Sexual Dysfunction In Multiple Sclerosis 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.

Pelvic Floor Muscle Training and Its Benefits for Multiple Sclerosis Patients Suffering From Urinary Incontinence and Sexual Dysfunction.

Several reports have been published during the last decade studying the effect of pelvic floor muscle training (PFMT) in treating urinary incontinence and sexual dysfunction in multiple sclerosis (MS) patients. The aim of the current study is to bring up-to-date findings of earlier systematic reviews, taking into account data published up till June 2023. Databases such as PubMed, Scopus, and EBSCOhost were screened for randomized controlled studies, clinical trials, and systematic reviews. The keywords for the current review were MS, urinary incontinence, sexual function, and PFMT. The implementation of predetermined eligibility criteria permitted an appropriate and convenient study selection. English language publications alone were considered. After removing duplicates and screening the initially recovered articles, an initial search within the present review identified 19 studies. Finally, 10 randomized control trials and two systematic reviews were eligible for evaluation and included in the current review. The outcome measures were the severity of incontinence or overactive bladder, leakage episodes, sexual dysfunction, health-related quality of life, and adherence to PFMT. PFMT is a convenient and effective treatment tool that can significantly improve health-related quality of life and reduce the severity of urinary incontinence and overactive bladder symptoms in people with MS. The present review confirms the effectiveness of specific exercises on leakage episodes, pad usage, sexual dysfunction, compliance to treatment, and treatment satisfaction. Further research is needed to strengthen the reported results.

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 Multiple Sclerosis: The Role of Executive Function

Cognitive impairment and sexual dysfunction are common symptoms in persons with Multiple Sclerosis (MS). The present study focuses on the relationship between these two dimensions by means of a specific assessment commonly used in clinical practice with this population. Fifty-five persons with a diagnosis of MS underwent specific cognitive tests and answered clinical questionnaires. Two cognitive tests, one for memory (the Selective Reminding Test), and one for attention (the Symbol Digit Modalities Test), were administered together with two tests for executive functions (the D-KEFS Sorting Test and Stroop Test). Two self-report questionnaires to investigate clinical, psychological and sexual features (the Beck Depression Inventory-II and Self-perception of Cognition in Multiple Sclerosis and Multiple Sclerosis Intimacy and Sexuality Questionnaire-19), were also administered. The main result highlights that sexual difficulties are associated with cognitive deficits, particularly with executive disorders, but not with memory and attention. Furthermore, sexual difficulties are better explained when depression symptoms are also taken into account. This study disentangles the interaction between sexual dysfunction, cognitive impairment and depression in persons with MS by emphasising the role of very high cognitive processing (i.e., executive functioning) in determining human behaviour.

Quantitative spinal cord MRI and sexual dysfunction in multiple sclerosis.

BackgroundSexual dysfunction (SD) is frequently reported in multiple sclerosis (MS) and is likely related to MS-related damage to the spinal cord (SC).ObjectiveTo assess associations between SD and quantitative MRI measures in people with MS (pwMS).MethodsThis pilot study included 17 pwMS with SD who completed questionnaires assessing SD, mood, and fatigue. All participants underwent brain, cervical, and thoracic SC-MRI at 3T. Quantitative brain and SC-MRI measures, including brain/SC atrophy, SC lesion count, diffusion-tensor imaging (DTI) indices (fractional anisotropy [FA], mean, perpendicular, parallel diffusivity [MD, λ⊥, λ||]) and magnetization-transfer ratio (MTR) were obtained. Associations between quantitative MRI measures and SD were assessed while controlling for the extent of mood and fatigue symptomatology.ResultsSubjects were a mean age of 46.9 years and 29% female. All subjects had self-reported SD (MSISQ-19 = 40.7, SQoL: 55.9) and 65% had a concurrent psychiatric diagnosis. When correlations between SD severity were assessed with individual brain and SC-MRI measures while controlling for psychiatric symptomatology, no associations were found. The only variables showing independent associations with SD were anxiety (p = 0.03), depression (p = 0.05), and fatigue (p = 0.04).ConclusionWe found no correlations between quantitative MRI measures in the brain and SC and severity of SD in pwMS, but psychiatric symptomatology and fatigue severity demonstrated relationships with SD. The multifactorial nature of SD in pwMS mandates a multidisciplinary approach.

