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Sex and Multiple Sclerosis

Sex and Multiple Sclerosis | Jo Divine

Research has suggested that up to 50%-80% of women with Multiple Sclerosis (MS) and 70% of men may experience sexual problems at some point during their lives, compared to 40% of all women and 22% of men in the UK. Many of these problems can be alleviated but are often under reported by people who have MS or are misdiagnosed or not even discussed by their medical practitioners.

People living with MS and their partners often report that the symptoms of the condition affects their physical and emotional well being, causing changes in their relationship.

For some couples, MS can cause a breakdown in communication and intimacy where one or both involved feel lonely, isolated, rejected or just confused. Often the person with MS feels guilty for not being able to have sexual intercourse with their partner, thus increasing their sexual anxiety and their partner worries that they will cause them pain so avoid having sexual intercourse.

Changes in levels of desire

Changes on levels of desire can affect both men and women, either as a direct result of having MS or as a consequence of having to live with the disease. When first diagnosed with MS or new symptoms of the disease develop, feelings of sadness and anger can occur, impacting upon both physical and emotional needs of the body. This can lead to a decrease in sexual libido.

How you feel about having MS can impact upon your desire and the way in which you feel about your body and your sexuality. Your partner will feel worried about your condition and might avoid having sexual intercourse as they fear it will cause you pain, thus increasing your anxiety.

Levels of sexual desire can drop at any time throughout your life, including during the menopause, periods of stress, having children or caring for elderly parents. All these can impact upon our libido whether we have MS or not.

MS and sexual function

Having MS can cause physical sexual difficulties due to interruption of the electrical impulses being sent from the brain to the sexual organs via the spinal cord. Sexual arousal, response and orgasm need messages to be sent through this pathway and any nerve damage in the brain and spinal cord can cause problems for both men and women.

Sex and single people

You still have sexual needs and desire even if you are not in a relationship. Having MS can affect you forming relationships, dating and meeting new people due to any concerns you may have about your sexual performance. You may feel anger and sadness at the break up of a former relationship, perhaps as a result of you developing MS. Problems can occur when masturbating, due to limited mobility or manual dexterity.

How MS affects sexuality

Primary sexual function

This relates directly to the changes in the brain and spinal cord bought about by the onset of MS which impact upon sexual pleasure. Both men and women can experience a decrease or loss in libido and genital sensation. Men can have difficulty in maintaining or achieving an erection and a decrease or loss of ejaculation. Women may experience reduced vaginal secretions leading to vaginal dryness, loss of vaginal muscle tone and diminished clitoral engorgement.

Secondary sexual function

This stems from MS symptoms that do not directly related to the nerve pathways for sexual pleasure or response. They can include bladder and bowel problems, fatigue, tremors, limited attention and concentration span and non genital sensory changes.

Tertiary sexual function

This is related to the mental and emotion aspects of MS and the feelings it creates, such as depression, sadness, loss of sexuality, mood swings and feeling less confident about their body image. The change of lover to caregiver puts tremendous strain on both the MS sufferer and their partner, which can ultimately lead to break down in communication, at a time when good communication is essential.

Sexual problems affecting women

Our sexual response and arousal relies upon messages being sent along the nerve pathways between the spinal cord and brain. MS can interrupt these pathways, and the sexual response messages never arrive at their destination.

Many women with MS can suffer from some of the following sexual problems throughout their lives but there is help available to alleviate some of these problems.

Vaginal dryness

This is a common problem for many women, not just those with MS, as hormonal changes throughout a woman’s life, such as childbirth, the menopause, ageing and side effects of medication, can have an effect upon the secretions of the vagina.

Vaginal dryness can make sexual intercourse uncomfortable or painful. Using a good lubricant can greatly alleviate this problem. Choose an organic lubricant such as YES which contains only plant extracts and is approved by the Soil Association. Offering both water based and oil based formulations, YES lubricates and nourishes the delicate tissues of the vaginal walls, making them more flexible.

YES is devoid of taste, smell and colour, thus avoiding any unpleasant chemicals which can cause allergies and sensitivity. Supplied in handy applicators, using YES is easy to use, if you have restricted mobility or manual dexterity problems.

Difficulty reaching orgasm

Some women with MS find that they have problems reaching an orgasm or require more stimulation to achieve one. Using a vibrator can help, as the waves of vibrations can help to trigger an orgasm by stimulating the nerve endings in the clitoris and vagina as well as your G-spot.

Desensitisation of the nerves within the vagina and clitoris may mean you are unable to orgasm through sexual intercourse, or manual stimulation. Using a body massager such as the Doxy or Lelo Smart Wand can help as these products offer much stronger vibratory power than conventional vibrators in addition to being body massagers too, so ideal for giving you an orgasm and easing your aches and pains!

