Sexuality and intimacy in MS – part 4 Secondary
In the fourth part of this series I will be addressing secondary causes of sexual dysfunction.
While life changes affect everyone, changes from MS can directly and indirectly affect sexuality.
Sexual changes in MS can best be characterised as primary, secondary, or tertiary.
Primary sexual dysfunction has been dealt with in parts 2 and 3. In this article I am going to deal with secondary sexual dysfunction but I am simply going to lay out the symptoms. A more advanced course is available which covers possible courses of action to take given the symptom.
Secondary sexual dysfunction
MS changes can affect sexual response by making sexual activity difficult physically and emotionally. Symptoms common to MS, such as fatigue or changes in muscle tone, lack of coordination or pain, can frustrate sexual expression and extinguish desire. Bowel and bladder dysfunction can inhibit and cause embarrassment. Cognitive changes challenge the most devoted couple, yet in the presence of any of these symptoms; it is possible to find creative ways to keep the physical expressions of love alive.
Fatigue
This is perhaps the most common symptom reported by people with
MS, and it can be the most disabling.
Weakness
Muscle weakness may necessitate alterations in sexual practices.
Lack of coordination and tremor
Lack of coordination may make sex and sexual expression feel clumsy, as can tremor. But besides being awkward, these symptoms may also interfere with the couple’s style of having sex.
Bowel and bladder problems
Another source of anxiety and distress can be bowel and bladder disturbances. These problems go hand in hand with sexual dysfunction, since nerve pathways are shared or close to each other. Incontinence, or even fear of having an accident, can cause a person to avoid sex entirely, thus depriving them of the closeness it brings.
Pain
This can impact significantly on interest in sex as well as performance ability. Understanding the type of pain can influence the best way to manage it. Muscle tightness, intense itching and spasticity may all be called “pain”. Also, medications used to relieve pain may add to sleepiness or fatigue.
What you can do
Medications that bring relief must be well prescribed for the type of pain they treat and used in just the right dose and frequency to give relief with the least disadvantageous side-effects. An extra or well-timed dose before intimacy can often provide effective symptom management and reassure the partner that he/she is not adding to discomfort.
It is also important that a symptom such as adductor spasms (which cause involuntary pulling together of the legs) is not seen as an indication of the person’s interest or willingness to have sex. Again, communication is the key to avoiding misunderstanding and hurt feelings.
Water soluble lubricants can make intercourse more comfortable, without predisposing to urinary tract infection.
Sensory issues
Changes in sensation can also interfere with sexual pleasure. Non-genital symptoms such as numbness and tingling can distract and discourage either partner. Impaired genital sensations can diminish pleasure, while heightened sensitivity may make even the lightest touch unbearable. What feels good at one time may be excruciatingly painful on another occasion
Mobility
Mobility devices used to compensate for loss of function can also damage your confidence and self-image. They may be seen as less than sexy. Canes, wheelchairs, braces and walkers are often identified with being “sick” or “old”. Spontaneity can be a problem if great effort has to be made to get about.
Cognition
Cognitive changes can be amongst the most potentially damaging to the relationship, since they can undermine the person’s sense of who he/she is. A partner may feel this is no longer the person they once knew. Changes in attention and concentration may be perceived as lack of interest or love, and may irreparably strain the relationship. Changes in mood, memory loss and depression can be frightening, frustrating and sometimes infuriating. All interfere with intimacy. Individual or couples counselling may be advised.
Conclusion
Sexuality is an important aspect of human life and must not be neglected when considering the impact of MS on an individual.
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Tags: disability, fatigue, living with ms, ms symptoms, quality of life, self-esteem, Sexual dysfunction, sexuality self-esteem
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