Sexual Dysfunction Related to Multiple Sclerosis: Literature Review

Multiple sclerosis is a common autoimmune disorder that affects young individuals. Sexual dysfunction among those populations has recently gained the researcher's attention since the finding of the higher prevalence of sexual dysfunction than general populations. Several articles have addressed the causality, but the exact etiology remains unclear. We aimed in this article to review the causality, prevalence, impact, and management of sexual dysfunction in multiple sclerosis. We us

The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15): translation, adaptation and validation of the Polish version for patients with multiple sclerosis and spinal cord injury

BackgroundPolish physicians and researchers lack an extensive and precise instrument in their native language for evaluating sexual dysfunction in individuals with neurogenic disorders. The aim of this study was to create a culturally adapted, validated, Polish language version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15) for persons with multiple sclerosis (MS) and spinal cord injury (SCI).MethodsInternational recommendations and standardized methods for instrument validation were followed. Sexually active patients with MS and SCI completed the MSISQ-15, International Index of Erection Function (IIEF-15, men), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-31, women). IIEF-15 and PISQ-31 were used as reference questionnaires. Responses were collected at baseline (test) and after 2 weeks (re-test).ResultsWe recruited 299 Polish-speaking patients with MS or SCI. Interviews disclosed that the translated questionnaire had optimal content validity/cross-cultural adaptation. MSISQ-15 scores correlated significantly with the severity of sexual dysfunction as evaluated by IIEF-15 (r = − 0.487) and PISQ-31 (r = − 0.709). These correlations substantiated the high quality construct/criterion validity. An analysis of reliability presented good internal consistency (Cronbach’s alpha of 0.93 for the total score of MS patients and 0.86 for the total score of SCI patients) and reproducibility (intraclass correlation coefficients of 0.91 for the total score of MS patients and 0.92 for the total score of SCI patients). There were no ceiling or floor effects.ConclusionsThe Polish version of MSISQ-15 exhibited excellent measurement properties. It is a suitable and reliable instrument to assess sexual dysfunction in MS and SCI individuals. The Polish MSISQ-15 will enhance routine clinical practice and assist research for neurogenic patients in Poland.

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.

Validation of the Italian version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19.

People with multiple sclerosis (MS) may experience sexual dysfunction throughout the disease course. Validated scales to assess sexual dysfunction in MS for Italian patients are lacking. Hence, we aimed at validating Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-19) for Italian MS patients. We included both male and female MS patients. Each patient completed the Italian translation of the MSISQ-19. Construct validity was explored by the exploratory factor analysis and the Cronbach's alpha coefficient. Test-retest stability and concurrent internal and external validity were examined by Pearson' correlation coefficients. We enrolled 369 MS patients (323 female and 46 male). Italian MSISQ-19 showed a Cronbach's alpha of 0.92. MSISQ-19 test and retest total scores correlated between each other (r = 0.48, p = 0.01). MSISQ-19 total score also correlated with primary, secondary and tertiary subscales (p < 0.001). The Italian Version of the MSISQ-19 showed satisfactory internal consistency and reliability with moderately adequate test-retest reproducibility, suggesting that it may be used as a valuable measure of sexual dysfunction in the Italian population.

Psychobehavioral Treatment Options for Sexual Dysfunction in Multiple Sclerosis: A Systematic Review.

