MS sexual issues associated with fatigue, depression: Study

Issues with sexual performance and satisfaction are common with multiple sclerosis (MS), and show significant associations with measures of quality of life, a study shows.

Sexual problems tend to be more pronounced among patients with severe fatigue and depression, data suggest. These findings highlight areas where healthcare providers can better support patients, as the data imply that helping manage symptoms may improve patients’ sex lives, researchers said in “Sexual Problems in MS: Sex Differences and Their Impact on Quality of Life,” which was published in Multiple Sclerosis and Related Disorders.

MS can result in challenges with sex and intimacy and directly affect sexual performance and satisfaction, causing issues like erectile dysfunction, reduced vaginal lubrication, lower sensitivity to touch, and difficulty achieving an orgasm. Symptoms of MS, such as fatigue, depression, and spasticity, may also complicate intimacy.

A team of U.S. scientists studied how sexual issues are associated with quality of life, as well as clinical and demographic features, among MS patients. The study included data for 702 people with MS (526 female, 176 male) followed as part of an ongoing study called CLIMB (Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women’s Hospital). Participants regularly completed a battery of standardized questionnaires about disease severity, depression, and fatigue, as well as sexual performance and sexual satisfaction.

Most were fairly young, with an average age of around 42, and most had minimal disability, with a median score of 1.5 on the Expanded Disability Status Scale (EDSS). The researchers emphasized the data they were assessing was about sex assigned at birth (male or female) and data on gender identity (man, woman, nonbinary, etc.) were not collected. “Using sex is more inclusive since we are including any participant assigned female or male at birth,” they said.

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Sexual function, satisfaction and quality of life

More than a third (37.7%) reported low sexual function and nearly half (44.7%) had low sexual satisfaction. These rates are “lower than previously described in the literature, potentially due to our cohort’s younger age and lower disability,” the researchers said.

Rates of sexual issues were comparable for males and females. In both, those with low sexual function and satisfaction tended to be older, with a longer disease duration and more pronounced disability.

Patients with sexual complaints tended to have poorer scores in measures of life quality, analyses suggested.

“All domains of quality of life were associated with low sexual function and satisfaction,” the researchers wrote. However, the team noted some associations were stronger among male patients. For example, males tended to have a stronger association between poor sexual function and worse health perceptions and overall quality of life, and the association between low sexual satisfaction and energy or physical health was also stronger in males.

“This study further elucidates the associations of various [quality of life] domains to low sexual function and satisfaction in males and females,” the researchers wrote, adding understanding these associations better “may help to guide patient care.”

In statistical models, worse physical function, fatigue, and depression were significantly associated with low sexual performance and satisfaction even after accounting for other factors. In sex-specific analyses, worse fatigue was significantly associated with poorer sexual performance for both males and females, and depression and physical disability were associated with worse sexual satisfaction in both sexes.

Fatigue was also associated with lower sexual satisfaction in female patients, but not males, and physical disability was significantly linked with worse sexual performance for females.

“When stratified by sex, the direction and magnitude of the associations were similar in the males and females. However, disability was only significantly associated with function in females, and fatigue was only associated with satisfaction in females,” the researchers wrote.

Comparing trends in data over time for patients followed up to three years showed scores for sexual satisfaction and function tended not to change much. Most patients who didn’t report issues at the start were still not having problems three years later. Among those whose sexual function or satisfaction worsened, there also tended to be worsening disability, fatigue, or depression.

“Patients whose [sexual function and satisfaction] scores decreased from typical to low were more likely to have increased fatigue, depression, or disability,” the researchers wrote.

These findings highlight areas where healthcare providers may be able to better help patients, since the findings imply that better managing fatigue and depression could improve a patient’s sex life, the researchers noted.

“Depression can be a particularly useful factor to address, as it is seen in approximately one-third of [people with MS], and there are many effective options for treatment. Fatigue is another excellent avenue of intervention,” the researchers wrote. “Neurologists may feel ill-equipped to manage or identify sexual problems. However, it is important to ask patients about sexual function and satisfaction because, as demonstrated, there are myriad opportunities to intervene.”