Sex Issues of Women With Multiple Sclerosis

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Multiple sclerosis (MS) is a disease in which the immune system attacks and strips away at the protective covering of nerves. This not only damages the nerves but interrupts with the line of communications between nerve cells.

Of the many symptoms caused by MS, sexual dysfunction is arguably one of the more upsetting. It can interfere with relationships and severely undermine a woman's sense of self-esteem and confidence.

Around 75 percent of women with MS experience problems with sexual function. Causes typically include fatigue, spasticity (a feeling of muscle tightness or stiffness), reduced genital sensation, and loss of libido (sex drive).

How MS Affects Sexual Function in Women

Sex is a complex process by which sensory stimulus of the nervous system provokes a physiological response. With MS, damage to those nerve pathways (caused by a process known as demyelination) can dampen not only the physiological response but the feelings of sexual desire, as well.

In men, this manifests most obviously with erectile dysfunction. In women, the experience may be entirely different and involve:

  • Diminished libido due to hormonal imbalances (sometimes referred to as hypoactive sexual desire syndrome)
  • Pain, fatigue, or muscle spasms that can affect a woman's ability to have sex
  • Numbness or impaired stimulation of the clitoris
  • Reduced vaginal lubrication ("dry vagina") that can make intercourse difficult

Sexual Impairment and MS Medications

Treating sexual dysfunction in women with MS is not always a straightforward thing given that there may be contributing factors that have nothing to do with the disease itself. These may include health or lifestyles factors such as stress, high blood pressure, obesity, diabetes, depression, and the use of certain medications. As such, doctors may need to identify and treat a number of associated conditions at once.

With regards to MS specifically, certain drugs used to treat the disease are known to cause sexual impairment. In most cases, a woman doesn't need to choose between her drugs and her desire to have sex. All it usually takes is a simple adjustment in the timing of the doses:

  • If you have been prescribed an anticholinergic to treat a bladder control problem, take it 30 minutes before sex to minimize bladder contractions and prevent urinary leakage during intercourse.
  • If you are taking injectable disease-modifying medications, coordinate the timing of the shots so that the side effects are less likely to interfere with sex.
  • If you are taking an antidepressant and experiencing low libido, speak with your doctor. Antidepressants are commonly associated with sexual impairment. It is possible that a simple change of drugs is all that is needed to improve your state.
  • Alternately, if you are on medications for fatigue, take them an hour before sex so that your energy levels peak at just the right moment.

Other Sex Tips for Women With MS

While finding a solution to sexual dysfunction can be complicated, particularly under the burden of MS, there are a number of things you can do:

  • Start by speaking with your partner about what you are and are not feeling. Be honest. It’s only by doing so that your partner can fully understand what you’re experiencing and work with you to find solutions.
  • Reassure your partner that you still feel desire for him or her. It’s important not to let things go unspoken or to take it for granted that your partner "already knows." Say what needs to be said.
  • Don’t create false expectations. Instead, focus on incremental changes which can often be the most impactful. For example, changing the time of day when you have sex may open the doors to other possibilities you can later explore.
  • Experiment with new positions if certain ones are painful to you. Using a water-based vaginal lubricant can also ease any discomfort you may feel during intercourse.
  • Explore vibrators, especially if you are experiencing numbness or impaired sensation. It may even add a little extra spice to your relationship.
  • Expand your idea of what sex is about. Just because you don’t have the energy for intercourse doesn’t mean that sex can't be just as satisfying. Hugging, kissing, mutual masturbation, and talking (yes, talking!) can be every bit as arousing and may even allow you to connect on a more intimate level.
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