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.

L'anéjaculation et l'éjaculation rétrograde font partie des dysfonctions éjaculatoires, leur fréquence est moindre que l'éjaculation prématurée. Elles peuvent être responsables d'anorgasmie et engendrer des problèmes d'infertilité. L'anéjaculation peut être congénitale ou acquise, fréquemment au décours de chirurgie prostatique ou de maladies neurologiques, en particulier médullaires. Les origines psychologiques ne doivent pas être ignorées. Les mêmes étiologies sont souvent retrouvées en cas d'éjaculation rétrograde. Différentes approches thérapeutiques existent en fonction de l'étio-logie. La stimulation pénienne vibratoire (vibromassage) et la stimulation pharmacologique sympathomimétique (midodrine) représentent souvent un traitement de première intention, qui permet un recueil de sperme sans nécessité d'électroéjaculation ou de techniques chirurgicales, plus contraignantes. La psychothérapie sera proposée en cas de nécessité. Le traitement par midodrine présente une certaine efficacité dans le traitement de l'éjaculation rétrograde, par fermeture du col vésical.Abstract: Ejaculatory disorders are common male sexual dysfunctions. Although premature ejaculation has been extensively studied, anejaculation and retrograde ejaculation are lesser known, though they have been associated with anorgasmia and reproductive disorders. Anejaculation can be congenital or acquired and is mostly seen after prostate surgery and neurological diseases (spinal cord injuries) or is related to psychogenic factors. Generally, the same causes are associated with retrograde ejaculation. The management of these disorders depends on aetiology. Penile vibratory stimulation and pharmacological stimulation, using sympathomimetic drugs, such as midodrine, are increasingly recommended as first-line treatments. Electroejaculation and surgical procedures should only be used when necessary. Behavioural therapy is sometimes indicated when psychogenic or relationship factors are identified. By inducing bladder neck closure, midodrine can prove effective in the treatment of retrograde ejaculation.

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