75% of women require clitoral stimulation to achieve orgasm, therefore you may prefer an external or clitoral toy which stimulates the clitoris. Many are small in dimensions making them light weight and easy to handle.

Classic vibrators can be used both internally and externally, some of which are designed to stimulate the G-spot, located just inside the vagina which can produce strong orgasms.

Rabbit vibrators offer both internal and external stimulation at the same time, producing both clitoral and vagina orgasms simultaneously.

The Nexus Bisous offers a rotating shaft , mimicing a finger like motion, suitable for g-spot stimulation. and the Nexus Cadence has stroker technology in the tip, which massages your G-spot too.

The Fun Factory Stronic range of sex toys use a thrusting motion for sexual stimulation, ideal if you want to experience a similar sensation to sexual intercourse.

Many vibrators are well designed and come in different shapes and sizes, so finding one to suit your needs can be easy. Some require batteries which can be fiddly to insert if you have problems with manual dexterity, others are rechargeable, thus removing the need for batteries and will not stop working at the most crucial moment! If you suffer from fatigue, there are several lightweight products which are easy to use and will not cause your hand to tire. Some can be worn in your knickers against your clitoris or just rested between your thighs.

Pelvic floor exercises

Strengthening pelvic floor muscles can increase orgasmic response and improve urinary incontinence. Some women find it hard to contract their pelvic floor muscles but the use of kegel exercisers can help. LELO Luna balls consist of weighted balls which can be inserted daily for 2 hours. When worn, the clay balls inside the outer shell move around as you go about your daily routine and cause the pelvic floor muscles to involuntarily tense. Using the 16 week exercise regime, a woman can strengthen her muscles which can improve her orgasms. Kegel exercisers are useful for all women, whatever their age and state of health pelvic floor link.

The Lelo Luna Smart Bead is a vibrating pelvic floor exerciser which offers a daily 5 minutes exercise programme to follow and tracks your progress by increasing the strngth of the vibrations, the stronger you PC muscles become.

Combining both vibratory power and electrical stimulation, the MyStim range of vibrators offer both a vibrator and pelvic floor exerciser in one product. They all offer a pelvic floor exercise programme to follow, using electircal impulses to exercise the PC muscles.

Drug therapy can alleviate decreased sensation and counselling can help to enhance intimacy and communication.

Body mapping involves identifying parts of the body and types of touch that feel good and increase sexual arousal. This process needs to be practised to enable the woman to become aware of what works for her. She can then communicate this information to her partner to increase their intimacy and sexual pleasure. Experimenting with different positions can help. Using cushions and pillows to support your body can enable you to find the most comfortable position. You may not be swinging from the chandeliers but you should be able to find the best position to have pleasurable sex.

Sexual problems affecting men

About 70% of men with MS experience erectile dysfunction, with some symptoms appearing several years after the onset of the disease. Problems can occur as a result of side effects from medication too. The degree of erectile dysfunction is dependant upon where the nerve damage occurs. A man may get an erection in response to genital stimulation but not as a response to sexual arousal if this pathway is disrupted due to MS related nerve damage.

Erectile problems

Medication in the form of tablets, intravenous therapy and intra urethral suppositories can help to enhance the blood flow to the penis as can topical medication, applied directly to the penis and should be discussed with a medical professional. However, some men do not find drug therapy helpful and the use of penis pumps can help to prolong an erection by creating a vacuum around the penis improving blood flow, then placing a constriction ring such as cock rings around the base of the penis can help to maintain the erection.

There are many other male sex toys which can help increase sexual sensations, including penis sleeves, ideal when it may take some time to reach orgasm and offer a vagina-like sexual experience. Stimulating the prostate gland with prostate massagers can enable a man to experience sexual sensation and produce strong orgasms.

Sex toys, such as Fun factory Cobra Libre 2 and the Pulse Solo III enable a man to enjoy sexual sensations even when he is unable to gain an erection as they sit either over the head of the penis or around the shaft. Using vibratory pulse plates, the Pulse offers different sexual sensations. It can be used hands-free so ideal for those with imited motor ability.

Limited mobility or reduced manual dexterity can be a symptom of MS but the use of penis sleeves or male masturbator, such as the Pulse by Hot Octopuss can aid masturbation, either for the man or his partner. It can reduce fatigue and increase stimulation to the penis. The internal moulded sheath of the penis sleeve can produce intense sexual sensations. Some vibrating sleeves increase the sensations felt, thus increasing the intensity of sexual pleasure.

