Sexual Dysfunction in Patients with MS Associated with Fatigue and Depression

For people with multiple sclerosis (MS), sexual dysfunction, including low sexual function and satisfaction, is a prevalent issue. In fact, 40% to 80% of females with MS and 50% to 90% of males experience sexual dysfunction.

Symptoms of low sexual function in people with MS can include erectile dysfunction, problems achieving an orgasm, decreased libido, reduced vaginal lubrication, and painful or diminished sensations. In MS, damage to nerve pathways that transfer sexual arousal messages from the brain to sexual organs directly affects sexual response. Additionally, symptoms of MS, such as spasticity, fatigue, bowel and bladder disorder, and mood changes, can also contribute to issues with sex and intimacy.

Although sexual dysfunction is common among people with MS, there is limited literature exploring factors that place MS patients at higher risk for sexual issues.

A recent study conducted at Brigham and Women’s Hospital in Boston, Massachusetts, investigated the association between sexual function and satisfaction and quality of life and other clinical and demographic factors.

Tamara Kaplan, M.D., of Brigham and Women's Hospital in Boston led a study of sexual dysfunction among patients wiht multiple sclerosis.

The three-year longitudinal study, led by Tamara Kaplan, M.D., from the Brigham Multiple Sclerosis Center, included data from 702 participants with MS who were part of the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women’s Hospital (CLIMB). The CLIMB study, which began in 2000, is an ongoing prospective study following over 2,000 people with MS to identify disease predictors and determine factors that affect disease progression.

Of the participants in the current study, 526 were female, and 176 were male. The average age was about 42 years, and the average expanded disability status scale (EDSS) score was 1.5, indicating minimal disability. Patients included in the analysis had completed the following questionnaires annually: Multiple Sclerosis Quality of Life-54 (MSQOL-54), Modified Fatigue Impact Scale (MFIS), and Center for Epidemiology Studies Depression Scale (CES-D).

More than one-third (37.7%) of patients reported low sexual function, and almost half (44.7%) had low sexual satisfaction. Older age and disease progression were associated with reduced sexual function and satisfaction to the same degree in males and females. However, males were more likely to link low sexual function with emotional factors, health perception, and overall quality of life. Females were more likely to associate sexual function with disability and satisfaction with fatigue.

For all participants, worsening physical function, depression and fatigue were significantly linked with low sexual function and satisfaction.

Kaplan and colleagues note that these study findings emphasize areas where clinicians can play a role in better understanding and addressing sexual issues in patients with MS.

“Neurologists may feel ill-equipped to manage or identify sexual problems. However, it is important to ask patients about sexual function and satisfaction because, as demonstrated, there are myriad opportunities to intervene," wrote Kaplan and her colleagues, adding that "depression can be a particularly useful factor to address, as it is seen in approximately one-third of [people with MS], and there are many effective options for treatment. Fatigue is another excellent avenue of interventions.”