Sexual dysfunction in multiple sclerosis (MS) is a significant but overlooked impairment, and treatment options are rare. The aims of this systematic review were to identify psychological interventions used to treat sexual dysfunction in MS, to estimate their benefit, and to note appropriate treatment approaches for research projects and clinical use. A systematic review update was conducted to find psychological interventions aiming to improve sexual dysfunction in MS. A comprehensive search and review of MEDLINE, PsycINFO, CINAHL, and PubMed were completed, and the effects and quality of selected studies were reported. Six publications with 295 participants were identified. All selected studies assessed the effectiveness of psychological interventions on sexual dysfunction or sexual satisfaction in people with MS; four studies directly targeted sexual dysfunction in MS, one was a mindfulness yoga program to improve fatigue and quality of life, and one other presented a secondary analysis of a study targeting depression in MS. All six studies reported significant improvements in sexual dysfunction or sexual satisfaction and somewhat in psychological variables. A pressing need for development and adequate evaluation of psychological interventions for sexual dysfunction in MS remains. In addition, assessment of sexual dysfunction in MS and its treatment should be more focused in clinical care.

ABOUT THE NEED TO CREATE PERSONALIZED REHABILITATION PROGRAMS FOR PATIENTS WITH DEMYELINATING PATHOLOGY

In most patients with multiple sclerosis there are developed the pelvic dysfunction, which significantly affects their general condition, impairs quality of life and may even lead to autoaggressive tendencies. Erectile dysfunction in multiple sclerosis is one of the manifestations of pelvic disorders, characterized by clinical heterogeneity and polyetiology. In most cases, the pathogenesis of sexual dysfunction in multiple sclerosis is mixed and is an integrative result of focal spinal cord injury and the patient's personal response to the disease, as well as changes in partnerships and social relationships. Erectile dysfunction in multiple sclerosis is characterized by clinical heterogeneity. The opinion is expressed about the need to develop differentiated personalized programs for its correction in patients taking into account different pathogenetic variants. Regional specifics are no less important in establishing such programs. In order to clarify the pathogenetic variants of erectile dysfunction among 33 men from the Western region of Ukraine with remitting type of multiple sclerosis in the post−performance period, a study was conducted, where three such variants were identified. This is a predominantly the disorder of suprasacral regulation of erection, sacral regulation of erection and psychogenic erectile dysfunction. A variant of erectile dysfunction with a predominant impairment of the sacral regulation of erection was defined as prognostically unfavorable. The obtained data are expected to be used in the development of neurorehabilitation personalized programs for patients with demyelinating pathology, taking into account the regional specifics. Key words: demyelinating pathology, multiple sclerosis, remitting course, erectile dysfunction, regional specifics.

Perceived cognitive impairment is associated with sexual dysfunction in people with multiple sclerosis: A 2.5-year follow-up study of a large international cohort

BackgroundThe potential relationship between perceived cognitive impairment (PCI) and sexual dysfunction in multiple sclerosis (MS) has not been studied. ObjectivesTo explore the relationship between cognitive impairment and sexual dysfunction over 2.5 years in people with MS. MethodsData were derived from the Health Outcomes and Lifestyle In a Sample of people with Multiple sclerosis (HOLISM) international cohort over 2.5 years' follow-up. Cognitive function and sexual function were assessed by sub-scores of the MS Quality of Life-54. The impact of perceived cognitive impairment on sexual dysfunction was assessed by calculating prevalence ratios (PR) and relative risks (RR) with 95% confidence intervals (CI) using log-binomial regression models. Results1958 participants were included at baseline, of whom 555 without perceived cognitive impairment at baseline comprised the longitudinal cohort. The prevalence of perceived cognitive impairment at baseline was 45.6%. At baseline, cognitive impairment was associated with increased frequency of self-reported sexual dysfunction (aPR=1.32, 95% CI: 1.17–1.48). Among the sample without sexual dysfunction at baseline, incident sexual dysfunction was more common among participants with persistent (aRR=1.61, 95% CI: 1.06–3.18) and newly reported cognitive impairment (aRR=1.89, 95% CI: 1.14–3.14). ConclusionResults suggest PCI may be an independent risk factor for sexual dysfunction in PwMS, which may represent an additional dimension whereby MS may adversely affect quality of life.

Epidemiology, diagnosis and management of sexual dysfunction in multiple sclerosis.

