Multiple Sclerosis Intimacy And Sexuality Questionnaire-19 Research Articles

Arabic translation, content validity and reliability of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19)

BackgroundThe prevalence of sexual dysfunction (SD) in multiple sclerosis (MS) patients is accounted to affect nearly 75% of them with higher rate in men than women. Though most of the patients may desire to discuss confidentially the SD with their physician, but both the physician and the patient usually hesitate to break into this presumed taboo. Assuming that MS affects about 35.9 per 100,000 population, it is clearly a problem of paramount significance not to find, to the best of our knowledge, a specific scale for assessing SD in MS patients who speak Arabic. We aimed to translate the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) from English into Arabic and then to Validate the Arabic version as a tool to evaluate the SD in MS patients.ResultsWe included 40 (21 males and 19 females) sexually active married MS patients. Every patient completed the Arabic translation of the MSISQ-19. Validity construction was explored by the Cronbach's alpha coefficient and the exploratory factor analysis. The Arabic version of the scale was evaluated for clarity, relevance, and translation of the content. The SD represents 45.5% in our study (47.6% in males, 43.4% in females).ConclusionThrough screening and diagnosis of SD in MS patients, MSISQ-19 would help both patients and physicians to invade the mystery of this hectic issue. In Arabic populations, Arabic version of MSISQ-19 could be a reliable, reproducible and validated tool for the targeting SD in MS patients.

Age-related differences in the severity of sexual dysfunction symptoms and psychological distress in individuals with multiple sclerosis.

Sexual dysfunction (SD) is a common symptom for many with multiple sclerosis (MS). However, SD research in general appears to often overlook young adults within their samples, which can be a major issue for better understanding and treatment for the MS population. Few studies have compared age-related differences in distress in response to physical disability. Research has also found that many people diagnosed with MS do not discuss any SD struggles with their providers. The present study hopes to see whether age-related differences exist in the reporting of the levels of primary, secondary, and tertiary SD, as defined by subscale scores of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), and amount of distress, as defined by the 12-Item Short Form Health Survey (SF-12)'s Mental Component Summary (MCS-12). Additionally, we hope to determine if there are any age-related or sex-related differences in help-seeking behaviors for SD. Study participants were recruited from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants completed the MSISQ-19, SF-12, and Patient Determined Disease Steps (PDDS), provided demographic information, and responded if they received medical or psychological treatment for SD. Study participants were 5815 respondents (Mage=51 years, SD=9.63, 75% female, 30% having attained a high school diploma, 35% scoring "advanced disability" on the PDDS). Young adult (19-39 years), middle adult (40-64 years), and mature adult (65-older) were compared on SD. Linear mixed effects modeling revealed that the MSISQ-19 subscale scores were significantly predicted by secondary SD (t=2.48, p<.13). Young adult participants had the lowest primary SD (M=13.87, 95% CI [13.13, 14.61]) when compared to mature adult (M=14.12, 95% CI [13.27, 14.97]) and middle adult participants (M=14.44, 95% CI [14.21, 14.66]), though none were statistically significant. Mature adults had the lowest secondary SD (M=16.50, 95% CI [15.65, 17.35]), a statistically significant difference from the middle adults (M=18.20, 95% CI [17.97, 18.42]) and young adults (M=18.91, 95% CI [18.17, 19.65]). Mature adults had the lowest tertiary symptoms (M=10.12, 95% CI [9.27, 10.96]), followed by young adults (M=12.23, 95% CI [11.48, 12.97]), and middle adults (M=11.65, 95% CI [11.43, 11.88]), though none were statistically significant. Hierarchical multiple regressions found that age had the most significant impact on SD. When SF-12 MCS-12 was added, linear mixed effects did not reveal any statistically significant results between the age groups and SD levels. In contrast, hierarchical multiple regressions found that SF-12 MCS-12 scores had the most significant impact on SD. There were significant age-related and sex-related differences in help-seeking behaviors in those who sought psychological counseling as opposed to medical treatment for SD. Our study has highlighted the importance of clinicians assessing for SD and psychological distress within their patients and to consider potential differences in symptom presentations of age groups to better address their unique needs.

Sexual dysfunction in multiple sclerosis: The impact of different MSISQ-19 cut-offs on prevalence and associated risk factors.

