Sexual dysfunction in female and male people with multiple sclerosis: disability, depression and hormonal status matter

Abstract

Background and purpose Sexual dysfunction (SD) in people with multiple sclerosis (pwMS) is common and an often underestimated issue in the care of pwMS. The objective of the study was to evaluate risk factors for SD in pwMS, correlate its prevalence with patient‐reported measures (quality of life and physical activity) and analyse its association with hormonal status. Methods Sexual dysfunction was determined in 152 pwMS using the Multiple Sclerosis Intimacy and Sexuality Questionnaire 19. A logistical regression model was used to identify independent risk factors for SD. Results The prevalence of SD in pwMS was 47%. Independent risk factors for the development of SD were ever‐smoking (odds ratio [OR] 3.4, p = 0.023), disability as measured by the Expanded Disability Status Scale (OR 2.0, p < 0.001), depression (OR 4.3, p = 0.047) and bladder and bowel dysfunction (OR 8.8, p < 0.001); the use of disease‐modifying treatment was associated with a lower risk for SD (OR 0.32, p = 0.043). SD was associated with worse quality of life (Multiple Sclerosis Impact Scale 29: physical score 6.3 vs. 40.0; psychological score 8.3 vs. 33.3; both p < 0.001) and lower physical activity (Baecke questionnaire, p < 0.001). Laboratory analysis revealed significantly higher luteinizing hormone and follicle‐stimulating hormone levels and lower 17‐beta oestradiol, androstenedione, dehydroepiandrosterone sulfate, oestrone and anti‐Mullerian hormone levels in female pwMS with SD. In male pwMS and SD, there was a significant decrease in inhibin B levels. Conclusions Our findings highlight the requirement of a holistic approach to SD in MS including physical, neurourological and psychosocial factors. Active screening for SD, especially in patients with disability, depression or bladder and bowel dysfunction, is recommended.

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

“…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 the same study, 6/20 MwMS reported that other MS symptoms overshadow their sexual problems, and 5/20 felt there was insufficient time to discuss sexual function during the encounter [ 46 ]. 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 ].…”

“…For MwMS, our summary identified erectile dysfunction as the most common factor categorized as a component of primary sexual dysfunction, disability due to MS categorized as secondary, and depression categorized as tertiary. Specific hormonal or neuroimaging findings pointing to sexual dysfunction in MwMS have not been identified, aside from a potential role of lower levels of inhibin B [ 42 ]. A prior electrophysiologic study based on volunteer sample of 29 MwMS reported neurogenic causes as more frequent than isolated psychological (26 vs. 3 participants), though the latter was also recognized as a potential co-factor when the former is present [ 66 ].…”

Fertility treatment-induced oxidative stress and reproductive disorders

“…42 Multiple sclerosis and spinal cord injuries are examples of conditions that disrupt the nerves that govern ejaculation. 43 PE may be genetically predisposed in some males. The polymorphism in the serotonin transporter-linked polymorphic region (5-HTTLPR) gene has been the subject of the most research (11 studies), with 7 demonstrating a significant association with PE and 4 refuting such a relationship.…”