications, injections, or penile pumps to help individuals get and maintain an erectionÂ
- personal lubricants to help with vaginal dryness and pain during sex
- vibrators or clitoral pumps to enhance arousal or physical sensationÂ
- exploring different types of sexual activity and forms of intimacy, such as kissing and cuddling, which may help make sexual experiences more satisfying
- identifying what feels good through strategies like body mapping or masturbation
- counseling or therapy, including couples or sex therapy, to discuss problems and navigate potential solutions
- physical therapy, especially for managing symptoms of MS such as spasticity, pain, weakness, or bladder and bowel issues that can interfere with sexual activity
- adjusting medications such as antidepressants that may have sexual side effects, under the guidance of a healthcare professional
Currently, there is not sufficient evidence to definitively establish whether MS disease-modifying therapies have a beneficial effect on sexual function.
Because both sexual problems and MS are highly individual, what works for one person may not work for another. People with MS should work closely with their care team and sexual partners to create a plan that helps them have a healthy, satisfying sex life.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