Although multiple sclerosis (MS) Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a widely applied tool, no unique definition of sexual dysfunction (SD) based on its score exists. To explore the impact of different MSISQ-19 cut-offs on SD prevalence and associated risk factors, providing relevant information for its application in research and clinical settings. After defining SD according to two different MSISQ-19 cut-offs in 1155 people with MS (pwMS), we evaluated SD prevalence and association with sociodemographic and clinical features, mood status and disability via logistic regression. Depending on the chosen cut-off, 45% to 54% of pwMS reported SD. SD defined as MSISQ-19 score >30 was predicted by age (OR=1.01, p=0.047), cognition (OR=0.96, p=0.004) and anxiety (OR=1.03, p=0.019). SD defined as a score >3 on any MSISQ-19 item was predicted by motor disability (OR=1.12, p=0.003) and cognition (OR= 0.96, p=0.002). Applying different MSISQ-19 cut-offs influences both the estimated prevalence and the identification of risk factors for SD, a finding that should be considered during study planning and data interpretation. Preserved cognition exerts a protective effect towards SD regardless from the specific study setting, representing a key point for the implementation of preventive and therapeutic strategies.

Sexual dysfunction in Brazilian patients with multiple sclerosis

People with multiple sclerosis (PwMS) show an increased risk of sexual dysfunction (SD), both in women and men. The aim of the present study was to apply the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) and evaluate our results by comparing them with those in in the literature, as well as to assess the ease of applying the scale and the engagement of the patients in discussing the topic of sexuality. We developed and applied a web-based Google form questionnaire that the respondents completed online, which included the MSISQ-19, for the assessment of sexual function. Baseline characteristics were reported as proportions and mean ± standard deviation (SD) or median ± interquartile range (IQR) as appropriate according to data distribution. Categorical variables were stratified by sex and compared with chi-squared tests. Statistical analyses were performed using STATA v. 16 (StataCorp., College Station, TX, USA). Of the 621 respondents, 541 were included in the analysis. Among the patients with MS, a total of 347 (64.14%) exhibited SD. When stratified by gender, the frequencies of SD were not significantly different. There is a high incidence of sexual dysfunction among PwMS and we need to identify the reasons for this and implement strategies to treat and counsel our patients. The MSISQ-19 can be used to help clinicians to assess sexual functioning in a quick and easy way and give patients the possibility to address this topic and receive appropriate help and support.

Translation, cross-cultural adaptation, and validation of the Greek version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19

Introduction Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) explores optimally impact of MS on sexual activity/satisfaction/intimacy. Aim The present study aims to provide the only validation of the Greek Version of MSISQ-19, and compare results to validation studies in other languages. Methods The original/English version of the MSISQ-19 was translated into Greek according to standardized guidelines, while validity/reliability, correlations with other scales and sexual dysfunction prevalence were tested. Subjects were requested to complete all questionnaires and MSISQ-19, being re-tested three weeks later. Construct-validity of the Greek version of the MSISQ-19 was confirmed with principal-component-analysis. Bartlett’s test assessed correlation-adequacy between items. Pearson’s correlation explored internal-construct-validity between subscales and overall score, and external–construct-validity with disease-status variables, cognitive testing and patient-reported outcomes regarding fatigue, depression/anxiety, MS impact, and quality of life. Results 201 PwMS (130 female). Mean age was 39.3 ± 11.8 years with median disease-duration 11.7 ± 7.9 years. 79.1% RRMS, PPMS (10.4%) and SPMS (10.4%). Cronbach’s alpha coefficient was 0.949. MSISQ-19 correlations between items were large. Significant associations of sexual dysfunction were identified with age (rho = 0.392, p < 0.01), years of education (rho=–0.199, p = 0.006), the Expanded Disability Status Scale (rho = 0.518, p < 0.01) and MS duration (rho = 0.354, p < 0.01). Correlations were disclosed with the Brief International Cognitive Assessment for MS (rho=-0.247, p < 0.05), Modified Fatigue Impact Scale (rho = 0.374, p < 0.05), Depression Anxiety Stress Scale (rho = 0.375, p < 0.05), Multiple Sclerosis Impact Scale (rho = 0.442, p < 0.05), and EuroQoL-five-dimensional instrument (rho = 0.375, p < 0.05). Internal consistency of the Greek version of the MSISQ-19 was confirmed with Cronbach’s alpha. Test-retest reliability (31 PwMS) was excellent with intraclass-correlation-coefficients > 0.90. Conclusion Besides Greek MSISQ-19 satisfactory validity/reliability/reproducibility and being first to include cognitive-testing, authors estimated sexual-dysfunction prevalence affecting half PwMS. HIGHLIGHTS This study provides the only validation of the Greek Version of the MSISQ-19. The latter was found with satisfactory validity, reliability and reproducibility. 50% of the Greek PwMS sample was found to be afflicted with sexual dysfunction. This is also the first validation study to examine associations with cognitive testing. Sexual function is still an underestimated functionality parameter upon examination.

