A satisfying, intimate relationship rests on a broad foundation of trust, open and honest communication, shared goals and expectations, and mutual respect and concern. MS can affect intimacy between partners by bringing about changes in the roles and responsibilities in the relationship; disrupting people’s plans and expectations for the future; changing sexual feelings and responses; and making it harder to share uncomfortable feelings and fears.
MS can interfere directly and indirectly with sexual function
Although study results vary somewhat, the data indicates that people with MS report problems with sex more often than people who don’t have MS. Fortunately, there are many sources of help and support. Your doctor can usually start the process of identifying the source of problems and offer both medical and non-medical treatment options and/or referrals to specialists.
MS can affect sexual feelings and functions both directly (referred to as primary sexual effects) and indirectly (referred to as secondary and tertiary sexual effects).
Primary sexual effects
The central nervous system (CNS) makes sexual arousal possible; the brain, sexual organs, and other parts of the body send messages to each other along nerves that run through the spinal cord. Just as with other aspects of MS, sexual problems can arise at any time, without any clear cause. The primary sexual effects, which occur as a direct result of demyelination in the spinal cord or brain, include:
Secondary sexual effects
In addition to the changes caused directly by damage to the nerve fibres in the CNS, secondary problems can arise as a result of other MS symptoms or the medications used to treat those symptoms. The most troublesome symptoms include fatigue, spasticity, bladder or bowel problems, sensory changes, decreased non-genital muscle tone, cognitive impairments, tremor, and pain.
Tertiary sexual effects
The tertiary effects on sexual feelings and responses result from psychological, social, and cultural attitudes and issues. Tertiary effects can affect both partners and may include performance anxiety and changes in self-esteem; depression, demoralization, and guilt; and family and social role changes
Loss of sex drive: Currently, there is no proven medical treatment for loss of sex drive (or libido) in women. Sometimes the sex drive simply returns. Other times the loss or lessening of intensity may be permanent. Demyelination, fatigue, anxiety, decreased self-esteem and/or depression can all cause loss of desire. Women can experience sexual pleasure even in the absence of a powerful drive.
Sensory changes: such as numbness, which sometimes occur in the vaginal area, can make intercourse uncomfortable or interfere with orgasm. Gently rubbing the genital area with a gel cold pack or a bag of frozen peas can also reduce discomfort. Increasing stimulation to the genital area can help overcome numbness. In some cases, oral or manual stimulation of the clitoris will be enough to enable a woman to achieve orgasm. If this is not sufficient, vibrators and other sex toys may provide even greater stimulation.
Decreased vaginal lubrication: can make intercourse uncomfortable. Water-soluble lubricants are an easy solution. Over-the-counter brands such as K-Y Liquid® and Astroglide® are widely available. Avoid oil-based lubricants like petroleum jelly because they can trap bacteria and cause infections
Muscle weakness in the vaginal area: kegel exercises can strengthen the muscles in the vagina, which may enhance sensation and sexual response. To locate these muscles, try to stop the flow of urine as you urinate. Once the muscle is located, contract it a couple of dozen times a day, independent of urination. Except for the test, don’t contract during urination as this may cause a pattern of incomplete emptying, leading to infection.
Achieving orgasm: people tend to think of orgasm as the ultimate goal of sex – but this doesn’t have to be true. In other words, sex can make people feel good, even when it doesn’t lead to orgasm. Temporary or even permanent loss of orgasm does not invalidate a woman’s need for intimacy and sexuality. Making love does not necessarily mean having intercourse.
Redefining sexuality: Women with MS may want to redefine sexuality for themselves. This may mean putting more emphasis on forms of touching that provide warmth: cuddling, caressing, and massage, for example. Some may need to explore sexual activities that require less mobility. Many people are uncomfortable with the idea of masturbation. The fact is most sex experts today say that solo sexual activities help people to redefine and renegotiate their sexuality
Rediscovering one’s body: certain MS symptoms cause the body to respond very differently than it once did. Body mapping is a simple exercise in self-exploration. The idea is to map out personal sensations by touching yourself from head to toe. Mapping will help identify areas of change, numbness, discomfort and pleasure. More advanced body mapping exercises include both partners.
Many sexual problems produced by MS symptoms (such as pain, spasticity and fatigue) or MS treatments (such as a catheter or medication side effects) can be managed with the help of your doctor.
Feeling sexy: Being sexy has a lot to do with feeling sexy. Take care of your body through healthy food, relaxation, and enjoyable exercise.
Thinking sexy: What things are sexually exciting to you? What things are turn-offs? What thoughts interfere with or suppress your sexuality? Self-scrutiny is an important part of maintaining sexuality in your life, especially if MS has dampened desire. Thinking more positively will help to restore enthusiasm. Enhancing romance: Find ways to transform the everyday into the romantic. Dine by firelight, take a bath by candlelight, watch the sun set or the moon rise, hold hands or flirt. Most important of all, don’t give up the pleasures of physical and emotional intimacy
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