Did you know that nerves are crucial for erections? If you have a condition that damages nerve function like multiple sclerosis, it’s no wonder you’re having erectile difficulties. This article expounds on the relationship between multiple sclerosis and erectile dysfunction!
What is Multiple Sclerosis?
Multiple Sclerosis (MS) is an autoimmune disease wherein the immune system mistakenly damages your myelin. Myelin is the protective sheath that covers your nerves. If myelin wears off, the nerves will have trouble transmitting messages to each other. This impacts biological functions. Since multiple sclerosis affects your brain and spinal cord, the most common symptoms are vision problems, motor function (movement), and sensory perception.
There are several types of multiple sclerosis depending on the severity and frequency of your symptoms:
- Clinically isolated syndrome (CIS) – occurs when a patient exhibits MS-like symptoms but don’t fit the full criteria to be diagnosed with MS. If you’ve only ever had a single episode of MS where symptoms eventually went away by themselves, you would have this diagnosis. But if it’s followed by another episode, regardless of how long it has been, you would fall under the next category.
- Relapsing-remitting multiple sclerosis (RRMS) – Most cases of MS fall under this diagnosis. MS is usually associated with what is called flare-ups. This means that the episodes are recurring. There are periods of remission between the episodes, which means there are no symptoms that occur. However, the MS eventually gets triggered with existing or new symptoms.
- Secondary progressive multiple sclerosis (SPMS) – If you’re having frequent flare-ups, you may already be at the secondary progressive stage. SPMS occurs because of widespread damage to myelin. Because of the accumulation of nerve damage, symptoms are often severe. There may still be periods of remission, but flare-ups are more common.
- Primary progressive multiple sclerosis (PPMS) – In PPMS, there is a steady progression with MS. It starts off with mild symptoms that steadily increase in frequency and intensity. Over time, the flare-ups will last longer. The patient may also relapse faster (MS will re-trigger). This means that periods of remission are much rarer.
Multiple Sclerosis and Erectile Dysfunction
One of the most common symptoms among male MS patients is erectile dysfunction (ED). Research shows that up to 91% of men with MS struggle with ED. This is because of the way arousal and erections work. It all starts in the brain and MS attacks brain nerve cells. It also attacks nerve cells in the spinal cord, which is also necessary for nerve transmissions and motor function in the pelvic area. MS can lead to ED due to 3 tiers of factors: primary, secondary, and tertiary changes.
Primary changes are direct sexual changes among MS sufferers due to physiological damage. Lesions in the parts of the brain or spinal cord involved in sexual function can inhibit sexual desire and the erectile process. A textbook symptom of MS is paresthesia which is the “pins and needles” feeling that most MS patients are familiar with. This can occur anywhere in the body, including in the abdominal area, causing discomfort. Medications taken for MS may also cause ED as a side effect.
Secondary changes are the nonsexual effects of MS such as fatigue, pain, spasticity (muscle stiffness), and brain fog. Even if they’re not directly tied to a man’s sexual function, these symptoms can still get in the way of intimacy. Being constantly exhausted or paralyzed by pain is a surefire way to kill one’s libido. The spasticity may also make it difficult to perform sex in certain positions. Lastly, tertiary changes are the psychosocial consequences of MS like the subsequent relationship issues and depression/anxiety resulting from the life changes brought by MS.
Other Sexual Dysfunctions Due to Multiple Sclerosis
ED isn’t the only sexual problem caused by MS. In fact, a study found that 67.2% of its 5,868 participants experienced a variety of sexual dysfunction either always or almost always in the past 6 months. Since nerves are involved in virtually every facet of sexual function, MS can also lead to the following:
- Premature Ejaculation – ejaculation depends on the proper functioning of the signals of the nervous system. Anything that interrupts this balance like MS or the inevitable hormonal imbalance caused by depression/anxiety from MS or the sexual dysfunction can derail the entire ejaculatory reflex. Note that premature ejaculation (PE) is also mostly psychogenic which means that mental health plays a huge role in regulating ejaculations. Additionally, bladder and bowel incontinence are also symptoms of MS.