Multiple sclerosis (MS) is the most common chronic neurological disorder in young adults, with numerous potential effects on neurologic function. Sexual dysfunction (SD) is a common and very stressful one in persons with MS and represents a significant burden of disease. It has been shown that proportion of SD in MS is greater than in other neurological diseases, and almost five times higher than in the general population. Since there is no consistent definition in the literature for the diagnosis of SD, various studies reported a prevalence of SD of 40-80% in women and 50-90% in men with MS. The nature of sexual changes in this chronic illness is best defined as primary, secondary, and tertiary. Recently, it has been emphasized that detailed sexual history is crucial for all SD assessments and diagnoses. Committee 3 of the international consultation on sexual medicine suggested an updating algorithm for diagnostic evaluation of SD in both genders, with specific recommendations related to sexual history taking and diagnostic evaluation. Because treatments and preventive strategies might manage SD, it is necessary to increase the focus on these aspects of the disease when counselling patients. Management of SD should be comprehensive because the symptoms could be somatic, psychological, or related to relationship problems.

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.

Sexual dysfunction in multiple sclerosis: A prospective monocentric Moroccan study

Background: Sexuals dysfunctions in multiple sclerosis have been widely described. Their prevalence is estimated at 45%-74% in the female population and 61%-91% in the male population.

Identifying barriers to help-seeking for sexual dysfunction in multiple sclerosis.

Sexual dysfunction (SD) is common in multiple sclerosis (MS), however, under-reported. The aim of this study was to identify barriers faced by patients with MS and healthcare professionals (HCPs) in discussing SD. This was a two-part prospective study carried out at a tertiary care centre. Patients with MS were surveyed using a 29-item questionnaire and SD was assessed using the MSISQ and ASEX questionnaires; depression screened with PHQ-2. HCPs were surveyed using a 23-item questionnaire. Seventy four patients (mean age 42.4 ± 10.7, 54 females) and 98 HCPs (mean age 45.8 ± 8.9, 90 females) participated. SD was significant, with primary (36.4%), secondary (27%) and tertiary (29.8%) contributory factors. Commonest barriers reported by patients were dominance of neurological symptoms (N = 30, 40.5%), presence of family or friends (N = 28, 37.8%), and not being asked (N = 25, 33.8%), while HCPs reported presence of family or friends (N = 34, 34.7%), lack of knowledge about SD (N = 30, 30.6%), and inadequate time during the consultation (N = 27, 27.6%). Barriers to discussing SD are similar between patients and HCPs. The most common barriers are addressable through modifications in the clinic environment, raising awareness and providing training opportunities.

Sexual dysfunctions in MS in relation to neuropsychiatric aspects and its psychological treatment: A scoping review.

ObjectiveSexual dysfunction in multiple sclerosis (MS) is a significant, but often underestimated and overlooked suffering. Interventions to treat sexual dysfunction in MS are rare. The relation between sexual dysfunction in MS and psychological as well as neuropsychological aspects is evident. However, this field of research remains markedly underdeveloped in this severe chronic illness. The aim of this scoping review is to describe the relevant knowledge in this area and to identify psychological interventions to treat sexual dysfunctions in MS.MethodsA scoping review was conducted to answer the following questions: (1) Which psychological and neuropsychological factors impact on sexual dysfunction in MS and vice versa? (2) What kind of psychological interventions aiming to improve sexual dysfunctions in MS are available? A comprehensive search and review of MEDLINE, PsycINFO, and CINAHL was completed by using a recent methodological framework for scoping reviews.Results23 publications covering a total of 13,259 people with MS and 532 healthy controls were identified. Sexual dysfunction was found to be very common in MS and there is an obvious relation to psychological disorders as e.g. depression and anxiety and also to psychological aspects as partner relationship and quality of life. The relation between sexual dysfunction in MS and neuropsychological impairment has only rarely been studied and no clear results were found. Only two studies were identified, assessing the effectiveness of psychological intervention studies on sexual dysfunction in people with MS, and a third study presenting a secondary analysis of a study targeting depression. All three studies reported significant improvements in sexual dysfunction as well as partly in psychological variables.ConclusionsThere is a pressing need for the development and adequate evaluation of psychological interventions for sexual dysfunctions in MS. In addition, sexual dysfunction and its impact on psychological wellbeing should be more focussed in clinical care.RegistrationThis review is registered with PROSPERO; Registration number: CRD42016033066.

