Sexual Health in MS Is Overlooked; Here's How to Change That
MS affects far more than motor or cognitive function — it also significantly impairs sexual wellbeing. Studies estimate that 40%-80% of men and 50%-70% of women with MS experience some form of sexual dysfunction. 'Because of its central neurological involvement, MS can cause a wide range of sexual dysfunctions,' said Zeler, noting that symptoms vary by sex, lesion location, and disease stage.
In women, common issues include reduced vaginal lubrication, diminished clitoral and erogenous sensitivity, difficulty achieving orgasm, and frequent dyspareunia. For men, erectile dysfunction — ranging from partial to complete — is most frequently reported, along with ejaculatory problems and decreased genital sensation. 'In both sexes, hypoactive sexual desire and chronic fatigue often diminish libido and hinder sexual activity,' Zeler added.
Beyond the Bedroom
These dysfunctions can have profound personal and relational consequences. 'They affect sexual health, self-esteem, and intimate relationships — leading to frustration, guilt, and lower overall quality of life,' he said. International surveys, including those from the Multiple Sclerosis International Federation, consistently emphasize the importance of sexual wellbeing in quality of life assessments.
Yet the issue remains taboo. 'Most clinical encounters do not address sexuality — this is acknowledged by both patients and clinicians,' Zeler said. On the patient side, modesty, fear of stigma, or assumptions that sexual problems are secondary to other MS symptoms may prevent disclosure. Only 22.4% of women with MS report sexual issues to a healthcare provider.
Clinicians, too, face barriers: limited time, lack of training in sexual health, personal discomfort, or uncertainty about how to broach the topic. 'Outside of specialized MS clinics, only 18.75% of physicians raise these issues. This reciprocal silence leads to underdiagnosis and inadequate management of sexual dysfunction, further complicating the patient's care journey,' Zeler warned.
Practical Solutions
That these challenges are often overlooked is particularly regrettable, given that effective interventions exist and targeted management is possible. 'Several therapeutic options are available,' said Zeler. 'For erectile dysfunction, phosphodiesterase type 5 inhibitors such as sildenafil or tadalafil are often effective first-line treatments.'
For women experiencing vaginal dryness, water- or silicone-based lubricants are essential, and regular use of vaginal moisturizers can improve comfort and tissue health. Managing associated symptoms like spasticity and pain can further support sexual function. This may involve pharmacologic approaches — including muscle relaxants, analgesics, and neuropathic pain medications — as well as nonpharmacologic therapies like physiotherapy, physical therapy, or osteopathy. Fatigue, one of the most common and debilitating symptoms of MS, also requires targeted management as it significantly limits sexual activity.
In parallel with medical treatment, sexological counseling is a key component of care. 'Support can include practical advice and individualized adjustments — such as modifying sexual positions to reduce discomfort, scheduling intimacy during times of lower fatigue, or exploring noncoital expressions of intimacy and pleasure like touch, massage, and erotic play,' Zeler explained.
A Holistic Approach to Intimacy
Addressing sexual health in MS is not ancillary — it's integral to comprehensive patient care. Zeler encourages healthcare providers to take the lead: Open the conversation, normalize the topic, and incorporate sexual wellbeing into routine evaluations. Doing so not only validates patients' experiences but may also enhance overall treatment outcomes and quality of life.
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