Diagram of the ODFS

They found that people with multiple sclerosis using the stimulator increased walking performance, compared to the exercise group and also experienced fewer falls.

authors: Esnouf J, Taylor P, Mann G, Barrett C.

source: Mult Scler. 2010 Jul 2

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Introduction

Multiple sclerosis presents in various ways and subsequently shows variable disease courses. If we knew early on what the disease course for Multiple Sclerosis would be then we could better target the medication in each individual case. To date it has been unpredictable right from disease onset but, knowing the disease course is of crucial importance in guiding treatment.

Now “The Department of Neurosciences” at Cardiff University has recently been looking into factor H as a biomarker for multiple sclerosis and the findings are promising.

Effective and accessible biomarkers are needed in order to stratify (separate into groups) patients and inform treatment. The team at Cardiff University decided to look into factor H as such a marker. Regulator factor H, has recently been implicated as a biomarker in other chronic inflammatory central nervous system conditions. Could it identify or predict specific pathological processes and outcomes in multiple sclerosis?

Method

They measured factor H in blood serum from 350 patients with multiple sclerosis classified according to disease course and relapse status. Controls were found for variables including disease duration, age, gender, disability and treatment. I have decided not to go into the full method in this document as the details will be somewhat turgid to the average reader. However, the findings are fairly clear and very encouraging.

Results

1) Factor H levels were significantly higher in progressive disease compared to controls and relapsing patients. Thus factor H levels were capable of distinguishing secondary progressive from relapsing remitting disease (excluding patients in clinical relapse)

2) Acute relapse was also associated with temporarily increased factor H levels compared to stable relapsing disease.

3) In clinically stable patients, factor H levels remained constant over 1 year but in patients in transition from relapsing to progressive disease, factor H levels significantly increased over a period of 2 years. This is a crucial point as the transition between relapsing and progressive signals the need for therapy change.

Conclusion

Serum factor H could be an effective indicator of progression and a practical and accessible tool to split patients into groups and to predict disease course, Once we have this information we have objective evidence which can help guide therapeutic decisions. As we have known for some time, the earlier you can pick up a disease pattern the better chance of success you have with the treatment.

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I first discovered I had a lot of “pseudo flare ups” when my MS nurse suggested I might have a UTI (urinary tract infection) Indeed I am very prone to UTIs but I had had no symptoms. No pain, no burning, no irritation no frequent urination. Sure enough that’s what it was and now I permanently have a supply of antibiotics on hand and dip sticks to test my urine if I’m suspicious. , Many people with MS suffer from chronic UTIs so drink plenty of water as a preventative (at least a litre(quart) a day or 2  in hot weather), and seek medical help as soon as an infection takes hold, to prevent a full-scale launch of MS symptoms. Personally it often takes a while for this to dawn on me as my UTI is asymptomatic but I get there in the end !

“Did you know that people with MS must also contend with pseudo flare-ups? Well we do. As if getting use to the real thing isn’t enough pressure to deal with, we quickly find out we must also contend with the false-positive nature of MS.”

Frequently an infection of any kind can trigger what is known as a “pseudo” or “fake” flare up but there is nothing “fake” about the MS symptoms. Furthermore it seems common that infections are asymptomatic, (apart from the MS symptoms) It is important to get to the root cause or causes so that your  symptoms can settle back down again.

For instance stress is a well know cause of exacerbations or “fake” exacerbations. I find that if I have a run in with my former husband you can get bet I will have a pseudo flare-up and if I’m on holiday in a hot climate you can be sure I’ll have a pseudo flare-up but that usually ends as soon as I’m in and air conditioned environment or have found another way to cool down.

You can read a bit more on Jen’s Hub page here http://hubpages.com/hub/How-to-Distinquish-Between-a-Real-Flare-Up-and-a-Pseudo-Flare-Up

I’d love to hear your comments on what causes a pseudo flare-up for you

Kath

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For many, the emotional and cognitive effects of Multiple Sclerosis represent its greatest challenges. Whether a person with MS will experience these problems cannot be predicted from age, level of physical disability, duration of MS, type of MS, or intelligence tests. Up to half of all people with MS will have some degree of cognitive disruption Fortunately only 10% of people with MS will have cognitive problems that significantly interfere with everyday activities. For those 10% it is a frustrating or even devastating change in their normal thinking process.

MS may be accompanied by a variety of emotional reactions and people with MS face some very special challenges. However, like everyone else, they are trying to do their best to cope with what life has sent them. In most instances, they cope very well and often are stronger for having met these challenges.

