Fatigue in patients with multiple sclerosis (MS) is a complex symptom that is notoriously difficult to treat, not least because it is extremely subjective and is experienced differently by each patient. Owing to the prevalence of this symptom, most patients with MS who are seen in outpatient settings complain of fatigue and experience the disabling effect it can have upon day-to-day living. Managing and treating this symptom is a challenge, although there is some evidence that applying fatigue management principles can potentially reduce the debilitating effect fatigue has on patients (Welham, 1995). This article reviews the evidence base surrounding the management and treatment of fatigue that is applied in clinical practice. It describes the fatigue management programme that had been introduced for people with MS at the authors' workplace, and evaluated whether applying fatigue management principles can make a difference to people's ability to self-care. The effect this symptom has upon people's quality of life will also be explored.

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Multiple sclerosis (MS) is a complex, incurable and unpredictable disease of the central nervous system diagnosed in young adults. The progression of the disease can result in significant sexual dysfunction for some, and can cause great distress and severely impair quality of life for both the individual and his/her partner(s). Much of the research into sexual dysfunction in MS has studied the male experience, partly because pharmacological treatments have become available to treat erectile dysfunction in men. However, women's sexual difficulties do not respond well to available drug therapies. This paper looks at the definition and categories of sexual dysfunction and at the assessment of sexual dysfunction in women with MS. Practical suggestions are made for the management of the symptoms of sexual dysfunction in women with MS, and it is argued that the specialist nurse has an important role in providing education and support for such women. A nurse sensitively raising the topic of sexual difficulties allows MS patients to relax and discuss this vitally important area; without this, patients may wish to initiate such a discussion but find it too embarrassing to do so.

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