The effects of bupropion on sexual dysfunction in female patients with multiple sclerosis: A double-blind randomized clinical trial

Background: Sexual dysfunction (SD) is one of the most common complications of multiple sclerosis (MS). The aim of this study was to evaluate the effects of bupropion on SD among female patients with MS. Methods: This double-blind placebo-control randomized clinical trial was conducted on MS patients with SD complaint. Diagnosis was based on the secondary SD subscale scores of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19). Accordingly, individuals scoring above 27 based on this scale were diagnosed with SD. The subjects were randomly assigned to the bupropion and placebo groups. Bupropion was administered 75 mg twice daily for twelve weeks. As for the study outcomes, besides MSISQ-19, quality of life (Multiple Sclerosis Quality Of Life-54 (MSQOL-54)), fatigue (Multidimensional Fatigue Inventory (MFI)), depression and anxiety (Hospital Anxiety and Depression Scale), and bupropion tolerability were assessed at baseline as well as at weeks 6 and 12. Results: From 84 patients who met the inclusion criteria, 64 patients completed the trial and were analyzed. Demographics and baseline clinical characteristics were not significantly differed between the two groups. The results showed the mean score of MSISQ-19 from baseline to the end of the study period significantly improved in the bupropion group compared with the placebo (week 6: P: 0.03; week 12: P: 0.03). Similarly, MFI scores showed significant improvement in the bupropion group compared with the placebo group (P: 0.001). Both anxiety and depression scores showed significant alterations at study interval between the two groups (Anxiety: weeks 6 and 12: P:0.04; depression: week 6: 0.01, week 12: 0.02). However, there was no significant change in the MSQOL-54 score between the two groups. Conclusion: The results of the study substantiated that bupropion can be an effective agent for SD improvement in female patients with MS. Further clinical trials with larger sample sizes can more accurately evaluate the observed findings.

Validation of the French version of the Multiple Sclerosis Intimacy And Sexuality Questionnaire-19: A preliminary study

IntroductionPatients with multiple sclerosis (MS) suffer from various symptoms, including sexual dysfunction. The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a scale that explores the impact of MS on sexual activity and satisfaction. AimThis observational cohort study aimed to provide a validated, cross-cultural, French version of the MSISQ-19 in patients with MS. MethodsThe original version of MSISQ-19 was translated into French according to standardized guidelines. Patients were asked to complete all questionnaires during the inclusion visit and the MSISQ-19 a second time two weeks later. Content validity was assessed by face validity. Internal consistency was evaluated using Cronbach's alpha. Construct validity was checked by the exploratory factor analysis. Concurrent validity was assessed by performing Spearman's correlation coefficient with the Female Sexual Function Index (FSFI), the Male Sexual Health Questionnaire (MSHQ), and the Multiple Sclerosis International Quality of Life questionnaire (MusiQoL). Spearman's correlation coefficient was also used to evaluate the relationship with the Expanded Disability Status Scale (EDSS), age, and disease duration. Test-retest reliability was assessed by intraclass correlation coefficient (ICC). Responsiveness was assessed by the standard error of measurement (SEM) and the minimum detectable change (MDC). Main outcome measuresMSISQ-19 is the main outcome measure. ResultsWe enrolled 71 patients with MS (49 female, 22 male). The mean age was 42.6 ± 9.7 years with a median disease duration of 8 [3–16] years. Sixty-four (90%) patients had relapsing-remitting MS, 4 (6%) primary progressive MS, and 3 (4%) secondary progressive MS. French MSISQ-19 showed a Cronbach's alpha coefficient of 0.89. MSISQ-19 scores correlated significantly and moderately between each other and correlated significantly and moderately with scores on the FSFI, MSHQ, MusiQoL and EDSS. Reproducibility was excellent with intraclass correlation coefficients > 0.80. Exploratory factor analysis was performed using principal component analysis. A three-factor solution was adopted giving eigenvalues higher than 1, supporting the primary, secondary, and tertiary dimensions. SEM was 4.55 and MDC was 12.6 (13.3%). ConclusionThis study provides a preliminary validation of the French version of the MSISQ-19 which could be a reliable, and reproducible instrument to assess sexual dysfunction in patients with MS. These results need to be confirmed in a larger cohort which will be more representative of the general MS population.

