Increased Risk Of Erectile Dysfunction In Men With Multiple Sclerosis: An Italian Cross Sectional Study

Abstract

IntroductionSexual dysfunctions (SDs) are common, but often underestimated symptoms in men with multiple sclerosis (MS). The most common sexual complaint in a multiple sclerosis male is erectile dysfunction (ED). The aim of this observational, cross-sectional study was to assess the prevalence of erectile dysfunction (ED) and its relationship with neurological disability, depression, urodynamic findings and lower urinary tract symptoms (LUTS) in these patients.Material and methodsFrom January 2014 to January 2016, there were 101 consecutive male patients with a diagnosis of Multiple Sclerosis according to the McDonald revised criteria and stable sexual relationships were included. Patients were evaluated with the International Index of Erectile Function (IIEF-15), Sexual Quality of Life Questionnaire-Male version (SQoL-M), International Prostate Symptom Score (I-PSS) and the Beck Depression Inventory-II (BDI-II). Neurological impairment was assessed using the Expanded Disability Status Scale (EDSS). The presence of Detrusor Overactivity (DO), Detrusor Underactivity (DU) and Detrusor Sphincter Dyssynergia (DSD), was defined by International Continence Society (ICS) criteria.ResultsErectile dysfunction (ED) defined according to the erectile function (EF)-subdomain score ≤25 was present in 75 patients (74.25%). Univariate regression analysis showed that Sexual Quality of Life Questionnaire-Male version (P <0.0001), age (P = 0.021), Expanded Disability Status Scale score (P = 0.001), Beck Depression Inventory-IIscore (P = 0.001),International Prostate Symptom Score (P = 0.001), Detrusor Underactivity (P = 0.002), Multiple Sclerosis-Secondary Progressive (P = 0.002) was significantly associated with erectile dysfunction. All significant findings in univariate analysis were then entered into a multiple logistic regression model. The results indicated that the Beck Depression Inventory-II score (P = 0.011) and International Prostate Symptom Score (P = 0.043) were the only independent predictive factors of erectile dysfunction onset in these patients.ConclusionsHence, in order to provide an effective approach and management for erectile dysfunction all the mentioned symptoms and clinical variables should be kept in mind.

Validation of the Italian version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19

“…Sexual dysfunction does not only affect MS patients in advanced disease stages but can be detected even in cases with mild and moderate disability [4]. In Italy, sexual dysfunction prevalence is estimated to affect about 75% of MS patients based on clinical reports [5][6][7].…”

Male sexual and reproductive health in multiple sclerosis: a scoping review

“…Besides the case–control study based on a national database (38,139 cases with erectile dysfunction and 262,848 controls) [ 52 ], the second largest study was a randomized double-blind placebo-controlled clinical trial including 217 participants [ 53 ]. All studies included the International Index of Erectile Function questionnaire as the main assessment method, with the addition of quality of life [ 27 , 53 – 55 ] or urinary tract function [ 27 , 54 , 56 ] metrics in some. In cross-sectional studies assessing the prevalence of erectile dysfunction in MwMS, the values were 45% [ 28 ] and 74% [ 27 ].…”

“…All studies included the International Index of Erectile Function questionnaire as the main assessment method, with the addition of quality of life [ 27 , 53 – 55 ] or urinary tract function [ 27 , 54 , 56 ] metrics in some. In cross-sectional studies assessing the prevalence of erectile dysfunction in MwMS, the values were 45% [ 28 ] and 74% [ 27 ]. Depression, urinary tract symptoms, and greater disability due to MS were factors associated with erectile dysfunction in MS [ 27 , 54 , 56 ].…”

“…In cross-sectional studies assessing the prevalence of erectile dysfunction in MwMS, the values were 45% [ 28 ] and 74% [ 27 ]. Depression, urinary tract symptoms, and greater disability due to MS were factors associated with erectile dysfunction in MS [ 27 , 54 , 56 ]. Diagnosis of MS was shown to be associated with erectile dysfunction in the large Taiwanese case–control study based on their national insurance database [ 52 ].…”

“…Our scoping review based on male sexual and reproductive health in MS included 34 original studies published over the last 2 decades (2002–2023). Most studies broadly focused on sexual dysfunction [ 26 , 29 , 30 , 35 – 51 ], followed by specific focus on erectile dysfunction [ 27 , 28 , 52 – 56 ], fertility [ 18 , 25 , 57 – 59 ], and family planning [ 61 , 62 ], respectively. Despite the growing availability of DMT options in recent years, including newer high-efficacy treatments, comorbidity management which includes sexual and reproductive health, remains one of the cornerstones to improve quality of life and minimize direct or indirect disability due to MS [ 63 ].…”