Sexual Dysfunction Common in Men with MS, Review Finds

Sexual dysfunction affects more than 60% of adult men with multiple sclerosis (MS), according to a review study.

The data add to previous findings showing that more than two-thirds of women with MS also experience these problems, highlighting the importance of detecting and managing sexual dysfunction in this patient population, the researchers noted.

The review study, “Prevalence of sexual dysfunction in men with multiple sclerosis: a systematic review and meta-analysis,” was published recently in the journal Systematic Reviews.

“Because of the significant relationship between sexual dysfunction and both physical and psychological disorders, MS symptoms can lead to different types and ranges of sexual dysfunction,” the researchers wrote.

Several studies have pointed out that sexual problems — affecting sexual desire, arousal, erection, orgasm, and pain — are highly common among MS patients, regardless of gender. Notably, women with MS also were found to be at a higher risk of sexual dysfunction than those without the disease.

Still, most MS patients do not discuss such problems with their physicians or healthcare providers, leaving them unaddressed and ultimately affecting the patients’ mood, relationships, daily functioning, and quality of life.

Sexual function is “an essential component of quality of life, and sexual problems such as erectile dysfunction and ejaculation disorders have been shown to be significantly associated with decrease of life satisfaction, mood disorders, and quality of relationship,” the researchers wrote.

As such, determining the frequency and nature of dysfunction in MS patients may help to raise awareness of these common problems and to open comfortable channels of communication between patients and physicians to address these issues and improve patients’ quality of life.

Researchers in Iran now have estimated, for the first time, the general frequency of all types of sexual dysfunction in adult men with MS. They systematically reviewed published studies up to December 2019 reporting the prevalence of any form of these impairments among these patients.

From a total of 351 hits, 89 studies were assessed for eligibility, and 20 of them — covering a total of 2,735 men — were included in the meta-analysis. The studies were published between 1996 and 2019 and most were conducted in European countries.

Studies varied for men’s age (mean of 32.6 to 51 years) and disease duration (mean of four to 17 years), as well as for the method of assessing their sexual problems — most often involving self-administered questionnaires (60% of studies). Of note, the two international studies included in the analysis were based on online surveys.

Results showed that sexual dysfunction was reported by 31% to 92% of the men in the group analyzed and that its pooled frequency was 62.9%.

Five studies assessed erectile dysfunction only — suggested by some studies as the most frequent sexual problem in these patients — and revealed that it was reported by 33.7% to 89% of men with MS.

In addition, the team found no significant association between sexual problems and men’s age, disease duration, or disability, which was consistent with findings from most previous studies.

However, they differed from what was previously reported for female patients, in which a significant relationship between sexual dysfunction and age was reported.

The observed differences in terms of age may be explained by age-dependent hormonal changes that lower women’s libido and increase their likelihood of experiencing pain during sexual intercourse as they get older, the team noted.

Researchers also emphasized that medications and depression may affect sexual function and that most studies did not control for such factors, preventing more adequate assessments. In addition, sexual dysfunction was mainly assessed through patient-reported measures, while clinical evaluation could “provide more accurate data,” the researchers wrote.

Among other limitations, the team pointed out the substantial variability across the included studies and the presence of publication bias — the selective publication of studies based on the direction and magnitude of their results.

Still, the findings highlighted that “sexual dysfunction is highly prevalent in adult men with MS,” the researchers wrote.

“Due to the important role of sexual dysfunction in different (physical and mental) aspects of life, diagnosing sexual dysfunction in MS patients in clinics by specialists is suggested to be considered a necessity,” the team added.