Recreating intimacy: understanding sexual change and multiple sclerosis

 

Whether you are in a relationship or not, everyone is entitled to and deserves to have a fulfilling sex life. Sex and intimacy play a huge role in your relationships, wellbeing, and allow us to express ourselves as sexual beings. Multiple sclerosis (MS) affects sexuality directly and indirectly, and it is completely normal for women with MS to have doubts and concerns about resuming their sex lives1.Educating yourself on your condition, how it affects sexual function, and creatively exploring potential solutions to problems you may face are important steps in rebuilding a fulfilling sex life for you and your partner. Regardless of the stage of your condition, your age, or your relationship status, you are still capable of giving and receiving love, closeness, and pleasure.

 

How will MS affect my sex life?

 

MS may affect sexual functioning in three ways. Primary sexual dysfunction refers to sexual changes that occur as a direct result of the demyelination process (the wearing down of nerve insulating material) that characterises MS1,2 .Sexual physiology involves complex networks in the brain and spinal cord, and MS can affect any of these neural pathways. Demyelination in the brain may alter the interpretation of sexual stimuli and sexual thoughts, while demyelination in the spinal cord may disrupt transmission of sexual responses1,2.The result is that you may experience differences in sexual arousal and sensation. Up to 80% of women will experience sexual difficulties of this nature at some stage in the course of their condition, with many women reporting an inability to climax, close to half complaining of reduced genital sensation, and around one in three women experiencing reduced vaginal lubrication and arousal1.Secondary causes of sexual problems in the setting of MS refer to changes in one’s body and general functioning that indirectly affect sexual performance and desire. The symptoms of MS, along with changes in dexterity and mobility can make sex challenging

Secondary causes of sexual problems in the setting of MS refer to changes in one’s body and general functioning that indirectly affect sexual performance and desire. The symptoms of MS, along with changes in dexterity and mobility can make sex challenging1,4. Fatigue is one of the most common MS symptoms, and of course when you’re tired and drowsy sex may be the last thing on your mind. Many women with MS find themselves withdrawing from sexual activities and intimacy, simply because they don’t feel they have the energy1,4 . Pain, muscle weakness, changes in muscle tone, and reduced coordination may also affect sexual activity, and require some problem solving to overcome awkwardness or feeling clumsy1. You may also be anxious if you suffer from bladder and/or bowel dysfunction, as this is another physical barrier which could cause anxiety when becoming intimate with a partner. 

Finally, the tertiary causes of sexual change in MS include emotional and psychosocial elements that determine our sexual feelings and our sexual expression1,2. As an MS patient you may find significant changes in self-perception, body image, and confidence1. In addition, your relationships and family roles may change, and your lover may also now be your carer. Transitioning between these two relationships can be difficult, and can have an affect on the way your relationship works. People living with MS often have trouble seeing themselves as sexual creatures, and the fear of real or imagined disability may extinguish any sexual urges before they can be explored1

Rebuilding intimacy with your partner

 

Anyone experiencing sexual problems would be advised to explore their own body, and the same is true in the case of MS. Begin by redefining your sexuality and spending time mapping your body. 1 You should be alone, warm, comfortable, and naked. Explore touching every part of your body, from your head to your toes, and vary the pressure and rhythm of touch as you discover what feels good. Once you have completed this body mapping exercise, it’s time to share your discoveries with your partner. Experiment with massage, sensual oils, ‘sex play’, or even using a vibrator. Remember that sex is about far more than genital stimulation and orgasm. Lubricants, oestrogen creams, or vaginal suppositories may be useful for women experiencing vaginal dryness1 , and your therapist or doctor will be able to advise on the best course of action. Note that some medications you may be taking can influence sexual performance, and you may wish to discuss this with your doctor3.Basic comfort measures and some creative problem solving are required to overcome secondary sexual dysfunction. If fatigue is the major problem, arrange

Basic comfort measures and some creative problem solving are required to overcome secondary sexual dysfunction. If fatigue is the major problem, arrange intimate time with your partner when your energy levels are at their highest1. Issues involving weakness and muscle tone can be addressed by trying different positions and using pillows for support1. Regular kegel exercises are advised to strengthen the muscles of the pelvic floor. Have frank conversations about any bladder or bowel fears you may have, and discuss what you will do if an accident happens. Padding the bed might give you a little more confidence in this regard, and those who self-catheterise are advised to empty their bladder before sexual activity1.

Finally, facing sexual challenges and recreating intimacy are not complete without some serious reflection and very open and honest discussions with your partner. Tertiary sexual issues and areas of concern can be managed by taking the time to explain your feelings to your lover, and talking about your fantasies and desires will boost your libido. Couples who struggle to initiate these talks should consider seeking professional help in the form of counselling or support groups3. Discuss your sexuality and your sex life, and share your fears gently and slowly, without blame1. Remind yourself that you are beautiful, you are sexy, and that you have the power to redefine your sexual experience.

 

If you need any more information relating to recreating intimacy with MS, just head to our Learn section. Our Bard nurses are always on hand for some advice, so get in touch if you feel like having a chat. 

 

1 Multiple Sclerosis International Federation. Intimacy and sexuality. MS in focus. 2005(6)

2 Kessler TM, Fowler CJ, Panicker JN. Sexual dysfunction in multiple sclerosis. Expert Rev Neurother. 2009 Mar;9(3):341­50.

3 Guo ZN, He SY, Zhang HL, Wu J, Yang Y. Multiple sclerosis and sexual dysfunction. Asian J Androl. 2012 Jul;14(4):530­5.

4 Fletcher SG, Castro­Borrero W, Remington G, Treadaway K, Lemack GE, Frohman EM. Sexual dysfunction in patients with multiple sclerosis: a multidisciplinary approach to evaluation and management. Nat Clin Pract Urol. 2009 Feb;6(2):96­107.