Multidisciplinary Management of Sexual Dysfunction, Perineal Pain, and Elimination Dysfunction in a Woman with Multiple Sclerosis

Abstract

Multiple sclerosis (MS) is a chronic progressive neurologic disease that is most likely to affect young adults, when sexual activity is high. In addition to sensory disturbances, spasticity, tremors, weakness, depression, and cognitive problems, MS is well known to have significant detrimental effects on bowel, bladder, and sexual function, worsening the quality of life. Although sexual dysfunction (SD) is common in patients with MS, it remains underdiagnosed. According to a recent literature review, 1 SD prevalence ranges from 34% to 85% in women with MS and is more common and more severe than in male patients. 2In particular, reduced sexual desire is reported in 31.4% to 74.4% of women with MS, decreased lubrication in 35.7% to 48.4%, and orgasmic dysfunction in 37.0% to 44.9%.3 These data derive from standard questionnaires used to assess SD in patients with MS, helping to alleviate the common barriers that are reported by professionals when addressing sexual issues. Despite the large numbers of women who chose not to answer questions about SD in the different studies, 42% of respondents report such dysfunction, confirming that SD seems to be a major concern.4 To achieve a common and shared definition, SD is categorized as being related

Effectiveness of Physical Therapy in Addressing Sexual Dysfunction in Individuals with Multiple Sclerosis

“…Primary consequences include impairments related to sexual health that are a direct result of MS-related lesions. 7 For example, lesions to the thoracolumbar spinal cord may result in decreased somatic and autonomic outflow to the genital region, impairing muscle control and genital sensation. 8 Secondary consequences involve the physical manifestations of MS that indirectly affect sexual health, such as fatigue, spasticity, and pain, which can contribute to decreased libido and difficulty reaching orgasm.…”

“…8 Secondary consequences involve the physical manifestations of MS that indirectly affect sexual health, such as fatigue, spasticity, and pain, which can contribute to decreased libido and difficulty reaching orgasm. [7][8][9][10] Tertiary consequences encompass the psychological, social, and emotional factors that contribute to sexual experience, such as depression, anxiety, low self-esteem, altered marital roles, and changes in body image. 7,8,11 Exacerbations of MS can increase the impact of primary and secondary consequences, thereby negatively affecting sexual function and sexual satisfaction, which may lead to decreases in emotional well-being, a tertiary consequence.…”

“…[7][8][9][10] Tertiary consequences encompass the psychological, social, and emotional factors that contribute to sexual experience, such as depression, anxiety, low self-esteem, altered marital roles, and changes in body image. 7,8,11 Exacerbations of MS can increase the impact of primary and secondary consequences, thereby negatively affecting sexual function and sexual satisfaction, which may lead to decreases in emotional well-being, a tertiary consequence. 12 This pattern demonstrates the profound impact that sexual dysfunction often has on QOL.…”

The relationship between coping strategies with sexual satisfaction and sexual intimacy in women with multiple sclerosis

“…It is estimated that 2.8 million people are living with MS worldwide [ 3 ], and its latest prevalence in Iran and Tehran (the capital) is 148.06 and 162.38 per 100,000, respectively [ 4 , 5 ]. The prevalence of MS in women is three times higher than in men [ 6 ].…”

Perineal pain: Think beyond gynaecological reasons

“…5 Rarely, medical reasons like multiple sclerosis may cause perineal pain. 6 Here, we report a series of three such patients who presented to gynaecology outpatient department with severe perineal pain, and final diagnosis of spinal canal stenosis was made after multidisciplinary approach. All three patients needed subsequent surgical decompression by a spine surgeon.…”