Predisposing Factors for Sexual Dysfunction in Multiple Sclerosis.

Sexual dysfunction (SD) in people with multiple sclerosis (pwMS) has a detrimental impact on individual health-related quality of life (HRQoL). It is not clear whether SD in multiple sclerosis (MS) is an independent symptom or merely a byproduct of other symptoms such as depression or anxiety. This cross-sectional study of 93 pwMS determines risk factors for SD in MS based on prevalence, HRQoL, and associated disease outcomes. Diagnosis of SD was determined based on the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) and correlated with physical disability (measured by Expanded Disability Status scale, EDSS), depression and anxiety [Hospital Anxiety and Depression Scale (HADS)], and HRQoL [Multiple Sclerosis Quality of Life-54 (MSQoL-54)]. Multivariate regression models were performed to determine independent risk factors for SD in pwMS. Almost half of the participants in this study (46%) reported SD. HRQoL was significantly poorer in patients with MS suffering from SD (median [IQR] MSQoL-54 scores: physical subscale 52 [41–68] vs. 81 [69–89], p < 0.001; mental subscale 50 [38–82] vs. 86 [70–89], p < 0.001). In the multivariate model, EDSS was the only independent risk factor for SD (OR 18.1 for EDSS ≥4 [95% CI 3.3–31.4, p < 0.001]), while depression and anxiety were not. We conclude that the risk for SD is growing with increasing EDSS and is independent of depression or anxiety. Screening for SD becomes particularly relevant in patients with growing disability.

Evaluation of sexual self-efficacy and sexual function in women with multiple sclerosis in Mashhad, Iran, in 2019: A cross-sectional study

Background: In chronic illnesses, sexual dysfunction (SD) is one of the most prevalent complaints. Sexual self-efficacy (SSE) is an individual’s beliefs about his/her ability to perform an effective sexual function and be favorable to their partner. The aim of the present study was to assess SSE and sexual function in women with multiple sclerosis (MS). Methods: This cross-sectional study was carried out in 2019 on 260 married women referring to the MS clinic and MS society of Khorasan-Razavi in Mashhad, Iran. The research population was selected using convenience sampling. The Sexual Self-Efficacy Questionnaire (SSEQ), Multiple Sclerosis Intimacy and Sexuality Questionnaire‎-19 (MSISQ-19), and the Female Sexual Function Index‎ (FSFI)‎ were completed by the participants who had the inclusion criteria. The collected data were analyzed using descriptive statistics and Spearman's rank correlation coefficient in SPSS software. Results: The participants had a mean age of 35.2 ± 8.4 years and their mean duration of MS was 4.46 ± 3.71 years. The findings showed a negative correlation between SSE and SD (r = -0.606; P = 0.001) and a positive correlation between SSE and sexual function (r = 0.644; P = 0.001). Moreover, MSISQ-19 and FSFI scores supported each other (r = -0.675; P = 0.001). Conclusion: SD is prevalent among women with MS. Moreover, sexual function is substantially associated with SSE in these women.

