Sexual relations are a sensitive — and difficult — topic for people with MS, just as they are for people in general. But in multiple sclerosis, damage to nerve impulses can directly affect arousal and orgasm, while spikes in symptoms like emotional stability and moodiness, or fatigue or spasticity, can make mutually satisfying sexual relations between adults somewhat challenging.
Sexual arousal begins in the central nervous system, with messages to sexual organs originating in the brain and running through the spinal cord. Because nerve pathways in MS can be damaged to the point where they disrupt the flow of these messages, problems with arousal and orgasm can be common. Surveys, in fact, suggest that more than 90 percent of men and 70 percent of women are aware of, and affected by, such problems during sex.
Sexual problems and women
Women may experience reduced or painful sensation in the vaginal/clitoral area, or vaginal dryness. Although no specific medications are available for these symptoms, vaginal dryness can be relieved with liberal use of water-soluble lubricants like KY-Jelly (but petroleum jelly — brand name, Vaseline — is not recommended; it is not water-soluble and can cause infections).
Problems with orgasm may be overcome by stimulating sensitivity — spending more time on foreplay and using a vibrator to overcome slow arousal and impaired sensation.
Sexual problems and men
Men commonly are afflicted with problems in achieving or maintaining an erection. About 70% of men with MS experience erectile difficulties within years of the first appearance of MS symptoms.
Depending on the extent and location of nerve damage, other problems can include a reduced sensation in the penis and difficulty ejaculating. No treatment exists for difficulties with ejaculation or orgasm, as these processes are much more complex than erection, and require healthy and intact connections between the spinal cord and brain.
Treatments for erectile dysfunction range from oral medications, such as Viagra (sildenafil), Levitra (vardenafil) or Cialis (tadafil), that work by enhancing blood flow to the penis to increase erectile responses — although not all men find these effective — to injectable medications such as papaverine and phentolamine, which also increase blood flow to the penis. Other options include the MUSE system, which is a small suppository inserted into the penis, vacuum devices, or implants.