Multiple Sclerosis and Sexuality: A Survey of MS Health Professionals' Comfort, Training, and Inquiry About Sexual Dysfunction

Abstract

2003 ;5:37-38, 44-51) M ultiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) resulting in a wide array of impairments that may include difficulties with gait, balance, sensation, pain, bladder and/or bowel control, vision, sexuality, and cognitive function.1 Sexual dysfunction is reported to occur in more than 70% of persons with MS, a frequency greater than that reported with other chronic diseases.2 In reports of men with MS, sexual dysfunction has ranged from 23% to 85%. lj3 Women, who are diagnosed with MS at a ratio of 2:1 compared to men, report sexual dysfunction up to 85% of the time. "3 MS patients followed for a two-year period indicated that the prevalence of sexual dysfunction remained higher than 70%, with additional sexual complaints and worsening of previous symptoms. 4Sexual dysfunction in MS has multiple causes. Anatomically, it is thought that lesions that affect the thoracic spine and autonomic nerves are the main factors that affect sexual function in MS patients. 5 However, many of the problems of sexual dysfunction in MS patients are not directly related to disease processes. A model of the categories of sexual dysfunction has been developed by Foley and Iverson. 6 Primary sexual dysfunction in MS is a direct result of

Assessment and Treatment of Psychiatric Distress, Sexual Dysfunction, Sleep Disturbances, and Pain in Multiple Sclerosis

“…23 One potential explanation is that only slightly more than half of the participants reported that they routinely ask their patients, which may result in an underestimation. Consistent with previous findings, providers tend to wait for their patients to initiate the conversation, 8 and as such they may not be aware that there is a problem unless the patient brings it up. That said, a reassuring finding was that only a minority of participants endorsed discomfort about discussing sexual dysfunction.…”

“…Previous suggestions have included more training about sexual dysfunction in MS, which has been associated with increasing clinicians' initiation with patients. 8 Although previous research indicated that psychiatric distress has been underdiagnosed in MS, 3,4 these findings show that most providers are asking their patients about their mood and anxiety, as well as their sleep and pain levels. That said, many endorsed using a general question to assess.…”

“…Although it is a common problem in MS, occurring in 40% to 80% of patients, sexual dysfunction has a high risk of undertreatment because providers frequently do not initiate the conversation with the patient. 7,8 Untreated sexual dysfunction not only tends to worsen over time in the number and severity of symptoms but also can be detrimental to the mental health aspect of patients' health-related quality of life. [9][10][11] Treatment-wise, the current literature is sparse.…”

“…Based on previous research on MS providers' assessment of sexual dysfunction, participants who endorsed not routinely inquiring about it were asked to indicate why from a list of potential barriers. 8 Participants were then asked to indicate which treatment recommendation(s) they make for each health issue, selecting as many as applicable from a list of preset choices (ie, prescribe a medication, refer to another provider or specialist for medication management, and refer to a mental health provider for psychotherapy), with a free-text option to write in others. Finally, participants were asked whether they could provide an armchair estimate of the prevalence of each issue in their practice, which they selected from preset percentage ranges (ie, 1%-10%, 11%-20%, 21%-40%, 41%-60%, 61%-80%, 81%-90%, and 91%-100%).…”

“…These areas are particularly important to reexamine because the literature on potential underdiagnosis and treatment for psychiatric distress and sexual dysfunction is older. 3,4,6,8 Furthermore, exploring how psychiatric, sexual, sleep, and pain concerns are being assessed and treated in MS may result in identifying potential strategies for improving patient care.…”