Sexual dysfunction and associated risk factors in multiple sclerosis

Aim: Sexual dysfunction (SD) is quite common in multiple sclerosis (MS), and exhibits a multifactorial pattern. This study was set out to evaluate the frequency of SD and explore the related factors to support the quality of MS patients’ lives. Methods: This cross-sectional study included 96 volunteer RRMS patients between 18 and 60 years of age who were diagnosed with MS according to the Mc Donald criteria between 2018 and 2019 in our hospital. Multiple sclerosis intimacy and sexuality questionnaire-19 (MSISQ-19), Arizona Sexual Experience Scale (ASEX), Multiple Sclerosis Inventory of Cognition (MUSIC) and Beck Depression Inventory (BDI) questionnaires were used. Results: Mean age of the patients was 38.46 (8.47) (min-max:20 – 60 years) years, and mean disease period was 77.02 (70.62) (3–324 months) months. Mean Extended Disability Status Scale (EDSS) score was 2.1 (1.33) (0-5) with a standard deviation of 80.5%. A negative correlation was observed between MUSIC cognitive and EDSS (P=0.017; r=-0.273), and BDI scores (P=0.003; r=-0.306). A significant and positive correlation was detected between MSISQ score (P<0.001; r=0.476) and BDI (P<0.001; r=0.529) in MUSIC fatigue test results. A negative and poor correlation was found between MUSIC fatigue and MUSIC cognitive score (P<0.001; r=-0.365). In patients with depression, mean MUSIC cognitive scores were lower (P=0.009), while MUSIC fatigue scores were higher (P<0.001). Age, educational status, presence of secondary SD were independent risk factors. Conclusion: SD, a quite common condition in MS, may be decreased to increase the quality of lives of patients through treatment of psychosocial factors associated with cognitive state.

Factors associated with intimacy and sexuality among young women with multiple sclerosis

BackgroundPatients with multiple sclerosis (MS) especially those with younger age experience an alteration in physiological and emotional lifestyle that can affect intimacy and sexuality. The aim of this study was to determine demographic and disease related determinants of intimacy and sexuality in young women with MS.MethodsThis was a cross sectional study carried out in Tehran, Iran. A convenience sample of young women aged ≤35 years old with MS attending to outpatient clinics in a teaching hospital affiliated to Tehran University of Medical Sciences was entered into the study. The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) was used to evaluate how the disease influences sexual function and satisfaction in these patients. Multivariable analysis using hierarchical method was performed to identify variables that are associated with intimacy and sexuality.ResultsIn total 117 young women with confirmed diagnosis of MS were included in the study. Participants mean was 25.7 (SD = 8.07) years. A multivariable hierarchical regression analysis was performed using demographic variables entered in step one, relevant neurological variables in step two, and psychological variables in step three. Furthermore, we loaded antidepressant use in the last step. Overall, the seven variables accounted for 39% of total variance observed for the MSISQ score (P < 0.001). At step one the demographic variables accounted for 13% of the variance in the MSISQ score (P < 0.001). At step two the inclusion of relevant neurological variables increased the R2 significantly and explained 27% of variance for the MSISQ (P < 0.001). However in the third step the inclusion of psychological factors increased R2 significantly (adjusted R2 increased to 0.39, P < 0.001).ConclusionsThe findings indicated that psychological, disease-related and demographic factors (education and employment status) contributed to intimacy and sexuality in young women with multiple sclerosis. Appropriate interventions, especially psychological interventions, appear to be essential immediately following a definite MS diagnosis in young women.

The Effect of Counseling Based on EX-PLISSIT Model on Sexual Dysfunction and Quality of Sexual Life of Married Women with Multiple Sclerosis: A Randomized Controlled Clinical Trial