Cognition

The areas of cognitive functioning that are most commonly affected in MS include the following:

• Memory
• Visual spatial abilities
• Attention and concentration
• Word-finding
• Speed of information processing
• Abstract reasoning and problem solving

Typically, MS affects some cognitive functions but leaves others relatively intact. For this reason, MS is not likely to lead to the sort of global cognitive decline seen in Alzheimer’s disease. People with Alzheimers, for example, have difficulty storing information from moment to moment. People with MS tend to have a difficulty with retrieving that information. But as MS can affect any part of the brain, almost any cognitive function can be impaired. In some cases, MS-related cognitive changes can be very pervasive, rendering the individual unable to deal adequately with day-today tasks.

There are some common misunderstandings about cognitive dysfunction in MS and the following is by way of reassurance :
• MS does not equal Dementia (as mentioned above)
• MS does not mean that intelligence has declined.
• MS is not a mental illness (although some people with MS experience depression, and this requires medical and psychiatric treatment).
• Cognitive functioning can be assessed
• Cognitive problems can occur at any level of physical disability

Cognitive changes can have a significant impact on one’s ability to live and work. Family members are often unaware that MS can cause cognitive problems and this misunderstanding can result in anger and confusion.

Many factors will determine your response to cognitive problems, including the impact of the disability on your normal way of life, previous ways of coping, and the support you receive from others. You and your carers should remain vigilant as to cognitive changes and if this happens it is wise to obtain a professional evaluation to clarify the nature and cause of the problems.

What can you do?

The health professionals who can help are neuropsychologists, occupational therapists, and speech language therapists. Keep this in mind as often input is needed from a professional trained to assess and treat people with cognitive problems.

As the impact of cognitive changes can be stressful, it may also be helpful to talk to a counsellor or your doctor about how you are feeling.

Hints and tips

• Keeping to a routine is important, as is being consistent. For example, when you open the door to your house, put your keys in the same place every time.
• It might help to get an ‘organiser’. Set it up with sections for everything that affects your day-to-day living. Sections for appointments, for phone numbers, addresses etc.
• Using mental pictures or images to remember something can be a good technique to aid memory.
• Having people repeat or write down instructions often helps. It is important that the person conveying the message, instructions or directions to you knows that you have understood. Repeat it back to the person, and ask for clarification if necessary.
• Keep your mind as active as possible. Reading, doing crosswords and puzzles are good ways of keeping mentally challenged, and it is best to find activities that suit you. However, you do need to be aware of your energy levels and be careful not to tire yourself out.
• Regular rests to recharge your brain (and body) become important when you have MS. Use energy conservation and work simplification techniques to ensure the best possible use of your physical and mental energy. Be aware of and alert for mental fatigue (a decline in cognitive performance following a task requiring continuous mental effort).
• It is also best to avoid noisy and/or distracting environments as these can make it difficult to concentrate.
• It is also important when learning a new task that you allow plenty of time to learn it. If you are having trouble, shift your attention to another task and come back to it later.

Finally
It is important that you know that you are not going crazy, that many people with MS experience similar problems with their thinking and memory. In particular, it is important for friends and family members to be aware of the relationship between MS and cognitive dysfunction.

Click Here to take Cognition Survey

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For some people with MS, medicines can provide complete relief from pain,but many pain sufferers do not achieve adequate pain relief by pharmacological means. Fortunately, a number of non-pharmacological approaches can be used that have been proven to be effective in other groups of people with chronic pain.

The biopsychosocial model of pain

The experience of pain is very complex, involving not only the body but also the mind. Current thinking is that chronic pain is best understood from a biopsychosocial perspective, which recognises the importance of the underlying biological basis of pain (for example, nerve damage due to MS), but  also acknowledges that psychosocial factors may have a significant impact on the experience of pain and its effects on life.

Some of these factors include one’s emotional reactions to pain and how one thinks about or deals with pain. The biopsychosocial model has led to treatments that are effective for decreasing pain severity and the negative impact of pain.

People with pain sometimes worry that others think that their pain is “not real”, exaggerated, or a sign of mental illness. On the contrary, chronic pain is a serious condition that is “in one’s head” only because pain signals are processed in the brain. Advances in brain science have confirmed that psychological factors such as one’s emotions or stress can affect physical health, including pain. Living with MS and pain can also cause chronic stress. The brain (mind) and body influence one another in ways that science is just beginning to understand.

Relaxation training

Pain and other stressors often result in a natural response of repeated and prolonged tensing of muscles, which tends to worsen pain. Research has shown that one of the best ways to counteract the tensing effects of pain and stress is to practice various forms of relaxation. There are many methods to achieve relaxation – deep breathing, baths, music, meditation or prayer for example.