- Orgasmic dysfunction – delayed ejaculation or inability to reach orgasm is another complaint of MS male patients. Apart from the disruption in the nervous aspect of sexual functions, MS can also cause genital numbness. This is also experienced by female MS sufferers (with the additional of vaginal dryness which can make sexual penetration painful). If you can’t feel anything with your penis, it will be difficult to reach the optimal levels of arousal to trigger an ejaculation or orgasm.
- Lower libido – pain and fatigue aren’t the only reason why MS leads to a drop in sexual desire. MS can also affect the regions of the brain that perceive sensations or situations as arousing. If the brain can’t process stimulations properly, then arousal and erections simply aren’t going to happen. MS can also lead to role reversals, so some patients may feel like the condition has emasculated them or ruined their sexual performance. This damage to self-confidence can lead to dread around sex making sexual situations a source of anxiety instead of pleasure.
The Next Steps with MS-induced Erectile Dysfunction
You may be feeling overwhelmed and confused on what to do next, so we’ve crafted a quick guide on how to calmly tackle MS and ED:
Take Deep Breaths
If you’re newly diagnosed with multiple sclerosis or suspect you may have it, take a moment to ground yourself. Inhale deeply and gently then pause for a few seconds (what feels natural). Exhale as slowly as you can. You may purse your lip to help slow down breathing. Repeat this for four more times. MS can feel overwhelming, but treatment is available. Most MS patients can live full lives (with certain adjustments due to the condition). Medical advancements are also regularly occurring which improves quality of life for MS sufferers.
Get MS Under Control
Your utmost priority would be to get the MS properly managed. This would mean responding appropriately to each symptom and finding the right blend of medication to calm the flare-up (and prevent relapse). Medications like ocrelizumab and cladribine are taken to manage MS itself. Corticosteroids like prednisone that suppress the immune system may also be taken during flare-ups. Then for symptoms like spasticity, targeted treatment is necessary. To manage it, anti-spasticity medications like baclofen and physical therapy may be prescribed by your doctor.
Review Medications
Once MS is being managed or you’re under remission, a review of medications should be done with your GP if you’re experiencing persistent sexual dysfunction. Some medications that manage symptoms of MS like antidepressants often have ED as a side effect. What would happen is that an alternative medication would be tested in managing MS symptoms and checking if the ED will improve. This will be a trial and error until you get to the right mix of medication with the least impact on your sexual health and general quality of life.
Answer the MSISQ-19
Your doctor might recommend that you answer a questionnaire called the Multiple Sclerosis Intimacy and Sexuality Questionnaire 19 (MSISQ-19). You can also access the questionnaire online and answer it yourself. MSISQ-19 is composed of 19 questions that check for sexual dysfunctions and the different causes of MS that may be related. The answers are a rating from a five-point scale ranging from one which means “never” and five which means “always” with the period of symptoms being the last 6 months. The test is relatively quick and can be answered within 2-3 minutes.
Talk to a Psychologist
MS can be debilitating to one’s mental health. A licensed therapist can help you cope with the disease and the resulting changes in your daily life or personal relationships. You will most likely be put under cognitive behavioural therapy (CBT) which is a type of therapy that reframes thoughts to change your actions and emotional response to the situation. At Men’s Health Clinic, we also have psychologists and sex therapists as part of our integrated treatments.
Do a Comprehensive ED Check
While MS is a culprit for a lot of ED cases, there are often multiple cases present for men. This means even if you manage the MS, if you’re unaware of the other triggers, the ED may continue. MS co-occurs with other conditions that can also cause ED like hypertension, thyroid disease, type 1 diabetes, and meningioma (brain tumour). It’s best to get an executive check-up that also tests these just to be safe. Certain diseases are relatively asymptomatic or share symptoms with other common health problems.
Men’s Health Clinic offers a comprehensive treatment package that comes with a team of experts. Not only do we extensively examine all root causes of your erectile dysfunction, we also make sure to tailor fit the medications, therapies, and health plans to your unique needs.
Conclusion
MS can disrupt your sexual function with ED being one of the first symptoms for men. But this doesn’t mean you must live with ED forever. There are ways to manage MS that preserves your erectile capacity. This is exactly why we use a comprehensive approach in designing our treatment plans. Book an appointment with us so we can discuss further how we will strategically manage your overall sexual health!