Sexual dysfunction is one of the most common complaints of patients with multiple sclerosis (MS). The study aimed to determine the effect of counseling based on the extended PLISSIT model (Permission, Limited Information, Specific Suggestion, and Intensive Therapy) on sexual dysfunction and the quality of sexual life of married women with MS. This randomized clinical trial was performed on 70 married women with MS aged between 18 and 45 years referring to the MS Association of Tabriz, Iran. The data were collected using a demographic questionnaire, Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), Sexual Quality of Life for a Female, Fatigue Severity Scale, and Beck Depression Inventory-Short Form Items (BDI-13). A neurologist rated the disability level using the Expanded Disability Status Scale. Using randomization, the participants with a score of 4 or 5 in each item of MSISQ-19 were assigned to counseling and the control group, with block sizes of four and six and allocation ratio of 1:1. The intervention group attended a counseling session or more if needed, based on the EX-PLISSIT model. Data were analyzed using SPSS software (Version 25). Independent t test and ANCOVA were used to analyze the data. After intervention, there was a significant difference between the two groups in terms of primary and tertiary sexual dysfunctions [AMD, − 7.84; 95% CI − 14.82 to − 0.86; P = 0.02]. Despite an increased mean score of quality of sexual life in the intervention group after counseling, there was no statistically significant difference between the two groups [AMD, 9.29; 95% CI − 1.46 to 20.04; P = 0.08]. Although counseling based on EX-PLISSIT had a positive effect on decreasing sexual dysfunction, it could not improve the quality of sexual life of women suffering from MS. Applying sexual counseling approaches with a focus on couple counseling is suggested for improving the quality of sexual life.

Prevalence, dimensions, and predictor factors of sexual dysfunction in women of Iran Multiple Sclerosis Society: a cross-sectional study.

Sexual dysfunction (SD) is a stressful and common symptom in women with multiple sclerosis (MS) and affects different aspects of their life, seriously. The purpose of this study was to determine the prevalence, dimensions, and predictor factors of SD in Iranian women with MS. This cross-sectional study was conducted in Iran MS Society. Participants were 260 married women who had definite MS. Data were collected using self-report questionnaires, including Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19); Fatigue Severity Scale (FSS); Depression, Anxiety, and Stress Scale-21 (DASS-21); Questionnaire for Urinary Incontinence Diagnosis (QUID); ENRICH Marital Satisfaction Scale (EMS); Sexual Self-Efficacy Questionnaire; and socio-demographic and disease information questionnaire. Pearson correlation coefficients, independent sample t-test, one-way analysis of variance (ANOVA), and multiple linear regression model were used for data analysis. Majority (76.2%) of the participants had SD, and according to the dimensions of SD in MS, primary SD was found in 176 (67.7%), secondary SD in 158 (60.7%), and tertiary SD in 126 (48.5%) of the participants. The most important and common problem was delayed orgasm (60%). According to the results of multiple linear regression model, the predictor factors of SD were sexual self-efficacy (B = -0.721, P < 0.001), disability status (B = 2.714, P < 0.001), urge incontinence (B = 0.367, P = 0.029), depression (B = 0.446, P = 0.007), anxiety (B = 0.332, P = 0.037), fatigue (B = 0.177, P = 0.002), duration of disease (B = -0.463, P = 0.014), and duration of DMT use (B = 0.662, P = 0.002). According to the results of this cross-sectional study, SD was a very common and complex problem in women of Iran MS Society, and a number of physical, neurological, and psychological factors, such as sexual self-efficacy, disability status, urge incontinence, depression, anxiety, fatigue, duration of DMT use, and duration of disease, play a role in SD of these patients. So, in the treatment procedure of SD in MS women, adopting a multidisciplinary approach, as well as considering all contributory factors and their impact on sexual function, is recommended.

The Prevalence of Sexual Dysfunction in Iranian Women with Multiple

Context: Sexual dysfunction is one of the mostcommonsymptomsinwomenwith multiple sclerosis (MS), which has a great impact onthe individuals’ quality of life, and is usually neglected. The present study was conducted with the aim of studying the prevalence of sexual dysfunction in Iranian women with MS. Evidence Acquisition: All Iranian articles published between 2000 and June 2018 in Persian and English were collected by using standard keywords in national and international databases. After evaluating articles based on inclusion/ exclusion criteria and quality assessment, related articles were selected. Heterogeneity of the studies was evaluated using the I2 index and the publication bias was assessed using the Egger and Begg tests. Data analysis was performed in STATA software version 11, 1 by using random effect model. Results: Eight studies with a sample size of 1,301 people entered in this meta-analysis. The overall prevalence of sexual dysfunction in women with MS was 62 (CI: 95, 51 - 73). In addition, the prevalence of sexual dysfunction by using female sexual function index (FSFI) was 57 (CI: 95, 46 - 68) and by using multiple sclerosis intimacy and sexuality questionnaire-19 (MSISQ-19), was 73 (CI: 95, 55 - 91). Conclusions: The results of the present study were indicative of a prevalence of 62 for sexual dysfunction in Iranian women with MS. Considering the high prevalence of sexual dysfunction and its impact on the quality of life of these women, it seems essential for treatment teams to pay attention, plan, and design effective interventions in this regard. © 2019, Shiraz University of Medical Sciences. All rights reserved.

