By Dr Annette Carruthers, GP
A diagnosis of MS often occurs at an age when sexual activity is peaking and is of particular importance in both established and emerging relationships. The profound impact that the diagnosis has, raises many questions for the person with MS and their partner.
Will our relationship change?
Will symptoms of MS affect the quality of our sexual relationship?
Research has demonstrated that around half of partners, in a relationship with someone with relapsing MS, report that the disease has impacted on their sex life. Depression and fatigue can impact on willingness to participate in sexual activity. Physical problems such as erectile dysfunction, vaginal dryness and decreased sensation can occur.
The good news today is that much can be done to keep people newly diagnosed with MS well and prevent the onset of symptoms that impact on a sexual relationship. There are also strategies to manage problems should they emerge.
Intimacy in a relationship has an essential emotional component, as well as physical sexuality. The desire to be loved is a key human characteristic. Both the person with MS and their partner need the emotional closeness, the feeling of mutual caring and the trust as core components of a successful relationship. As roles change both partners need the reassurance that the core relationship is strong and enduring.
Your partner can aim to remain well and avoid the onset of symptoms affecting sexuality by embracing the lifestyle changes that have been shown to reduce progression of the disease and also by taking medication when advised by their neurologist. A partner’s support for significant dietary changes, regular exercise, and daily meditation practice will create the sense of partnership on the MS journey and be greatly valued.
MS can cause a loss of confidence and self-worth. Building self-esteem by words and actions can help both partners feel comfort and love. Unexpected gifts, flowers, short breaks and nights out all help sustain and enhance intimacy. Making love can be a time when a person with MS feels normal again. Couples who address the challenges together can grow closer than ever before.
Communication is so important. Couples are encouraged to share what they most enjoy in a sexual relationship, and also what they don’t like, in order to meet each other’s needs. Sexual intimacy can be achieved by kissing, cuddling, stroking sensitive areas, genital stimulation as well as orgasm. Experiment with new positions. Non-penetration activities can be satisfying, it’s doesn’t have to be all about orgasm!
Where fatigue is a problem, be aware that this is often worse in the afternoons and evenings. This will vary with individuals but targeting times of less fatigue for both partners is a good idea.
Depression can affect both people with MS and result in lack of sexual interest and fatigue. Unfortunately, some medications to treat depression can also cause sexual dysfunction especially difficulty maintaining an erection. Depression can also be managed with psychological therapies and result in the need for less medication. Pay attention to your own mood. It is natural for carers to experience symptoms of depression and fatigue at times. Don’t allow yourself to become overwhelmed by the carer role. Should these issues arise you are encouraged to raise them with your GP, MS nurse or neurologist. There are medications that can be very helpful for erectile dysfunction, so please don’t feel embarrassed to discuss these with your GP. Medications such as Viagra, Cialis and Levitra are generally effective and well-tolerated and can be prescribed by your GP.
People with MS can experience changes in sensation in sexually sensitive areas. This may reduce the response from being touched in certain areas such as the breasts, nipples or genital areas or your partner may prefer a more vigorous stimulation to achieve the same effect. Again, communication is the key to understanding changes that could otherwise be interpreted as loss of interest. Dryness of skin and vagina can be corrected by use of massage oils and lubricants. Massage can enhance the sexual experience and there are many lovely massage oils to choose from. Oestrogen creams can also help dryness around the time of the menopause.
There are many sex aids that can help overcome difficulties. Local sex shops and on-line stores have a range of toys that can be fun to use and enhance the experience particularly if penile penetration has become difficult. Don’t be embarrassed to visit one.
As with all sexual relationships, lack of privacy, haste, intoxication and aggression can all impair the experience. Creating the right environment at the right time pays dividends.
Obesity and cigarette smoking can impair sexual performance. Seek help with managing these risk factors. People with MS should not smoke, actively or passively.
For specific problems that you are unable to overcome, raise the issue with your GP who can also refer you to a sexual health physician, if the issues are beyond their own expertise.
Dr Annette Carruthers is a general practitioner who also serves on a range of boards in health and aged care.
She was recently awarded the Medal of the Order of Australia for services to community health, and to people living with MS.