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Sex and MS by Dr Tom Gilhooly

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Posted 04 July 2006 - 06:01 PM

Sex and MS by Dr Tom Gilhooly

One of the great ?unspoken? problems that affect MS patients is sexual dysfunction. This is a difficult subject to raise with health professionals in any case, no matter what the context is. Within a consultation for MS, where there are usually multiple problems to address, it is all too easy to ?let it lie?. Given the central part that a healthy sex life plays in many long term relationships, it is a potentially tragic omission. Relationships are put under enough strain by the impact of a chronic debilitating condition such as MS, and the caring role that one partner adopts, sometimes inadvertently. Patients attending my clinic are normally accompanied by a partner, if they have one, and it is indicative of the huge impact of this condition on families, and couples in particular. The issue of sexual dysfunction is seldom volunteered, and it does remain the responsibility of health professionals to sensitively raise this, where appropriate.

Estimates of the numbers of MS sufferers with sexual problems range from 60% for females, to up to 90% for males. Proper sexual function does depend on adequate blood flow and nerve function. MS affects both of these factors adversely, de-myelination reducing nerve transmission and the nerve supply to blood vessels, affecting blood flow to the sexual organs. The impact on urinary function is better documented, and affects over 60% of MS patients. Those with urinary problems often have sexual dysfunction for the same reason that their bladder is malfunctioning, poor nerve signalling.

The question that everyone wants to know the answer to is ?can anything be done?? Why raise an embarrassing subject such as this, if nothing can be done about it?

The new generation of medications aimed at erectile dysfunction, such as Viagra, work by increasing the release of a chemical known as Cyclic GMP within the cells. This is a very clever system, as this increase in CGMP will only be used if there is sexual arousal. Viagra is licensed for use in MS, and studies in male sufferers show a 50% success rate. Most MS patients do not realise that they qualify for this treatment on the NHS, and so have never sought it. The responsibility for this is shared with health professionals, who need to routinely enquire about sexual problems. This is now standard practice in diabetic clinics, and the taboo of sexual problems is now much reduced.

What about females? Damage to the nerves involved in sexual arousal and stimulation will have the effect of reducing sexual pleasure. Although there is no current treatment for this, there are several intriguing questions. Would Viagra help female sexual dysfunction in MS patients? The increase in cyclic GMP should, in theory, also have an impact on female sex organs but, as yet, there is little evidence to support this hypothesis. Also, what about LDN?

In our trial on the impact of LDN on bladder dysfunction in MS, sexual dysfunction is an area we will also be focussing on, and may be able to give an indication of whether improvements in bladder function are associated with improvements in sexual function. Many of the same nerves are involved in both areas, so again, in theory, there could be some impact; time will tell.

Sexual problems are common in MS, and should be raised by both the patients and health professionals. Current treatments are surprisingly effective for many patients, and future developments should further increase the available options. The potential role of LDN will become clearer in the near future.

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