Patient perceived changes in sexual dysfunction after initiation of natalizumab for multiple sclerosis.

PurposeSexual dysfunction is a common but often overlooked secondary symptom of multiple sclerosis (MS) and can be associated with a decreased health-related quality of life (HRQoL). Natalizumab is a disease-modifying therapy approved for the treatment of relapsing forms of MS. In addition to its efficacy, those using natalizumab have shown improvement in HRQoL parameters, including fatigue and cognition. The idea that improvement in fatigue may also correlate with improvement in sexual dysfunction is the impetus for this study.MethodsA single-center, open-label, single-arm, 24-week study was performed to evaluate perceived change in sexual dysfunction in MS patients treated with natalizumab. Adults with relapsing MS initiating natalizumab treatment and had a baseline level of sexual dysfunction were enrolled. The primary endpoint was change in the MS Intimacy and Sexuality Questionnaire-19 (MSISQ-19) score from baseline to week 24. Mean age of patients was 41 years, median disease duration was 7 years, and 73% of patients used at least one prior MS disease-modifying therapy.ResultsNatalizumab-treated patients experienced improvement in sexual dysfunction within the first 24 weeks of starting therapy, as demonstrated by the primary subscale of the MSISQ-19 questionnaire (–0.6976, p = 0.02).ConclusionsGiven the high prevalence of sexual dysfunction in MS patients and the significant impact it has on HRQoL, more research on this often overlooked symptom of MS could be very informative for patients that are deciding to initiate a new disease modifying therapy.

Validation and cross-cultural adaptation of sexual dysfunction modified scale in multiple sclerosis for Brazilian population.

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS). These patients suffer from various comorbidities, including sexual dysfunction (SD). The lesions of MS may affect regions of the CNS along the pathway of sexual response. The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) is a scale that assesses sexual dysfunction. Adapt and validate the MSISQ-19 to Brazilian patients with MS. 204 individuals were evaluated, 134 patients with MS and 70 healthy persons for the control group. It was determined reproducibility, validity, internal consistency and sensitivity of the MSISQ-19-BR. Among patients with MS, 54.3% of male and 71.7% of female presented some kind of SD. In the control group the results were 12.5% and 19.5%, respectively. The MSISQ-19-BR is reproducible, reliable and valid for the Brazilian population and may be used as a tool for assessing the impact of sexual dysfunction in patients with MS.

The multiple sclerosis intimacy and sexuality questionnaire-19: reliability, validity, and factor structure of the Persian version.

The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) was designed to assess the perceived influence of multiple sclerosis (MS) symptoms on sexual activity and satisfaction. This study aimed to translate and validate the MSISQ-19 in women with MS in Iran. The translation of the original questionnaire was carried out in accordance with a standard forward-backward procedure. Then, a sample of 226 married women with MS completed the questionnaire. Reliability was estimated using Cronbach's alpha coefficient. Concurrent validity was assessed by comparison with the Female Sexual Function Index (FSFI), the Expanded Disability Status Scale (EDSS), and the Beck Depression Inventory-II (BDI-II). The factor structure of the questionnaire was extracted by performing exploratory factor analyses. All patients underwent a full neurologic examination. MSISQ-19 score was the main outcome measure. The mean age of participants was 35.77 years (SD = 8.07), with mean disease duration of 1.84 years (SD = 0.79). Cronbach's alpha coefficient was 0.90 for total MSISQ-19 score, with values of 0.85, 0.90, and 0.78 for the subscales assessing primary, secondary, and tertiary sexual dysfunction, respectively. The principal component analysis indicated a three-factor solution, similar to that found in the original validation study, that explained 63.0% of the total variance for women with MS. Scores on the MSISQ-19 and its subscales correlated with scores on the FSFI, EDSS, and BDI-II (all P < 0.01). In general, the findings suggest that the MSISQ-19 is a reliable and valid measure of sexual function among Iranian women with MS. However, further studies are needed to establish psychometric properties for male MS patients in Iran.