Some relaxation strategies can be tried without instruction, whereas others may need to be learned under the guidance of a professional.

People vary in their ability to relax, so trying a variety of relaxation techniques may be necessary to find what works best. Relaxation exercises may also work best when paired with other coping strategies.

Deep breathing is the basis for many relaxation techniques, so it is often a good skill to learn first.

It is generally done lying down or sitting in a comfortable chair. The basic method involves taking a deep breath through the nose, trying to cause a rise in the abdomen, followed by a brief pause, and then exhaling through the mouth. To heighten the sense of relaxation, some people say calming words to themselves, such as “relax” or “peace” on each exhalation. To achieve maximum benefit, deep breathing should be practiced for at least five minutes, several times per day.

One technique that has been used for some time iscalled Binaural Beats.

Two tones at slightly different frequencies are presented separately, one to each of a subject’s ears, using stereo headphones. A beating tone will be perceived, as if the two tones mixed naturally, out of the brain.

These two frequencies, when mixed together, result in a different frequency which aligns your brain waves into a different way of thinking. This is often called brainwave entrainment.

I have used this myself to get a better night’s sleep with amazing results

12 Amazing Binaural Beats Audios

Self-hypnosis training

Research published over the past decade supports the benefits of self-hypnosis training for helping individuals better manage both acute and chronic pain. Like relaxation training, self-hypnosis is a way to use the power of the mind to manage pain by altering the experience of pain.

This may include distracting from pain, focusing on more pleasant sensations, or even experiencing pain as decreasing or going away. Contrary to how hypnosis is portrayed in the media, people using self-hypnosis always remain in control of themselves. Training in self-hypnosis should be done with a professional experienced in its use for pain. It can often be learned in only a few sessions and should be practiced regularly to maintain benefits.

Like medications, self-hypnosis training rarely, if ever, eliminates pain completely; nor does it benefit everyone who tries it. However, there appears to be a subgroup of individuals, including those with MS, who report substantial decreases in pain severity following self-hypnosis treatment and who are able to maintain this improvement over time. In addition, unlike some medications, the “side-effects” of self-hypnosis training are positive. For example, in a study that included people with MS, 40 different benefits of self-hypnosis were identified in addition to pain relief and no negative effects were reported.

Self Hypnosis Questions, Answers, and MP3s

Cognitive behavioural therapy

Numerous studies indicate that the way people think can have a big impact on how much pain they experience, how they deal with pain, and how much pain interferes with their lives and functioning. Things people do to cope with their pain can also be helpful (for example, using relaxation techniques) or unhelpful (for example, using alcohol excessively to relieve pain).

Cognitive behavioural therapy (CBT) involves teaching people how to change their pain-related thoughts and behaviours in order to reduce pain and its associated suffering. In CBT, individuals are taught to examine the thoughts they have about pain, determine whether these thoughts are helpful or unhelpful, and replace any unhelpful thoughts with helpful, reassuring ones.

CBT often also includes teaching other pain management techniques such as relaxation training, distraction techniques, or activity scheduling. It typically involves either group or individual treatment by a professional with expertise in CBT, and optimally, pain.

Other psychological interventions

Other psychological treatments may be useful in addressing pain and its impact, including support groups, pain education, and psychotherapy. Treating depression, when present, is recommended, given that depression and pain often impact one another. Physical exercise (for example, walking, swimming, or yoga) often has beneficial effects not only on a person’s physical condition but also on pain and stress.

How to find help

Unfortunately, many people with MS pain are offered these treatments only after all medical treatments have been tried and failed. Psychological interventions should be considered early, soon after the development of pain, along with other appropriate and effective treatments such as medications or rehabilitation. The sooner these treatments are used, the more likely they are tobe of benefit. For those who do not have access to specialists in the psychological treatment of pain, text and web-based resources may be available from your national MS society, or via your nurse or doctor

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Interestingly the most common areas for this type of pain are the face, neck

and torso so let’s start at the top with TGN

Trigeminal Neuralgia

TGN is an excruciating, sharp, shock-like pain in one side of the face, lasting seconds to minutes and often repeated; may be triggered by speaking or a touch. It usually settles spontaneously by itself over several weeks. Unfortunately many of the side effects of the usual drugs mimic the symptoms experienced in MS anyway so it is difficult to tell the cause and it may lead to alarm that the disease is getting worse. To allay these fears I have outlined the usual side effects of each drug,

Usual medications

Carbamazepine (anticonvulsant): Side effects Drowsiness, Dizziness, Coordination difficulties

Phenytoin (anticonvulsant): Side effects Dizziness, Nausea, Insomnia, Uncontrollable eye movements, Coordination difficulties, Slurred speech, Confusion

Baclofen (muscle relaxant): Side effects Weakness, Drowsiness, Dizziness

Gabapentin (anticonvulsant) may also help: Side effects Dizziness, Coordination difficulties, Fatigue

Lhermite’s Sign/Symptom

This is a  brief, stabbing, shock-like sensation that runs from the back of the head down the spine, (like an electric shock) brought on by bending the neck forward. It is not always painful.

