Sexual disorders in men with multiple sclerosis: evaluation and management.

Abstract

Sexual dysfunction (SD) is a common feature of men with multiple sclerosis. SD is often unrecognized as patients and physicians are reluctant to discuss these problems. Rates of symptoms range from 50% to 90% and include erectile dysfunction, ejaculatory dysfunction, orgasmic dysfunction and reduced libido. SD can arise at any stage of the disease, even without severe disability. While erectile dysfunction is thought to be related to impairment of the pathways in the spinal cord, fatigue, spasticity, bladder and bowel dysfunction, and pain, contribute to SD. Psychosocial and cultural issues also need evaluating, and include depression, performance anxiety, lowered self-esteem. A comprehensive assessment of all theses aspects must be taken into account. Erectile dysfunction can be treated with phosphodiesterase inhibitors and intracavernous injections, with good efficacy. Ejaculatory dysfunction is managed through penile vibratory stimulation and midodrine. Concerning fertility issues, the effects of or immunomodulating drugs on semen quality are largely unknown, whereas many immunosuppressive therapies have a negative effect on semen quality that may be definitive. Advanced methods of assisted reproduction may sometimes be the only option for conception. Physicians' awareness of this problem may help to bring about appropriate treatments, and improve the quality of life for these patients.

• Authors: J G Prévinaire, G Lecourt, J M Soler, P Denys
• Journal: Annals of physical and rehabilitation medicine (Ann Phys Rehabil Med) Vol. 57 Issue 5 Pg. 329-336 (Jul 2014) ISSN: 1877-0665 [Electronic] Netherlands
• PMID: 24958443 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Topics

• Humans
• Male
• Multiple Sclerosis (complications)
• Sexual Dysfunction, Physiological (diagnosis, etiology, therapy)