Letter to the Editor: Sexual Support for Iranian Women with Multiple Sclerosis During Treatment Process: Sufficient or Insufficient?

Abstract

The prevalence of multiple sclerosis (MS) has been steadily rising over the past century, and this increase has been seen mainly in women. The results of a meta-analysis in 2019 showed that the prevalence of MS in Iran is high (29.3/100,000) and rising over time.1 Also in this study, the prevalence of MS in women was estimated to be 44.8/100,000, which was three times more than in men (16.5/100,000 people).1 On average, MS occurs in the third and fourth decades of life, so women of childbearing age are at the highest risk of developing the disease. In women with MS, sexual dysfunction, which has a major effect on quality of life, is one of the most common problems.2 The prevalence of sexual dysfunction in Iranian women with MS is 62%.3 In a qualitative study in 2017, Iranian women with MS indicated that they did not receive enough attention about their sexual problems during the treatment process. They also reported that they did not receive adequate sexual training and counseling from the treatment team.4 On the other hand, in Iran along with other countries, because of cultural context, women feel ashamed and embarrassed to talk about sexual feelings and experiences. For some Iranian women, talking about sexual issues is an undesirable action.5 Therefore, such problems seem to be neglected during the treatment process for female patients with MS.To understand the status of sexual support and health services provided to Iranian women with MS, a qualitative study was performed based on a conventional content analysis approach, with the participation of 11 married women with MS who were referred to the Iran Multiple Sclerosis Society and four key informants including a neurologist, a sexologist, a psychologist, and a reproductive health specialist. The Iran MS Society is a rehabilitation referral center in Tehran, Iran; most patients with MS visit this center to use free-of-charge rehabilitation and medical services. Participants’ experiences demonstrated the insufficiency of sexual health services in three categories: insufficient attention and skill of the treatment team to sexual issues, inappropriate and insufficient sexual education and counseling in the treatment process, and lack of access to centralized and low-cost sexual health services.In the first category, most participants reported a lack of attention by physicians to their sexual problems due to the short duration of visits. A number of participants also discussed the inadequate skills of physicians and a lack of teamwork in the treatment of their sexual problems. In the second category, most participants pointed out they feel ashamed and embarrassed in expressing their sexual problem with health care providers. In addition, some of them stated that if they did not bring up their sexual problems, they would not receive any sexual education and counseling routinely from the treatment team. In the third category, participants pointed to the high cost of sexual health services and the lack of centralized sexual health services in the MS Society.The results of the present study show that sexual health services for Iranian women with MS are insufficient. Therefore, it is recommended that need-based, culture-based, and low-cost (or even free) multidisciplinary sexual health services be provided to all women and their spouses as an essential part of the treatment process.The authors declare no conflicts of interest.