Abstract
BackgroundSexual dysfunction (SD) is very common in people with multiple sclerosis (PwMS) and contributes a significant burden of disease, particularly for young people. SD has direct neurological contributions from depression and fatigue, which occur commonly in PwMS. Modifiable factors may represent potential targets for treatment and prevention of SD. We aimed to assess the prevalence of SD and explore associations between SD and demographic and modifiable risk factors, as well as depression and fatigue in a large cohort of PwMS.MethodsWe analysed self-reported data from a large, international sample of PwMS recruited via Web 2.0 platforms, including demographic, lifestyle and disease characteristics. Specific sexual function questions included 4 items from the sexual function scale and 1 item regarding satisfaction with sexual function, part of the MS Quality of Life-54 instrument.Results2062 PwMS from 54 countries completed questions on sexual function. 81.1 % were women, mean age was 45 years, most (62.8 %) reported having relapsing-remitting MS. The majority (54.5 %) reported one or more problems with sexual function and were classified as having SD. Lack of sexual interest (41.8 % of women), and difficulty with erection (40.7 % of men) were most common. The median total sexual function score was 75.0 out of 100, and 43.7 % were satisfied with their sexual function. Regression modeling revealed independent associations between sexual function and satisfaction and a range of demographic factors, including age, as well as depression risk, antidepressant use, and fatigue in PwMS.ConclusionThis cross-sectional study shows that SD and lack of satisfaction with sexual function are associated with depression risk and fatigue, as well as modifiable lifestyle factors diet and physical activity (after adjusting for depression and fatigue). Planned longitudinal follow-up of this sample may help clarify these associations and the underlying mechanisms. There is potential to prevent and treat SD in PwMS by addressing depression and fatigue and their determinants. Clinicians and PwMS should be aware of SD and associated factors as part of a comprehensive preventive approach to managing MS.
Highlights
Sexual dysfunction (SD) is very common in people with multiple sclerosis (PwMS) and contributes a significant burden of disease, for young people
A comparison of those completing sexual function items and those not completing this part of the MSQOL-54 revealed participants were more likely to complete sexual function items if they were younger, more recently diagnosed, male, and partnered
Our data on a large sample of PwMS world-wide confirmed that SD is common, with over half of the sample reporting one or more problems with sexual function, and that SD is associated with lower satisfaction with sexual function
Summary
Sexual dysfunction (SD) is very common in people with multiple sclerosis (PwMS) and contributes a significant burden of disease, for young people. Multiple sclerosis (MS) is the most common disabling condition of young adults with myriad potential effects on neurological function, including sensory and autonomic function [1]. Disturbed sexual function can have detrimental effects on partner relationships and mental healthrelated quality of life, well demonstrated in a large North American Research Committee on Multiple Sclerosis (NARCOMS) Registry sample of 6,183 PwMS [3]. The need for standard definitions has been recognised and specific indices proposed [10,11,12]. These include definitions for sexual arousal disorders in women, erectile dysfunction in men, orgasmic dysfunction and dyspareunia. There is not, a consistent definition in the literature for the diagnosis of SD [9]
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