Sexual Dysfunction in Women with Early Multiple Sclerosis

Abstract

Sexuality and intimacy are crucial to our well-being. Among other manifestations of Multiple Sclerosis (MS), sexual dysfunction (SD) is highly prevalent, yet it is still under-reported and under-diagnosed. Our objective is to address the prevalence and pattern of sexual dysfunction in female patients with early MS. A comprehensive clinical interview to identify SD in female patients (n=43, age 18-48 years) with early MS in the first 6 months of diagnosis according to McDonalds criteria 2010. All patients were subjected to Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-19), Fatigue Scale for Motor and Cognitive functions, Hospital Anxiety and Depression Scale (HADS), Expanded Disability Status Score (EDSS) and hormonal assessment. Radiological findings were compared between those with SD and those without. Assessment was done after at least 8 weeks of steroids intake and before starting any disease modifying drugs (DMDs). Exclusionary criteria: Post-menopausal, sexually inactive, physical disabilities hindering sexual courtship (FS>2 in motor/sensory/coordination), endocrinal disorders and patients on medications affecting sexual activities. Mean patients age (±SD) was 24.71±3.55. According to MSISQ-19 scores, SD was reported in 24/43 (55.81%). Three levels of influence were reported; Primary, secondary and tertiary SD (MSISQ-19 sub-scales). They all had manifestations of primary SD; with decreased libido, less intense orgasm and inadequate lubrication being the most prevalent (47% n=11, 40% n=10, and 13% n=3 respectively). 7 patients (29.1%) had manifestations of secondary SD. Tertiary SD was prevalent in all patients and was mostly related to lack of confidence about sexuality and fear of rejection. Fatigue (P=0.006) and depression (P=0.002) were significant predictors. Higher Prolactin levels, Luteinizing hormone (LH) and Follicle stimulating hormone (FSH) were detected in 6, 7 and 5 patients respectively. No statistical difference in MRI brain/spine lesions sites between both groups of patients. Sexual dysfunction assessment should be incorporated in our routine assessment of MS since SD is a core disabling manifestation to the patient and to the integrity of relationships and families.