Usual medications

Carbamazepine or Phenytoin (see above)

Other treatments

A soft collar may limit neck movement. Most often Lhermite’s symptom disappears spontaneously and medical treatment is not necessary.

Tonic Spasms

These, known as spasticity are sudden and painful muscle contractions, producing stiffness of the whole limb, which can last up to two minutes.

Usual medications

Carbamazepine, phenytoin, and baclofen (see above) and

Clonazepam (anticonvulsant): side effects Sedation, Dizziness

Dysaesthetic Pain in Limbs and Trunk

Dysaesthetic means any impairment of the senses especially the sense of touch

This is a condition in which light physical contact of the skin causes pain; Such as the weight of sheets in bed.  It involves a persistent burning, tingling, tightness, or aching which may be worse at night and after exercise It may be aggravated by temperature and weather.

Patients frequently state that dysaesthetic burning corresponds with what they imagine a hell might be like. Some of the descriptions given by patients include:

- “Like Hell’s hottest knives tearing at my flesh”
- “Like my flesh is being consumed in a fire”
- “Like my flesh is being torn from my body”
- “Like my flesh has been burned off”
- “A pain worse than pain”
- “Indescribable burning”
- “Like an alien pain monster has taken over my body and has ignited my flesh”

Usual medications

Nortriptyline and amitriptyline.(anti-depressants): side effects Dry mouth, Blurred vision, Sedation, Urinary retention

Gabapentin, (see above)

Tegretol (Carbamazepine – see above) and Epilim (sodium valproate – anti epileptic) may also be useful.

Side effects of Epilim nausea, diarrhoea, increased appetite and weight gain, shaky movements, tremor, drowsiness, confusion, temporary hair loss

Other treatments

• Application of cold, pressure stockings
• Capsaicin ointment/cream. Capsaicin is the active ingredient in chilli peppers. It’s what gives chilli peppers their kick. When it is applied to the skin, capsaicin cream has been found to deplete substance P— a neurochemical that transmits pain—which desensitizes a person to pain. Capsaicin cream produces a temporary reduction in pain, so it must be used regularly to provide prolonged pain relief.

Capsaicin can cause an intense burning feeling when it is applied, particularly if it is used less than 3-4 times a day, or if it is applied just after taking a hot bath or shower. However, this side-effect tends to ease off with regular use. Capsaicin cream should not be applied to broken or inflamed skin. Wash your hands immediately after applying capsaicin cream.

In my next article I will be discussing secondary pain in MS.

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In the last of the series I will be addressing tertiary causes of sexual dysfunction.

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.

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.  Secondary was dealt with in part 4. In this article I am going to deal with tertiary 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.

Tertiary sexual dysfunction
The onset of MS can alter a person’s perception of himself or herself as an individual, altering sexual development and expressions of sexuality and it can have a negative impact on sexual and intimate functioning. These are known as the tertiary sexual problems of
MS, derived from the resultant psychological and social changes, as distinct from the direct neurological dysfunction (primary sexual problems) and the symptoms of MS (secondary sexual problems).

People with MS can find it difficult to see themselves as being “sexual”, having sexual thoughts, desires and needs whilst at the same time identifying with the role of a person with a chronic illness.

Individuals see themselves as complete persons in terms of their roles within families, friendship circles, sporting clubs, activities and occupations. Any feelings of loss of control over events or unplanned changes because of MS can affect one’s confidence and self-esteem and alter the dynamics of relationships, especially close and intimate ones.

Dealing with the impact of MS and symptoms can leave one neglecting the emotional and psychological aspects of life in general. Simply attending to the physical needs of life’s daily activities can leave little time or energy for emotional contemplation and intimate relationships. This is particularly evident if fatigue is experienced as a symptom of the MS.

What you can do

If you experience problems with intimacy and sexuality, you need to allow yourself time to assess your overall situation and to feel confident about communicating any difficulties to those close to you.

Counselling can help individuals to explore feelings and facilitate discussion in a respectful and professional way. You can identify negative emotions such as guilt, anger and resentment, see them in context, and work through them, in a non-judgemental environment.
Here you can discuss topics, perhaps seen as too embarrassing to discuss alone, in an open and supportive atmosphere. Strategies for improving the situation, or adopting new ways of considering and developing sexuality, can be introduced.

