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Multiple sclerosis and sex

The sexual spirit can shine through despite incredible challenges. A situation where one partner has multiple sclerosis demonstrates the power of intimate connection, and how everyone is deserving of the feeling of sexual closeness.

Granted, a diagnosis of multiple sclerosis (MS) does require some reassessing of your sexuality and sex life. Sometimes it doesn’t come in the package you expect, or in the ways you’ve had it previously, but it’s still there. Be aware that you need to check with your doctor before trying anything new.

How MS can affect the sexual response
Sexual arousal begins in the nervous system, as the brain relays messages to the sex organs along nerves running through the spinal cord.

MS may damage these nerve pathways, meaning that sexual response can be affected. Other indirect symptoms can play havoc with a person’s sexuality as well, causing issues such as fatigue or muscle spasticity, and changes in mood. As a result, MS is a humbling disease, one that can affect self-esteem and the ability to feel sexually desirable.

General sexual symptoms include:

- Reduced sensation or painfully heightened sensation
- Vaginal dryness in women
- Erection problems in men
- Trouble reaching orgasm
- Loss of sexual appetite
- Positioning problems due to muscle spasms
- Bowel or bladder incontinence
- Overall weakness and fatigue

As many as 80% of women and 90% of men with MS say the disease has negatively affected their sexuality.

Treatments include Viagra or the Muse system (which involves inserting a small suppository into the penis), inflatable devices and implants for men. For women, good lubrication can address vaginal dryness.

Usually both partners can benefit from using alternative methods of sexual stimulation, like vibrators and dildos. This can help overcome slow arousal or impaired sensation. At various points throughout the disease, medications can help with spasms and mood swings. Intermittent catheterisation can control urinary leakage during intercourse, and enemas can be used prior to sexual encounters.

We all have sexual needs and a need for closeness
This may sound daunting but all is not lost, even in the advanced stage of MS. It can be difficult to come up with strategies as the condition changes or progresses. But people still have sexual needs and a need for closeness to their partner.

In cases where there is an indwelling catheter, usually with removal of this on occasion, vaginal/penile penetration can be achieved as well as anal intercourse. A “side spooning” position is considered the best option for penetration, if such factors as spasms and vaginal irritation from the catheter aren’t an issue.

Kissing and caressing are always possibilities, even if you have to give your partner some assistance.

Let’s not forget about everyone’s favourite sexual organ either: the mind. Appeal to what turns your partner on mentally. Light some candles, read erotic novels, watch adult movies together. The more you focus on the other senses your partner has, the more satisfaction you’ll both experience. Use aromatherapy oils in a warm bath, or rub fragrant oils on the skin. Gently touch where there is feeling – behind the ears, stroking the hair, nibbling the neck.

Many people with limited movement have found that having sex in water, with the freedom buoyancy brings, has allowed them to have sex more easily.

Reinforce your partner's sexuality
If you’re comfortable, go through the motions of helping your partner masturbate – with or without a vibrator. Some quadriplegics have said that by fantasising they can recall the sensation of an orgasm in their mind. Perhaps you can masturbate in front of your partner. The more you can do to reinforce that your partner still is a sexual being, the more both of you as a couple can still share eroticism with one another.

There are many MS and disability organisations out there that are finally beginning to address sexuality. Often, there are message boards where the individuals affected and their partners can swap ideas on positions and sexual products.

It’s helpful to also have a doctor who is open to discussing these issues. A good doctor will always make time to discuss the sexual impact of your diagnosis. In addition, many sexologists and sex therapists also specialise in sex and disability.

Focus on the sexuality you can still share. The more each of you can get comfortable with the disease and the bodily changes associated with it, the better.

And like any couple, don’t forget to communicate! If one of you is having a rough day, talk about it. Communication will be especially helpful to you both in monitoring the status of the disease and any changes sexually you may need to make along the way. A diagnosis of MS doesn’t have to mean that you lose all sexual options; it can be an opportunity to embrace the bond you have.

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