Sexuality and intimacy in MS – part 3 Male sexual dysfunction
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In this the third of the series I will be addressing male Sexuality.
Many symptoms of MS are invisible while others are painfully obvious. Whether a person is in an intimate relationship or not, it is a challenge to maintain a sexual identity and take care of one’s sexual self-esteem (how one feels about oneself as a sexual being) while dealing with a chronic illness such as MS
Male sexual dysfunction
Sexual activity for men usually requires the co-ordination of arousal, penile erection and orgasm including ejaculation, along with the many other emotional and relationship components that are integral for satisfaction. Direct disruption of nerve pathways controlling erection and ejaculation are common.
Erectile dysfunction (ED) is the commonest sexual dysfunction in men and usually is due to a disease of the vascular or neurological systems, but psychosexual influences are also important. ED can have a major impact on self-esteem, relationships and general well being.
The limited studies of men with MS indicate that ED is a frequent symptom, often affecting younger men and sometimes affecting fertility.
If you are a man with MS, let your neurologist, GP or MS Nurse know if you are having any erectile dysfunction. If you talk to them about it, its impact can be assessed and, if it is considered significant, a full range of treatment options can then be discussed with you.
Treatment is usually erection-promoting medications rather than treating the underlying disorder. Drugs used to modify MS progression may also help. They are generally safe, well tolerated medications and observation of their use in MS and spinal cord injury confirm a high efficacy, with about three-quarters of men experiencing satisfactory outcomes. Patience and perseverance are the most important aspects of the use of these medications. They need to be taken at least half an hour before sex, but some couples find the idea of premeditating their sexual experience off-putting, and this often interferes with treatment. Normal sexual stimulation is required to initiate the erection, therefore the couple needs to be in the mood for sex.
The most commonly-used medications act to enhance the relaxation of muscle cells in the penis. Sildenafil, tadalafil and vardenafil all act in this way through a similar mechanism. They are generally safe, well tolerated medications and observation of their use in MS and spinal cord injury confirm a high efficacy, with about three-quarters of men experiencing satisfactory outcomes. Patience and perseverance are the most important aspects of the use of these medications. They need to be taken at least half an hour before sex, but some couples find the idea of premeditating their sexual experience off-putting, and this often interferes with treatment. Normal sexual stimulation is required to initiate the erection, therefore the couple needs to be in the mood for sex.
Alternative treatments
If these drugs do not work or cannot be safely used, injecting drugs into the penis or the use of mechanical aides may be helpful.
Ejaculatory dysfunction
At ejaculation there is widespread muscle contraction in the pelvic area that leads to expulsion of the semen and much of the sensation
associated with the broader response of orgasm.
Often, delayed ejaculation and complete failure of ejaculation
(anejaculation) are caused by disruption of the nerve pathways and
may be part of a broader orgasmic failure.
Ejaculatory disturbances also occur in MS, although there is less information about the prevalence. Anti-depressant medications that may be used in MS often cause ejaculatory problems as a side-effect. Some men with MS may develop premature ejaculation because of anxiety about their disease
Sexual desire
Testosterone is active in several brain centres important for sexual thoughts and desire (libido) and low levels of it are associated with depression and obesity, both of which can relate to MS. Frequently, desire is affected by factors other than the direct physical component of the disease, and this is particularly so in MS where other physical and psychological factors, such as fatigue, may play a major role.
The importance of assessing both the man with MS and his partner cannot be over-emphasised, particularly if initial treatment is not successful. This will require more developed skills that not all doctors will have. Your doctor may be able to refer you to another professional for further help.
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Tags: living with ms, ms symptoms, Sexual dysfunction, sexuality self-esteem
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