Multiple sclerosis and sex

The sexual spirit will always shine through despite incredible challenges. A situation where one partner has multiple sclerosis demonstrates the power of intimate connection, and how everyone is deserving of the feeling of sexual closeness. Sometimes it just doesn’t come in the package you expect, or in the ways you’ve had it previously, but it’s still there. Granted, there tend to be many nuances to an advanced stage Multiple Sclerosis (MS) diagnosis. Be aware that you need to check with your doctor before trying anything new.

What’s involved with this disease when it comes to sexuality? Sexual arousal begins in the nervous system, as the brain relays messages to the sex organs along nerves running through the spinal cord. MS has a tendency to damage these nerve pathways, meaning that sexual response can be affected. Other indirect symptoms can play havoc with a person’s sexuality as well, causing things such as fatigue or muscle spasticity, and changes in mood. As a result, MS is a humbling disease, one that can really affect self- esteem and the ability to feel sexually desirable. General sexual symptoms include:

• Reduced sensation or painfully heightened sensation
• Vaginal dryness in women
• Erection problems in men
• Trouble reaching orgasm
• Loss of sexual appetite
• Positioning problems due to muscle spasms
• Bowel or bladder incontinence
• Overall weakness and fatigue

As many as 80% of women and 90% of men with MS state that their disease has negatively affected their sexuality. General treatments have included Viagra or the Muse system (which involves inserting a small suppository into the penis), inflatable devices and implants for men. For women, good lubrication can address vaginal dryness. Usually both partners can benefit from using alternative methods of sexual stimulation, like vibrators and dildos. This can help to overcome slow arousal or impaired sensation. At various points throughout the disease medications can help with the spasms and mood swings. Intermittent catheterisation can control urinary leakage during intercourse, and enemas can be used prior to sexual encounters.

Everyone has sexual needs and a need for closeness This may sound daunting but all is not lost – even in the advanced stage of MS. It can be difficult to come up with strategies as the condition changes or progresses. But people still have their sexual needs and a need for closeness to their partner. Usually with the removal of the indwelling catheter on occasion, vaginal/penal penetration can be achieved as well as anal intercourse. A “side spooning” position is considered the best option for penetration, if such factors as spasms and vaginal irritation from the catheter aren’t an issue. It could be that a partner is craving the sheer act of being treated prior to the onset of symptoms. Kissing and caressing are always possibilities, even if you have to give your partner some assistance.

Let’s not forget about everyone’s favorite sexual organ either: the mind. Appeal to what turns your partner on mentally. Light some candles, read erotic novels, watch adult movies together. The more you focus on the other senses your partner does have, the more satisfaction you’ll both experience. Use aromatherapy oils to draw a bath, or rub fragrant oils on the skin. Gently touch where there is feeling – behind the ears, stroking the hair, nibbling the neck. Many people with limited movement have found that having sex in pools, with the freedom buoyancy brings, has allowed them to have sex more easily.

Reinforce your partner's sexuality If you’re comfortable, go through the motions of helping your partner masturbate - with or without a vibrator. Some quadriplegics have said that fantasising they can recall the sensation of an orgasm in their mind. Perhaps you can masturbate in front of your partner. The more you can do to reinforce that your partner is still is a sexual being, the more both of you as a couple can still share eroticism with one another.

There are many MS and disability organisations out there that are finally beginning to address sexuality. Often, there are message boards where the individuals affected and their partners can swap ideas on positions and sexual products. There is now an MS Intimacy and Sexuality Questionnaire that can help you figure out how to address the affects of MS on sexuality. Search the Multiple Sclerosis International Federation as well as the National Multiple Sclerosis Society for more information. It would be helpful to also have a doctor who is open to discussing these issues. A good doctor will always make time to discuss the sexual impact of your diagnosis. In addition, many sexologists and sex therapists also specialise in sex and disability.

The important thing here is to focus on the sexuality you can still share. The more each of you can get comfortable with the disease and the bodily changes associated with it, the better. And like any couple don’t forget to communicate! If one of you is having a rough day, talk about it. Communication will be especially helpful to you both in monitoring the status of the disease and any changes sexually you may need to make along the way. A diagnosis of MS doesn’t have to mean that you lose all sexual options. It can be an opportunity to embrace the bond that you have and not take for granted the simple sexual pleasures that most unimpaired individuals do.

(Dr Elna MacIntosh, Health24 sexologist)