Drugs that affect sexual functioning

Some people with MS may experience depression and/or anxiety, and medications prescribed for these conditions can affect sexual functioning.

The drugs used to treat depression and anxiety belong to a family called ‘Selective Serotonin Reuptake Inhibitors’ (SSRIs). Commonly prescribed SSRIs include Fluoxetine, Sertraline, Fluvoxamine, Paroxetine, Citalopram and Venlafaxine.

Conclusion

Sexuality is an important aspect of human life and must not be neglected when considering the impact of MS on an individual.

Increasing awareness and acknowledgement of the effects of MS on sexuality has greatly improved the management and treatment options available for people with MS experiencing difficulties in this area.

While this is often a difficult and sensitive subject, discussing sexual difficulties with your GP or neurologist is the first step to identifying effective strategies to manage any problems, and to support your need for sexual expression.

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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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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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• Living with MS (0)

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

Female sexual dysfunction is very common in women with neurological conditions, including MS. The majority of women with MS suffer from sexual dysfunction at some stage of the condition. This is estimated to be as high as 80 per cent, compared to the general female population, in which only 20-50 percent of women are affected. Sexual dysfunction has a major impact on quality of life and interpersonal relationships. For many women it is a physically disquieting, emotionally disturbing and socially disruptive disorder.

In spite of its high prevalence, these aspects of an individual’s wellbeing have been considerably neglected until recently, making female sexual dysfunction a very important but often overlooked

Symptoms most commonly reported include:
•     Reduced genital sensation (48%):
•     Reduced vaginal lubrication and difficulty with arousal (35%);
•     Difficulty or inability reaching orgasm (72%).

Pain during intercourse is also a frequently reported symptom in
women with MS, which may be due to vaginal dryness, spasticity or sensitivity.

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.

Where diminished genital sensation occurs, you can increase stimulation through oral stimulation or use mechanical vibrators, which are widely available by mail order online

Painful or irritating genital or body sensations can be relieved with medication. Amitriptyline (Amitrip®), carbamazepine (Tegretol®) and phenytoin (Dilantin®) can be prescribed to help manage this.

It is not yet clear how helpful oral medicines like Viagra or Cialis could be for women with MS. These are targeted at sexual dysfunction in men to increase blood flow to the genitals.

Lowered libido

Loss of sex drive, or libido, can be a frequent sexual symptom among women with MS. There are currently no effective medicines for this. However, there are reports that sex therapy combined with MS symptom management and communication skills training, can be successful.

How and why MS can affect sexual functioning

Sexual dysfunction in women has many causes and effects:

•    Abnormalities in blood circulation
•    Lesions in the brain can interfere with the interpretation of sexual stimuli as arousing.
•    Lesions in the sacral (lower) spinal cord can also cause primary sexual dysfunction, , resulting in diminished or absent clitoral swelling and/or vaginal lubrication.
•    In primary sexual dysfunction, MS lesions in the spinal cord may make it difficult to sustain clitoral/vaginal engorgement during the plateau phase (between arousal and orgasm).
•    In addition, sensory changes in the genitals can interrupt or diminish nerve signals that initiate and/or maintain vasocongestion at both the spinal cord and cerebral cortex (brain) levels.

Types and frequencies

It is known that approximately 80 per cent of women with MS experience sexual dysfunction at some time during the course of the disease. Some women just stop engaging in sexual relations, while others (approximately 40 per cent) have reported that participating
in sexual relations is significantly unsatisfactory.

Symptoms most commonly reported include:
•     Reduced genital sensation (48%):
•    Reduced vaginal lubrication and difficulty with arousal (35%);
•    Difficulty or inability reaching orgasm (72%).

Pain during intercourse is also a frequently reported symptom in women with MS, which may be due to vaginal dryness, spasticity or sensitivity.

Vaginal dryness and tightness

Vaginal lubrication may be compromised by MS. The best way to cope with vaginal dryness is to apply liberal amounts of water-based lubricants (e.g., K-Y® Jelly).

Oestrogen creams may be useful for women experiencing vaginal dryness, pain or burning. Another treatment is a vaginal suppository. Ask your GP or pharmacist about what is best for you.

Conclusion
Sexual dysfunction is highly prevalent among women with MS. While identification, assessment and treatment of sexual problems can be embarrassing and complicated, addressing them is important. In this way you can identify and manage the symptoms that can have a negative impact on your personal life as well as that of your partner.

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