Erectile dysfunction in multiple sclerosis Associated neurological and neurophysiological deficits, and treatment of the condition

Abstract

Forty-eight men with multiple sclerosis and erectile dysfunction were evaluated. Emphasis was placed on the neurological features and the relationship between impotence and the bladder dysfunction in multiple sclerosis. Erectile failure was invariably associated with pyramidal signs in the lower limbs and with urinary symptoms. All of the men with impotence and marked pyramidal dysfunction in their legs were found by cystometric studies to have bladder hyperreflexia. The severity of the urinary symptoms was related to the degree of pyramidal impairment in the lower limbs. The posterior tibial and the pudendal cortical evoked potentials were abnormal in most of the men with multiple sclerosis and erectile failure. However, recording the pudendal cortical responses in patients with multiple sclerosis and impotence provided no more information than the tibial cortical evoked potentials. The neurological examination findings together with the results of the neurophysiological and cystometric tests suggest that erectile dysfunction in multiple sclerosis is due to spinal lesions situated proximal to the sacral cord. The feasability of papaverine intracorporeal injection therapy for men with multiple sclerosis and impotence was assessed. Papaverine intracorporeal injections produced satisfactory erections in the majority of the impotent men. Erectile failure in patients with multiple sclerosis was successfully managed for up to 2 years, by intracorporeal self-injection therapy.

Sexual function in men with cauda equina lesions: a clinical and electromyographic study

“…The IIEF used here may also be more sensitive than the clinical evaluations performed in published studies. [1][2][3][4] Comparing our results with two other neurological disorders that affect young men-multiple sclerosis and spinal cord injuries-reveals a similar prevalence of sexual dysfunction, which affects about 70% of men with multiple sclerosis 18 and 25-95% of men with spinal injuries. 19 The main difference, however, between the population of patients with cauda equina lesions and these other two conditions is in the importance ascribed to sexual dysfunction.…”

Bulbocavernosus-reflex latencies and pudendal nerve SSEP compared to penile vascular testing in 669 patients with erectile failure and other sexual dysfunction

“…In patients with a history of multiple sclerosis, Ghezzi et al 29 found in a sample of 34 patients 9% pathological BCR-L and 77% pathological pudendal nerve SSEP without any correlation to the respective erectile capacity, whereas Betts et al 30 described in an equivalent sample of 34 MS-patients a considerable even if not as high as for tibial SSEP correlation between pudendal SSEP and hyperre¯exogenic bladder as well as Kurtzke score. Considering erectile function, however, no correlation was observed.…”

Autonomic symptom burden is associated with MS-related fatigue and quality of life

“…Visceral symptoms are perhaps the most evident in clinical practice with reports documenting bladder, bowel or sexual dysfunction in 50-75% (Betts et al, 1993(Betts et al, , 1994Fowler and Henry, 1996;Hinds et al, 1990). Cardiovascular manifestations such as syncope, orthostatic dizziness and excessive postural tachycardia, the latter of which has been documented at rates of up to 63% (Adamec et al, 2012(Adamec et al, , 2013Flachenecker et al, 1999;Kanjwal et al, 2010;Sterman et al, 1985), have also been reported, although the pathophysiological relationship of these disorders to MS is not clearly established.…”