Consortium of Multiple Sclerosis Centers Annual Meeting kicks off
Sexual health — or the lack of it — can sometimes be a taboo or embarrassing topic, but it is an important component of comprehensive health, quality of life and relationships.
That’s why one session on the first day of the 39th Consortium of Multiple Sclerosis (MS) Centers Annual Meeting in Phoenix focused on assessment and treatment of sexual dysfunction in people with MS. The session was among nearly 60 offered during the May 28-31 meeting, which brings together clinicians, researchers, nurses, nutrition experts, pharmacists, advanced practice professionals, mental health professionals, advocates and people living with MS to connect and learn about the latest research and best practices.
Speaker Frederick Foley, PhD, says everyone throughout their lives have different capacities for relating, intimacy, love, affection and the expression of sexuality, but when someone develops MS or another illness or injury, it complicates the picture.
Foley discussed a 2000 study his team conducted using a standard questionnaire they created to measure sexual dysfunction in people with MS. The 15- or 19-item Multiple Sclerosis Intimacy and Sexuality questionnaire seeks to define primary, secondary and tertiary sexual dysfunction. Primary occurs as a result of changes in the central nervous system that directly impair sexual feelings or response, such as sacral spinal lesions causing lost sensation in the genital area, while secondary sexual dysfunction occurs as MS-related physical changes or treatments that indirectly affect sexual feelings or response, such as spasms or urinary symptoms. Tertiary dysfunction refers to the psychological, social and cultural issues that interfere with sexual feelings or sexual response, such as body image problems or feeling insecure about sexuality after developing MS.
In their study, Foley says 68% of the group reported at least one persistent sexual dysfunction symptom almost always or always over the previous six-month period, with no differences between men and women.
Because sexual dysfunction is so prevalent, Foley says clinicians first need to ask patients about their sexual function while gathering sexual history. He says clinicians need to know if the patient is pre-, peri- or post-menopausal, check blood work, ask about other comorbidities, discuss fatigue impacting libido, screen for depression and ask if the patient is taking selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SSNI) antidepressants, which often have sexual side effects.
“Depression is a serious symptom of MS, and it’s typically under-assessed and under-treated,” he says.
Foley also covered several methods for helping with sexual dysfunction in men, including oral medications, penile vacuum devices, injections, urethral suppositories, penile prostheses and other sexual aids and counseling.
For women, using water-based lubricants, clitoral vacuum devices, vibrators and sexual aids, transcutaneous tibial nerve stimulation and pelvic floor exercises can help. Foley says there’s also preliminary evidence that yoga and aquatic exercise and can improve sexual function. He notes that no herbal supplements have been tested for safety and efficacy in female MS patients.
If a patient loses his or her libido, Foley says behavioral reconditioning can help uncouple the idea of sexual desire from sensual and sexual pleasure. To establish this new communication framework, a body mapping exercise can be utilized, starting at the top of the head and working down to note areas of pleasure and sensory change.
Foley says patients also need to be educated about navigating sex with catheters, wheelchairs or other appliances.
In addition, MS patients often have cognitive issues, and attention and concentration impairments can impair sexual response. The solution could be creating a minimally distracting atmosphere and intimacy re-entry rituals to start over.
“The way people like to be touched at the very beginning of a sexual encounter is different than the way they like to be touched in the middle of a sexual encounter, or towards the end of a sexual encounter,” Foley says.
Overall, he says several of his team’s studies found that if clinicians educate their patients, with or without consultation, and encourage them to have open, honest conversations with their partners and their health care providers, it has a clinically meaningful effect on sexual dysfunction.
“Giving them pamphlets or book chapters on it is associated with a significant improvements in sexual functioning in the couple, so you don’t have to do much to help them. You just have to have educational materials in your office,” he says. “And we educate patients to know that sexual feelings and preferences change, especially as MS symptoms can fluctuate. We encourage people to use nonverbal communication and assertively take his or her hand and show how you like to be touched. Demonstrate for that person. And don’t expect your partner to do anything unless you explicitly ask them or show them. No mind-reading.”
For more information, visit https://www.nationalmssociety.
