Multiple sclerosis is a disorder in the central nervous system that has far-reaching neurologic and psychological effects. Of the various symptoms of multiple sclerosis, sexual dysfunction is one of the most common but underreported symptoms. In reality, the prevalence of sexual dysfunction in men with multiple sclerosis is as high as 90%.
Aside from the neurologic effects of multiple sclerosis on sexual functions, sexual dysfunction in multiple sclerotic patients is often a multi-faceted condition, affected by various factors such as anatomic and psychological factors.
Impotence is the most common form of sexual dysfunction in male multiple sclerotic patients. Erections are triggered by various signals coming from the brain. However, multiple sclerosis destroys the myelin sheath protecting nerve fibers. This causes scarring in the spinal cord, which is the nerve pathway used by the brain to send nerve impulses to the genital area.
Since the nerve pathway between the penis and the brain is damaged, it impairs the transmission of nerve impulses between the two organs. Thus, even if the brain sends signals to the penis telling the penis to become erect, the penis may not be able to properly receive the signals. The penis then becomes unresponsive to sexual stimulation, resulting in problems with erection.
Depression is also highly associated with multiple sclerosis. Depression may happen because of damage to the nerves which render the brain incapable of processing mood altering signals. Depression may also be a result of multiple sclerosis medications.
The mental stress and body fatigue that often accompany multiple sclerosis can also cause depression. Whatever the cause, depression often leads to erectile dysfunction. On the other hand, the mental disorder may also come about as a result of erectile dysfunction caused by multiple sclerosis. Either way, both erectile dysfunction and depression are significantly associated with multiple sclerosis.
The brain may also fail to receive the nerve impulses sent by the penis. Thus, even if the penis is stroked or caressed, the sensations are not processed by the brain properly. This usually manifests as penile numbness wherein the male sclerotic patient is unable to feel any penile sensations. In female patients with multiple sclerosis, this is equivalent to reduced sensations in the thigh and genital regions.
In fact, it’s not just penile sensitivity that’s affected by multiple sclerosis. Men afflicted with multiple sclerosis are often unable to process visual and auditory cues, as well and not just sensory sexual cues. In severe cases wherein multiple sclerosis affects the optic nerve, the patients can suffer blurred vision or can even go blind.
Ejaculatory problems are another form of sexual dysfunction that multiple sclerotic patients often experience. Multiple sclerotic patients who develop depression are often prescribed anti-depressants.
Unfortunately, medications like SSRIs or selective serotonin reuptake inhibitors are known to have adverse effects on erectile and orgasmic functions. Hence, multiple sclerotic patients taking SSRIs often experience delayed orgasms or even a complete loss of orgasm response.
The loss of sensations in the genital area often associated with multiple sclerosis can also affect the quality of orgasms. Thus, men with multiple sclerosis often find that orgasms are no longer as pleasurable as they used to be.
Sexual arousal doesn’t happen without the brain’s go signal. This is one of the reasons why patients with multiple sclerosis often suffer from decreased libido. Since the brain and the sexual organs are no longer able to communicate properly with each other, the brain is unable to tell your penis that you should feel aroused.
In addition, any sexual stimulation may go to waste as signals from the sensory nerves going to the brain may get lost in transmission. Aside from this, the fact that a multiple sclerosis patient suffers from various symptoms such as fatigue can also distract the brain away from all thoughts about sex.
Aside from fatigue, patients with multiple sclerosis also often experience visual disturbances as the optic nerve is affected by the disease. Difficulties with balance and bodily coordination also happen frequently.
The patient may experience changes in his body image or may develop sexual performance anxiety because of the disability caused by multiple sclerosis. Cognitive functions such as memory are also impaired. All of these factors contribute to the loss of sexual desire as the patient is preoccupied with dealing with these symptoms.
There are three general categories of sexual dysfunction based on the cause of the condition. Primary sexual dysfunction occurs when sexual feelings and responses are directly affected because the nerves in the central nervous system are damaged.
The second type happens when sexual responses are indirectly affected by physical changes in the body. Tertiary sexual dysfunction, on the other hand, occurs when psychosocial issues affect sexual function.
The problem with multiple sclerosis is that the disease can cause all three types of sexual dysfunction to occur simultaneously, hence making sexual dysfunction difficult to treat. For instance, a man suffering from multiple sclerosis may develop erectile dysfunction due to nerve damage affecting the genital area. That’s primary sexual dysfunction at work.
However, the fatigue, pain, muscle spasms, bowel dysfunction, and vision problems can also cause a man to lose his erectile capabilities. That’s an example of secondary sexual dysfunction.
And lastly, the depression induced by the neurological damage that is often experienced by men with multiple sclerosis can also contribute to the loss of erectile function. That’s how tertiary sexual dysfunction works.
Thus, to treat the erectile dysfunction, all three causes must also be addressed. This does not mean, however, that treatment of impotence in male sclerotic patients is not possible. Many multiple sclerotic patients are able to overcome their sexual dysfunction.
Most of the time, however, a combination of therapies will be needed. For instance, phosphodiesterase type 5 inhibitors (PDE5I) such as Viagra may be prescribed along with hormone therapy and psychotherapy.
For male patients who are concerned by the loss of their erectile functions, penile implants, inflatable devices, and injectable erectile dysfunction medications may also help. For men suffering from loss of penile sensations, vibratory stimulation can help in achieving erections.