Q&A 98: male sexual dysfunction in MS

Sexual dysfunction is a common symptom in men with MS, with a prevalence that surpasses that seen in the general population and other chronic disease states.

Case

I am a 30-year-old man with relapsing MS. I was diagnosed when I was in my first year of University, aged 18. I presented with transverse myelitis and weakness of both legs and urinary retention. I have been on natalizumab for 12 years and have done very well. However, I have sexual problems with difficulty getting and maintaining an erection. This is affecting my relationship with my wife. Whenever I bring this up with my MS nurse or neurologist, I get fobbed off. My GP has given me Viagra, which helps, but it is unpredictable in its effects, and more often than not, it lets me down. I have gotten to the point where I now avoid sexual activity. Is there any advice you can give to help me and others like me? Thank you.

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Prof G’s answers

Your email is very timely, as I was in the process of writing a chapter for the MS-Selfie microsite on sexual dysfunction (SD) in males with MS (mwMS). Sadly, SD in mwMS is a neglected topic. While the clinical presentation of MS is variable, MS can rarely present in men as SD. I have had a handful of men referred to me from the urologist with SD who are found to have MS-like lesions in their spinal cords. The following is what is currently known about the problem of SD in mwMS and how it can be managed.