Sexual Dysfunction in MS Real But Often Ignored: Neurologist Survey

Responses by doctors in Colombia point to 'underdiagnosed, undertreated' issue

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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Neurologists in Colombia agree that sexual dysfunction is burdensome and affects quality of life in major ways for people with multiple sclerosis (MS), but some still don’t ask their patients about it, a survey study reported.

Findings also revealed that many neurologists there do not use formal tools to evaluate sexual dysfunction, and most don’t prescribe treatment, referring patients to a specialist instead.

Main reasons that sexual difficulties with MS go “underdiagnosed and undertreated,” particularly for patients cared for outside an MS specialty program, include a lack of time or knowledge, and the presence of another person during an examination.

“It is necessary to strengthen knowledge about the diagnosis and treatment of sexual dysfunction … [and] imperative to eliminate barriers around the topic and include sexual function evaluation and treatment as the routine care,” the researchers wrote.

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The survey-based study, “Assessment of sexual dysfunction in patients with multiple sclerosis: a perspective from neurologist,” was published in BMC Neurology.

Sexual dysfunction is common in people with MS, affecting an estimated 50–90% of men and 40–80% of women. It can have substantial impact on a patient’s self-esteem, relationships, and other aspects of health, all of which relate to quality of life.

Sexual dysfunction often not part of comprehensive MS care

Despite its prevalence and impact, sexual health is not always considered in examinations, with one large U.S. study finding that just over 20% of patients reported having been asked about it by their doctors.

“Considering the sizable impact [sexual dysfunction] has on quality of life, self-image, self-esteem and interpersonal relationships, sexual function needs to be addressed and included as a part of the comprehensive care of patients with MS,” the researchers wrote.

A team with the Universidad del Rosario, in Bogotá, set out to examine how neurologists in Colombia address sexual function in their clinics using a 20-question survey delivered via email in September 2020.

A total of 45 physicians with experience treating MS patients responded to the survey. Of them, 21 occasionally treated MS, 11 usually did, and 13 worked in an MS-specific program. Most — 28 doctors (56%) — had been caring for patients for more than 10 years.

All surveyed neurologists considered sexual dysfunction of importance, and most (91.1%) said their patients usually or frequently ask about sexual health.

Still, some neurologists (18.8%) working outside an MS program reported never having asked their patients about sexual function. All doctors with an MS program or center, in contrast, reported asking about sexual health.

The main reasons for not discussing sexual dysfunction included lack of knowledge (65.1%), patients bringing a companion to an appointment (65.1%), and lack of time (55.8%). Less frequently reported reasons included not enough skills to manage the topic (16.3%), feelings of discomfort or anxiety when addressing the issue (14%), cultural or religious factors (14%), or that treating sexual dysfunction is not part of their role (2.3%).

In evaluating sexual dysfunction, 80% of doctors reported asking related but informal questions, although 64.4% were aware that formal questionnaires, like the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ), existed.

“This conduct can be explained by the lack of time available during the consultation or lack of training on how to apply and interpret these questionnaires,” the researchers wrote.

Neurologists with an MS program or clinic were more likely to use these tools (38%) than those in more general healthcare facilities (12%).

Additional tests for evaluating sexual dysfunction, including MRIs, nerve conduction examinations of the genitals, or a hormone profile, were reported to be requested by 20% of surveyed physicians.

Patient with identified problem often sent to another specialist

Upon detecting sexual dysfunction, 91% of neurologists said they refer their patients to another specialist, typically a gynecologist or urologist, and most (87%) don’t initiate any treatment.

Researchers said that a broader implementation of tools like the MSISQ or the Sexual Dysfunction Management and Expectations Assessment in MS is needed to better address these common problems in MS and make them easier to talk about. Such questionnaires also can help to identify the underlying causes of sexual dysfunction — an important consideration when choosing a treatment.

“Moreover, including [sexual dysfunction] topics in conferences, symposia and local education sessions addressed by neurological associations or MS programs could be a plausible and useful strategy to strengthen sexual function knowledge,” the researchers wrote.

The study noted that only 15.3% of doctors with the Colombian Association of Neurology responded to the survey, meaning its findings may not be applicable to all neurologists practicing in Colombia. Its brief nature also marks a study limitation.

“Our survey only provides a broad landscape of the perceptions of patients and the approach [taken] to evaluate and manage sexual dysfunction in patients with multiple sclerosis,” the researchers wrote.

Nonetheless, “this study opens the possibility of continuing to research the different symptoms that [people with MS] present and that impact their quality of life, and the importance of multidisciplinary management.”

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