Predictors of Fear of Sexual Rejection in Individuals with Multiple Sclerosis

Multiple Sclerosis (MS) is an autoimmune disease of the central nervous system that is often associated with a myriad of physical and cognitive impairments. Sexual dysfunction (SD) is a common yet often overlooked symptom in MS. The present study aimed to explore one type of SD, namely perceived fear of sexual rejection among individuals with MS. Predictor variables, including gender, age, employment status, bladder/bowel symptoms, mental health status, and disease severity were explored. The sample comprised of 5,979 respondents to the spring 2006 North American Research Committee on Multiple Sclerosis Questionnaire. Respondents who answered the fear of sexual rejection item on the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) in the MS Intimacy and Sexuality Section were included in the analysis. The Patient Determined Disease Steps was used to measure disease severity. The 12-Item Short-Form Health Survey, Version 2, Mental Health Scale was used to assess mental health. The MSISQ-19 was used to assess fear of sexual rejection. A logistic regression analysis was performed. The full model containing all predictors was statistically significant, χ2 (7, N = 5,979) = 1,426.01, p < 0.001, indicating that the model was able to distinguish between respondents who reported fear of sexual rejection and those who did not. The model as a whole explained between 21.2 and 29.0 % of the variance in fear of sexual rejection, and correctly classified 72.9 % of cases. The strongest predictor of reporting fear of sexual rejection was gender. Findings indicate that SD, particularly fear of sexual rejection, is a complex and multi-faceted phenomenon. This study highlights the need for interventions designed to help people with disabilities work through their fears and build their sexual confidence to help facilitate healthy sexual activity.

The impact of sexual dysfunction on health-related quality of life in people with multiple sclerosis

Background: Sexual dysfunction is a prevalent symptom in multiple sclerosis (MS) that may affect patients’ health-related quality of life (HrQoL). Objective: The objective of this paper is to examine the impact of sexual dysfunction on HrQoL in a large national sample using The Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19). Methods: Participants were recruited from a large MS registry, the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants self-reported demographic information and completed the Patient Determined Disease Steps (PDDS), MSISQ-19, and the Short Form-12 (SF-12). Results: The study population included 6183 persons (mean age: 50.6, SD = 9.6; 74.7% female, 42.3% currently employed). Using multivariate hierarchical regression analyses, all variables excluding gender predicted both the physical component summary (PCS-12) and the mental component summary (MCS-12) of the SF-12. Scores on the MSISQ-19 uniquely accounted for 3% of the variance in PCS-12 scores while disability level, as measured by PDDS, accounted for 31% of the variance. Conversely, MSISQ-19 scores uniquely accounted for 13% of the variance in MCS-12 scores, whereas disability level accounted for less than 1% of the variance. Conclusion: In patients with MS, sexual dysfunction has a much larger detrimental impact on the mental health aspects of HrQoL than severity of physical disability.

Sexual problems among women with multiple sclerosis

BackgroundSexual problems are prevalently experienced by women with multiple sclerosis (MS) and have been investigated in several studies. The nature of sexual changes in MS is best defined as primary, secondary, and tertiary. ObjectivesThe aim of this study was to investigate three levels of sexual problems (SP) in female patients with MS and to examine their relationship with various clinical and demographic variables. MethodsA total of 132 women with MS completed two questionnaires; demographic and clinical history, and Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19). Fatigue was evaluated by Fatigue (energy) sub-scale of Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaire. General physical ability and frequency of sexual intercourse were also evaluated. ResultsOne hundred and fifteen patients (87.1%) reported primary SP. The most frequent symptoms of primary, secondary and tertiary sexual problems were delayed orgasm, spasticity and concern about partner's sexual satisfaction, respectively. The MSISQ-19 total score was correlated with age(p=0.002), disease duration(p=0.010), marriage duration(p=0.001), fatigue(p<0.001), number of children(p=0.006), physical ability(p<0.001), education(p=0.006), economic status(p=0.002), number of times having sexual intercourse(p=0.007) and number of times approached by spouse for intercourse(p=0.012) in the last 30days. ConclusionsSexual problems were prevalent among our participants. Appropriate management of SP depends on understanding the disturbed level.