Sexual Problems

Intimacy with your partner is part of a fulfilling life. Sometimes, though, the physical changes people experience and the psychological impact of these symptoms can make it difficult for people with MS to feel enthusiastic about their sex lives. The good news is that there are quite a few strategies that can help you manage these difficulties and get your relationship back on track.

Some of the most common changes in sexual function are a direct result of neurologic changes (such as spasticity or bladder problems), or they can be a result of psychological problems, such as not feeling very sexy during a relapse. Medications can also cause changes in libido.

Sexual problems in MS are defined as primary, secondary, and tertiary. Primary problems are the direct result of the disease affecting the nerves in your CNS and can result in a decrease in sex drive, difficulty reaching an orgasm or maintaining an erection, or numbness, pain, or increased sensitivity in the vaginal area. A decrease in vaginal lubrication can also occur.

Because sexual arousal begins in the CNS, changes to the nerve pathways can directly impair sexual functioning. But the secondary problems or psychological effects can be just as devastating. Fatigue can put a damper on your sex life and sensory problems can make you oversensitive to contact. Bowel and bladder problems can create a roadblock to intimacy, as can difficulty with movements or positions involved in sex because of pain or muscle spasms.

Tertiary problems are caused by the psychological problems rooted in self-image. Depression, changes in self-image, and lack of confidence can dampen your moods and sex drive.

There are all kinds of ways (whether directly or indirectly) for sexual dysfunction to sneak into your relationship, so it's important to speak to your doctor if you have questions or concerns. Medication may be useful in tackling some of the problems. Communication with your partner is also imperative. Enlisting the help of a therapist is also important; she may be able to shed some light on the psychological barriers that may be preventing you from having intimate relations with your partner.

Medications and Treatments for Men

Men report failure to have an erection as their primary problem. Here are some treatments to consider:

  • Oral medications. Viagra (sildenafil) and other medications can help men achieve and maintain erections, and are effective for about 50 percent of men with MS.

  • Injectable medications. These medications are injected into the base of the penis. Unlike oral medications, the injectable medications produce an erection within a couple of minutes.

  • Penile treatments. A doctor can insert various devices into the penis to assist with erections.

  • Muscle relaxants and pain medication. These medications can be used to help spasms and pain that may interfere with sex.

Some treatments, such as penile implants, are more invasive than others, but your physician can assist you in finding an option that you're comfortable with.

Medications and Treatments for Women

Women with MS report failure to achieve an orgasm and lack of sex drive as among their most troublesome sexual symptoms. Here are some treatments to consider:

  • Vaginal lubricants. These over-the-counter gels can help with vaginal dryness. It's important to use an adequate amount.

  • Timing. If fatigue is an issue, try having sex at different times during the day.

  • Vibrators. These electronic devices can help if impaired sensation or slow arousal is an issue.

  • Muscle relaxants and pain medication. If muscle spasms or pain are getting in the way, these medications can be very helpful.

  • Positioning. Try different sexual positions to find one that works best for you and your partner. This is often helpful for people who have a decrease in the range of motion in their arms and legs from spasticity or muscle weakness.

  • Bladder control. If bladder control is an issue for either sex, self-catheterization, going to the bathroom before sex, or medication can be used to help control the symptoms.

Alert

Don't forget that medication can decrease libido. Some of the drugs used for depression and bladder control can cause some sexual problems. Go over your list of medications with your doctor. Sometimes drugs can be substituted with others that have fewer sexual side effects.

Recent studies have shown that a woman's concept of sexuality and her sexual identity are more complex than those of men. Therefore, interventions for women are more relationship focused and counseling is often recommended.

Communication Is Key

Being able to talk about sex is often the biggest obstacle to tackling sexual dysfunction. Learning to communicate (no matter how uncomfortable at first) with your partner and your health care team can empower you to approach these problems with a sense of knowledge and creativity.

Picking an appropriate time to approach your partner is imperative. The best time to approach someone for a talk about your sex life isn't when either one of you is busy or tired. Pick a time when you're both relaxed and enjoying a moment together.

Question

Does health insurance cover sex therapy?

Some policies do. If you select a therapist, call her to check. If payment cannot be worked out through insurance, many therapists can adjust their fees. Sex therapy clinics tend to be less expensive than private therapists. Call your local hospital or university medical center to see if they have a sex therapy clinic.

Being a good listener is also a good rule of thumb, albeit a difficult task for some people. Agree not to interrupt or talk over your partner. Remember to be specific when you articulate your concerns. If there's something new you'd like to try — a new position or medication — state it clearly and confidently. Telling your partner what feels good or what doesn't feel good during intimacy is also essential for an intimate relationship.

Although it can be uncomfortable at first, good communication with your health care team about sexual dysfunction is essential. You don't have to suffer in silence when there is a plethora of strategies that can help you. Since sexual dysfunction is common in MS, your doctor has had this conversation many times before.

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