Patients and physicians in the past rarely discussed sexual function and performance despite its central role in life. This was especially true when illness other than heart disease was at issue. Sexual relationships are a major bond between married couples, and the new frankness about these issues promises to benefit particularly MS patients greatly. There are a number of pertinent issues in this regard, many of which are equally important to healthy persons.
The most common sexual problem affecting both men and women in good health is the lack of libido (sexual interest or sexual drive). Psychologic stress arising from interpersonal relationships and work is probably the most common single cause for this; it is obviously much more of an issue in young adults affected by a major health problem. The resultant uncertainties that naturally arise in these situations contribute to this greatly. The actual diagnosis of illness may induce acute stress, which can precipitate sexual difficulty or aggravate a pre-existing sexual problem. In both men and women with MS, the loss of a feeling of well-being contributes to sexual dysfunction, whether accompanied by a depressed mood or not. Studies have shown that a caring, understanding relationship between the sexual partners is the single most important factor in maintaining good sexual health. It is important to be aware that the use of drugs for erectile dysfunction does not increase libido. Decision making in regard to changes of lifestyle and treatment for MS is an obviously important issue. Professional counseling is sometimes advisable.
Fatigue is a major symptom in MS and contributes to sexual dysfunction, as it does in healthy men and women. Modification of lifestyle to conserve energy and the use of amantadine or other medications to increase energy are helpful. Amphetamine ("speed"), Ritalin, and cocaine are dangerous and should not be considered. Patients should be cautious of the plethora of products flooding the health food market because some of these agents could actually contain harmful ingredients.
The topic of sex and MS has different components: how I feel about myself; how my husband feels about me; and how we feel together. These components naturally intertwine and interact. Before my diagnosis I did not give my body much thought. I felt vibrant and was physically and sexually active, but my sense of myself was more cerebrally focused. I took my body, including sexuality, for granted, assuming that it would all just work without effort or intention. With my diagnosis and the effects of the steroids, I became almost fearful of my body—what was it going to do next? With time, fearless physical therapists, and the love of my husband, I have come to value and work hard on functioning physically. Furthermore, my view of myself sexually is independent of whether all of the parts of my body work on command and without pain. Rather, it depends on how I feel about myself, mind and body.
In the sixth grade, my husband wrote in my autograph book, "Have a great summer and please wear your sexy pink sweater often next yeari" After 25 years of marriage he still finds me sexually desirable; when I get out of the shower, he whistles. Nonetheless, MS has had an effect on how he relates to me sexually. Over the years, he has voiced concerns that he could hurt me, worries that I will get tired, and wonders whether I have physical sensations. Together, we manage MS and sex like other issues—with talking, laughing, and crying.
Recently, I was on a panel about issues of illness and caregivers. I relayed our feelings that we do not want my husband to be my full-time caregiver if we can find other good people to help me. Certainly my husband does many care-giving tasks he had not done before my MS. Although he is trained to touch me to help with pain, stiffness, or spasms, we distinguish this "medicinal touch" from sexual touch. Both are done with love but have different mental and physical basis. Not only do we prefer for him not to do certain caregiving functions, he is, by his own admission, much better at taking my clothes off than putting them on. He is totally inept at mascara, and pantyhose get him sidetracked! After I relayed this information to the audience, a petite grandmotherly woman raised her hand to speak: Dr. Ruth gave us her approval!
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