Multiple sclerosis (MS) is the most common disabling neurological condition for young adults in the United States, affecting approxi? mately 250,000 people. Sexuality and fertility are important concerns for this population since the onset of MS generally occurs between ages 20 and 40. MS is typified by lesions in the white matter of the brain and spinal cord, particularly the periventricular region in the brain and the tracts of the optic nerves and chiasm, brainstem, and spinal cord (Adams & Victor, 1981). Nerve conduction in these areas may be entirely impeded, or impaired on a partial or intermittent basis. Consequently, MS produces a variety of symptoms that may change as disease activity fluctuates. Although studies of sexual function in MS patients have been limited, surveys of male patients reveal that 44% to 77% report unspecified difficulties in the orgasm phase of the sexual response cycle (Lilius, Valtonen, & Wikstrom, 1976; Minderhoud, Leemhuis, Kremer, Laban, & Smits, 1984; Valleroy & Kraft, 1984). Abnormalities in orgasmic sensation or ejaculation of semen can be detrimental to sexual pleasure and fertility. Most clinicians treating sexual dysfunction in men with MS have focused narrowly on erectile dysfunction, which is reported by 63% to 80% of men with MS (Goldstein, Siroky, Sax, & Krane, 1982; Lilius et al, 1976; Minderhoud et al, 1984; Valleroy & Kraft, 1984). Unfor? tunately, urologists and mental health clinicians often overlook orgasm phase dysfunctions when a patient seeks help for an erection problem (Schover & Jensen, 1988). Some men with erectile dysfunction can reach orgasm with a flaccid penis and would be willing to continue noncoital sexual activity despite impaired erections. For them, im? paired orgasm remains an important handicap. Others are candidates for a penile prosthesis or intracavernous injection therapy (Montague, 1988; Segraves & Schoenberg, 1985), but have unrealistic expectations that these treatments to enhance penile rigidity will also resolve prob-