“…173,174 Other useful assessments include Szasz Sexual Functioning Scale, International Index of Erectile Function, Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-19) or MSISQ-15. 173 For complete evaluation of SD, patients should also be assessed on mood, urodynamic function, and overall quality of life. 173 Primary sexual dysfunction is caused directly by lesions and can primarily be localized to the spinal cord, although can also result from peri-insular injury, similarly to bowel and bladder complaints in patients with MS. 117,118 In women, this can manifest as concerns about pain, numbness, or parasthesias during vaginal intercourse, lubrication, sexual satisfaction and orgasm.…”