Quantitative spinal cord MRI and sexual dysfunction in multiple sclerosis

Abstract

Background Sexual dysfunction (SD) is frequently reported in multiple sclerosis (MS) and is likely related to MS-related damage to the spinal cord (SC). Objective To assess associations between SD and quantitative MRI measures in people with MS (pwMS). Methods This pilot study included 17 pwMS with SD who completed questionnaires assessing SD, mood, and fatigue. All participants underwent brain, cervical, and thoracic SC-MRI at 3T. Quantitative brain and SC-MRI measures, including brain/SC atrophy, SC lesion count, diffusion-tensor imaging (DTI) indices (fractional anisotropy [FA], mean, perpendicular, parallel diffusivity [MD, λ⊥, λ||]) and magnetization-transfer ratio (MTR) were obtained. Associations between quantitative MRI measures and SD were assessed while controlling for the extent of mood and fatigue symptomatology. Results Subjects were a mean age of 46.9 years and 29% female. All subjects had self-reported SD (MSISQ-19 = 40.7, SQoL: 55.9) and 65% had a concurrent psychiatric diagnosis. When correlations between SD severity were assessed with individual brain and SC-MRI measures while controlling for psychiatric symptomatology, no associations were found. The only variables showing independent associations with SD were anxiety ( p = 0.03), depression ( p = 0.05), and fatigue ( p = 0.04). Conclusion We found no correlations between quantitative MRI measures in the brain and SC and severity of SD in pwMS, but psychiatric symptomatology and fatigue severity demonstrated relationships with SD. The multifactorial nature of SD in pwMS mandates a multidisciplinary approach.

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

“…The largest study was based on North American Research Committee on Multiple (NARCOMS) Registry and included 1568 male participants [ 29 ], while the smallest included 12 male participants [ 35 ]. Most studies used standardized questionnaires such as MS Quality of Life [ 26 , 30 , 36 – 38 ], MS Intimacy and Sexuality Questionnaire [ 29 , 35 , 39 – 46 ], Sexual Quality of Life Questionnaire for men [ 35 , 44 , 47 , 48 ], and International Index of Erectile Function [ 44 , 47 , 48 ], but other methods also included original surveys created by the investigators [ 46 , 49 ], or other validated forms [ 38 , 39 , 46 , 49 – 51 ]. Serum laboratory tests [ 42 ] and magnetic resonance imaging (MRI) [ 35 ] were uncommon across studies.…”

“…Most studies used standardized questionnaires such as MS Quality of Life [ 26 , 30 , 36 – 38 ], MS Intimacy and Sexuality Questionnaire [ 29 , 35 , 39 – 46 ], Sexual Quality of Life Questionnaire for men [ 35 , 44 , 47 , 48 ], and International Index of Erectile Function [ 44 , 47 , 48 ], but other methods also included original surveys created by the investigators [ 46 , 49 ], or other validated forms [ 38 , 39 , 46 , 49 – 51 ]. Serum laboratory tests [ 42 ] and magnetic resonance imaging (MRI) [ 35 ] were uncommon across studies. Based on instruments applied, sexual dysfunction was predominantly determined as a composite qualitative outcome comprising a sexual quality of life metric in combination with measurements of erectile dysfunction and issues with libido, orgasm, or ejaculation.…”

“…In a cross-sectional study of 50 MwMS investigating serum sex hormone profiles including 17-beta estradiol, progesterone, androstenedione, dehydroepiandrosterone-sulfate, total testosterone, estrone, prolactin, sex hormone-binding globulin, inhibin B, and anti-Mullerian hormone, there were no substantial differences in those with or without sexual dysfunction, except for lower levels of inhibin B in those with sexual dysfunction [ 42 ]. No specific brain or spinal cord MRI findings were found to be associated with the severity of sexual dysfunction [ 35 ].…”

“…No specific brain or spinal cord MRI findings were found to be associated with the severity of sexual dysfunction [ 35 ].…”

Peculiarities of the Course, Diagnosis, and Treatment of Multiple Sclerosis

“…Therefore, MS is considered an immune-mediated disease of the central nervous system (CNS) and belongs to the group of demyelinating diseases, with the main pathological manifestation being the destruction or degradation of myelin. Recently, there has been enough evidence disproving that MS is exclusively a disease due to demyelination [6,12]. Myelin sheath decomposition, even in the early stages of the disease, can be accompanied by damage to axons, although axon loss is particularly significant during the exacerbation and progression stages of the disease.…”