Changes to sexual function and intimacy are common in MS, but they are among the least discussed symptoms. Many people feel uncomfortable raising them, and they are often missed during routine appointments.

These changes are a recognised part of MS, and a range of approaches can help. This article explains why MS affects intimacy, what can help day to day, and how to raise it with your healthcare team.

Key Takeaways

• How common changes to intimacy are in MS
• The three ways MS can affect sexual function
• Practical steps that can help
• The treatments that are available
• How to raise the topic with your healthcare team

How Common Is It?

Changes to sexual function are common in MS. Studies report that they affect a large proportion of people, with estimates of around 40 to 80 per cent of women and 50 to 90 per cent of men at some point. Research also indicates that sexual difficulties are more common in MS than in many other conditions.

Despite being common, these changes are often not raised. Surveys show that many people would like their healthcare team to ask about them, but the topic is frequently left undiscussed.

How MS Affects Intimacy

Researchers describe three ways MS can affect sexual function.

Direct effects. MS can affect the nerves involved in sexual response. This can change desire, arousal, sensation, lubrication, erection, and orgasm.

Indirect effects. Other MS symptoms, such as fatigue, spasticity, pain, bladder symptoms, and reduced mobility, can affect intimacy without directly involving the sexual nerves.

Emotional and social effects. Changes to mood, self-image, confidence, and relationships can also affect intimacy. Depression and anxiety, which are common in MS, can reduce desire.

Many people experience a combination of these, which is why a broad approach is often helpful.

Practical Steps That Can Help

Talk openly with your partner. Open communication about what has changed, and what feels comfortable, can reduce pressure and help both partners adjust.

Manage contributing symptoms. Addressing fatigue, spasticity, pain, and bladder symptoms can make intimacy easier. Planning intimacy for times of higher energy can help.

Use lubricants for dryness. Water-based lubricants can help with reduced lubrication.

Allow time and reduce pressure. Unhurried intimacy, with a focus on closeness rather than performance, can help.

Consider position and comfort. Adjusting positions can help with spasticity, pain, or mobility.

These steps can be adapted to what works for you and your partner.

Treatments and Support

Several treatments are available, depending on the cause. For men, medications for erectile difficulties are commonly used and can be effective. For women, lubricants and other measures can help with dryness and sensation. Managing other MS symptoms, reviewing medications that may affect sexual function, and treating depression or anxiety can all make a difference.

Psychological support, including counselling and cognitive behavioural therapy, can help with the emotional and relationship aspects. Some couples find counselling together useful. A continence or pelvic health physiotherapist can help where bladder symptoms or pelvic floor function are involved.

How to Raise It

It can feel difficult to raise intimacy with a healthcare professional, but it is a common and legitimate part of MS care. Your GP, MS nurse, or neurologist can help, or refer you to a specialist such as a urologist, gynaecologist, sexual health professional, or psychologist.

A short questionnaire called the Multiple Sclerosis Intimacy and Sexuality Questionnaire is sometimes used to start the conversation. Many of these services are available by telehealth, which can be helpful for people in regional areas, and can also feel more comfortable for a private topic.

Summary

Changes to intimacy are common in MS and can affect desire, arousal, sensation, and satisfaction. They can arise from direct nerve changes, other MS symptoms, or emotional factors, and often from a combination.

A range of practical steps and treatments can help, including open communication, managing contributing symptoms, lubricants, medications, and psychological support. Raising the topic with your healthcare team, including by telehealth, is a useful first step, even though it can feel difficult.

FAQs

Are intimacy problems a normal part of MS? They are common in MS, affecting many people. They are recognised symptoms, and help is available.

Will my healthcare team mind if I raise it? No. It is a legitimate part of MS care, and many people wish they were asked about it. Raising it helps your team offer support.

Can MS medications affect intimacy? Some medications, including certain treatments for mood, can affect sexual function. It is worth discussing this with your GP rather than stopping any medication.

Can these problems be treated? Often, yes. Treatments include managing other symptoms, medications, lubricants, and psychological or couples support, depending on the cause.

Can I get help in a regional area? Yes. Many relevant services, including psychology and specialist consultations, are available by telehealth.

References

1. Fletcher, S. G., Castro-Borrero, W., Remington, G., Treadaway, K., Lemack, G. E., & Frohman, E. M. (2009). Sexual dysfunction in patients with multiple sclerosis: A multidisciplinary approach to evaluation and management. Nature Clinical Practice Urology, 6(2), 96–107. https://doi.org/10.1038/ncpuro1298
2. Zorzon, M., Zivadinov, R., Bosco, A., et al. (1999). Sexual dysfunction in multiple sclerosis: A case-control study. I. Frequency and comparison of groups. Multiple Sclerosis, 5(6), 418–427. https://doi.org/10.1177/135245859900500i609
3. Sanders, A. S., Foley, F. W., LaRocca, N. G., & Zemon, V. (2000). The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19). Sexuality and Disability, 18(1), 3–26. https://doi.org/10.1023/A:1005421627154
4. Schairer, L. C., Foley, F. W., Zemon, V., et al. (2014). The impact of sexual dysfunction on health-related quality of life in people with multiple sclerosis. Multiple Sclerosis Journal, 20(5), 610–616. https://doi.org/10.1177/1352458513503598
5. Tepavcevic, D. K., Kostic, J., Basuroski, I. D., Stojsavljevic, N., Pekmezovic, T., & Drulovic, J. (2008). The impact of sexual dysfunction on the quality of life measured by MSQoL-54 in patients with multiple sclerosis. Multiple Sclerosis, 14(8), 1131–1136. https://doi.org/10.1177/1352458508093619
6. Bronner, G., Elran, E., Golomb, J., & Korczyn, A. D. (2010). Female sexuality in multiple sclerosis: The multidimensional nature of the problem and the intervention. Acta Neurologica Scandinavica, 121(5), 289–301. https://doi.org/10.1111/j.1600-0404.2009.01314.x