Sexual dysfunction in people with multiple sclerosis (MS) can be caused by a combination of physical, psychological, emotional and social factors.
In MS, damage to nerve impulses can affect arousal and orgasm. Arousal begins in the central nervous system (CNS), 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 are common.
Treating sexual dysfunction in men
Erectile dysfunction affects around 70 percent of men with MS. Depending on the extent and location of nerve damage, other problems can include reduced sensation in the penis and difficulty ejaculating. Drugs for erectile dysfunction fall into two categories: phosphodiesterases and vasodilators.
- Phosphodiesterases (PDEs): These oral drugs enhance blood flow to the penis to increase erectile response. The best-known is Viagra, which is taken once a day, 30 to 60 minutes before intercourse. Its effects can last up to four hours. Levitra is taken 25 minutes to an hour before sex. The dose range is 5 to 20 milligrams, as needed. Its effects last around four hours. It should be taken only once a day. Cialis is also taken before sex. The standard dose is 10 milligrams, but it can be increased to 20 milligrams or reduced to five, depending on how much a man needs. Cialis should not be taken more often than once in 24 hours. None of these drugs will cause an erection without physical stimulation of the penis.
- Vasodilators: This class of drugs works by lowering blood pressure, dilating blood vessels and increasing blood flow. Papaverine facilitates erections. It is available only by prescription because if not used properly it can result in permanent damage to the penis. The oral form of Papaverine is taken three to five times a day at evenly spaced intervals. The injection is taken once per day and no more than two consecutive days. The MUSE system is a small suppository, or alprostadil pellet, applied directly to the penis. An erection occurs five to 20 minutes after its insertion. Effects differ between patients.
Treating sexual dysfunction in women
Women with MS can experience pain in the vaginal and clitoral area, vaginal dryness and difficulty achieving orgasm. Although there are no specific medications for these symptoms, there are things that can be done to relieve them.
- Vaginal dryness: Water-soluble lubricants like KY-Jelly can be purchased over-the-counter. Specialists advise using them generously.
- Difficulty with orgasms: Stimulating sensitivity by spending more time on foreplay and using a vibrator to overcome slow arousal and impaired sensation can help.
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