Worse disease severity predicts erectile dysfunction in MS men

Erectile dysfunction is more likely to occur among men with multiple sclerosis (MS) whose disease is more severe, according to a study, which noted that the ability to contract the cremaster muscle, which controls the position of the testicles, was linked with a decreased likelihood of erectile dysfunction in MS.

While erectile dysfunction occurred more often in men with MS than those without (39.4% vs. 27.8%), the difference wasn’t statistically significant, according to “Characteristics and predictors of sexual dysfunction in men with multiple sclerosis,” which was published in Multiple Sclerosis and Related Disorders.

Sexual problems, such as erectile dysfunction, are common symptoms of MS, an autoimmune disease marked by damage to the healthy parts of the brain and spinal cord that can interfere with neurological signals from the brain that promote sexual arousal, and reduce or alter function and sensations in the genitals.

A recent pooled analysis of published studies found erectile dysfunction was about three times more likely in men with MS compared with healthy men. The frequency of sexual dysfunction remains underreported because it’s not brought up in clinical appointments, however.

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“One way to overcome this is the use of specific questionnaires on SD [sexual dysfunction],” wrote researchers in Croatia who validated two sexual dysfunction questionnaires, the Sexual Health Inventory for Men (IIEF-5) and the Premature Ejaculation Diagnostic Tool (PEDT), and adapted them for Croatian culture.

The questionnaires were applied to 216 adult men with MS and 37 men without MS, and then used to determine the frequency and severity of erectile dysfunction in MS, and identify factors that might predict its occurrence.

Men with MS scored significantly lower on IIEF-5 than healthy men, indicating worse erectile dysfunction, or a reduced ability to achieve or maintain an erection. While erectile dysfunction, defined as an IIEF-5 score of 21 or less, occurred in more men with MS, the difference wasn’t statistically significant.

Premature ejaculation, defined as a PEDT score of 11 or more, was reported in more men with MS than without (12.1% vs. 5.6%), but the difference also wasn’t significant.

The researchers also conducted statistical analyses to better understand which factors are associated with erectile dysfunction and premature ejaculation in MS.

Data showed a worsening of 1 point in the Expanded Disability Status Scale (EDSS), a measure of disease severity, significantly increased the likelihood of erectile dysfunction by 45.5%. The ability to contract the cremaster muscle, called the cremasteric reflex, decreased the probability of erectile dysfunction by 61.9%.

“[Sexual dysfunction] is frequent in [men with MS] with EDSS being a positive and the presence of cremasteric reflex a negative predictor of [erectile dysfunction ],” the researchers wrote.

No predictive factors were found for premature ejaculation, or for having both erectile dysfunction and premature ejaculation. In fact, signs of nerve involvement, called lesions, in the brainstem and upper spinal cord didn’t predict erectile dysfunction or premature ejaculation in the patients.

Still, erectile dysfunction was associated with worse depression and more fatigue, and was weakly linked with a worse quality of life.

The researchers also used the Composite Autonomic Symptom score-31 (COMPASS-31) to measure autonomic dysfunction, or problems with body processes that take place without conscious effort. Here, erectile dysfunction was linked with total COMPASS-31 scores and those specifically related to bladder function problems.

Lastly, a weak correlation was found between premature ejaculation and fatigue and total COMPASS-31 values.

“Further prospective studies using specific questionnaires are needed to assess the changes in [sexual dysfunction] in [men with MS] over time and establish the causality between symptoms of depression, fatigue, autonomic symptoms, and [sexual dysfunction],” the researchers said.