Prostate massagers can help a man to achieve an orgasm by stimulation of the prostate gland or P-spot, a chestnut sized swelling, situated about 2 inches inside the anus. Some massagers can be manually manipulated to massage the prostate, others vibrate, sending waves of pleasure to this erogenous zone.

Urinary catheters can be folded inside a condom during sex to avoid getting in the way or try to self catheterise or void before sex. Use towels to protect your bed sheets.

Body mapping is helpful for men too, helping them to know what arouses them and to enable their partner to touch them affectively to bring about the most sexual pleasure.

Sex without intercourse

You can have great sex without intercourse to enjoy the pleasures of sex. If sexual intercourse in no longer an option, sexual intimacy and pleasure can be achieved in other ways. Some of the following can help to reignite the sexual intimacy and pleasure that may have been lost since being diagnosed with MS. Being imaginative with your sex play can increase pleasure and intimacy.

Massage

A sensual massage can help to arouse sexual feelings and bring you closer together as well as easing muscle spasm. It can reinforce positive feelings about your changing body image and make you feel loved and cherished. Take antispasmodic drugs 60 minutes before having a massage to help to relieve any pain.

Masturbate together

This can be extremely arousing and will show your partner how and where you like to be touched. It takes confidence to do this which can be difficult to overcome initially, especially if you are struggling with body image issues but your partner loves you no matter how you look. Knowing that your partner still finds you desirable can go along way to boosting your confidence and sexual arousal.

Masturbate each other

Limited manual dexterity may be problematic when masturbating each other but the use of penis sleeves and vibrators can help and reduce fatigue.

Sex toys

As mentioned above, sex toys can really help with decreased sexual arousal and sensation. Using a vibrator, vaginally or clitorally, can induce intense orgasms. Many men will gain immense pleasure from being able to stimulate their partner with a vibrator or dildo if full sexual intercourse is not possible.

Oral sex

Great oral sex is essential for non penetrative sex. Men enjoy oral sex and do not need a fully erect penis to enjoy the benefits it offers. Some women enjoy oral sex but are often let down by poor technique. Communicate to your partner what feels good and what to avoid. This works for men too. Knowing what turns you both on will enhance your sexual enjoyment. There are many flavoured lubricants you can use if you find the taste unpleasant.

Be aware that flovoured lubricants contain glycerine, which is sugr and can cause thrush if used vaginally.

The Lelo Ora v2 is a superb oral sex toy, mimicing oral stimulation if oral sex is not possible.

Ties and blindfolds

Spice up your sex life using light bondage. Incorporating silk ties can bring an element of kinkiness to your sex life and hopefully ignite those flames of arousal. Being blindfolded can increase your sense of taste, touch, sound and smell. You can feel sexually aroused if you don’t know what if coming next!

Watch erotic films and read erotic fiction

There is a wealth of erotic fiction available so read to your partner to get in the mood or read a naughty chapter to yourself before bedtime to trigger sexual arousal. By reading or watching erotica, you may both discover an idea or story line you want to use to spice up your lovemaking

Time your medication

Take your pain medication or anticholinergenics for bladder dysfunction 30 minutes before having sex to ensure that they have started working.

Massage before sex can help reduce the occurrence of muscle spasm. Take any antispasmodic medication one hour before having sex.

Medication for fatigue should be taken 1 hour before sexual activity. If you self inject your medication, ensure that you do it well in advance of sexual intercourse to ensure that any side effects of having an injection have passed and sex can be enjoyed. On the other hand, sex might just be the perfect thing to take your mind off unpleasant injections.

If you take antidepressants, these may have a negative effect upon your libido so speak to your GP about changing to an alternative drug to help your symptoms.

Having MS should not stop you from enjoying sex. Your MS Nurse Specialist will be able to offer you advice about sexual issues and refer you for sex counselling. There are so many ways in which you can enjoy intimacy and sexual pleasure by incorporating sex toys, erotica, oral sex and masturbation into your lovemaking, it just may take time and experimentation to find out what works for you.

At Jo Divine we believe that sexual health and sexual pleasure go hand in hand and have created a health brochure with suitable products to help people with sexual issues. We also have our Jo Divine catalogue with male products too. Working with medical professionals, we hope to encourage patients and HCPs alike in talking more freely about sexual problems. A health issue doesn’t mean your sex life will have to stop!

There are also several excellent free publications by the MS society including:

Sexuality: a guide for women by Nicki Ward-Abel and Janice Sykes

Sex and MS: a guide for men by Simon Webster and Sex, Intimacy and relationships by Sarah Westlake

The Ultimate Guide to Sex and Disability by Cory Silverberg et al (Cleis Press)

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