Effects of Onabotulinum Toxin A Intradetrusor Injections on Urinary Symptoms and Sexual Life in Women Affected by Multiple Sclerosis: A Prospective Controlled Study

Background: Voiding and sexual dysfunction in Multiple Sclerosis represent the most devastating dimensions of the disease. Pharmacological treatment of voiding dysfunction could improve sexual life in patients affected by the disease. We investigated the effects of Onabotulinum toxin A intradetrusor injections on urinary symptoms and sexual dysfunction, and on the psychological status of women affected by Multiple Sclerosis with refractory overactive bladder. Methods: 41 patients underwent neurologic and urologic clinical evaluations and were administered the Female Sexual Function Index, the Incontinence-Quality of Life questionnaire, the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale, before and six months after Onabotulinum toxin A intradetrusor injection; 21 continent females affected by the disease acted as controls. Results: At baseline, all patients were incontinent and 35/41 was sexually active, with low Female Sexual Function Index scores. Mild depression and anxiety were detected in all cases with a reduced quality of life. Six months after treatment, overactive bladder symptoms improved significantly in all patients. Arousal, lubrication, orgasm-related problems and desire alterations markedly improved, together with an improvement in anxiety, depression and quality of life. Scores of Female Sexual Function Index, Incontinence-Quality of Life questionnaire, Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale remained unchanged in controls. Conclusion: Onabotulinum toxin A intradetrusor injections not only control overactive bladder symptoms in women affected by multiple sclerosis, but also significantly improve sexual life.

Neuroanatomic Correlates of Female Sexual Dysfunction in Multiple Sclerosis.

This study intended to determine associations between alterations of female sexual arousal as well as vaginal lubrication and the site of cerebral multiple sclerosis (MS) lesions. In 44 women with MS (mean age: 36.5 ± 9.9 years), we assessed their medical history and evaluated sexual function using the Female Sexual Function Index scores for arousal and vaginal lubrication. We determined potential confounding factors of sexual dysfunction: age; disease duration; physical disability; depression; bladder or urinary dysfunction; and total volume of cerebral lesions. Arousal and lubrication scores were correlated with one another and with potential confounding factors. Cerebral MS lesions were recorded on imaging scans. A voxel-based lesion symptom mapping (VLSM) analysis adjusted for confounding variables was performed correlating cerebral sites of MS lesions with arousal and lubrication scores. Decreased arousal scores correlated with decreased lubrication scores; decreased lubrication scores were associated with bladder or urinary symptoms. Arousal and lubrication scores were not associated with any other variables. Multivariate VLSM analysis, including arousal and lubrication scores as covariables of interest, showed right occipital lesions associated with impaired arousal and left insular lesions associated with decreased lubrication. Impaired lubrication remained associated with left insular lesions after adjustment for bladder or urinary dysfunction. Our data indicate that impaired female sexual arousal is associated with MS lesions in the occipital region, integrating visual information and modulating attention toward visual input. Impaired lubrication correlated with lesions in the left insular region, contributing to mapping and generating visceral arousal states. Ann Neurol 2016;80:490-498.

Female sexual dysfunction in multiple sclerosis: Results of a survey among Dutch urologists and patients

The objective of this study was to determine the prevalence of female sexual dysfunction (FSD) in patients with Multiple Sclerosis (MS) in one of the leading MS centers in the Netherlands. Furthermore, we evaluated the practice patterns of members of the Dutch Urological Association (DUA) with respect to FSD. A self-administered Web-based questionnaire for physicians was mailed to all 467 members of the DUA. The questions covered different topics in female sexuality. For the patient survey the Female Sexual Function Index (FSFI) was used. The response rate of the physicians survey was 42% (n = 194). Sixty-one percent of the responders reported to ask their female patients about their sexual function. Thirty-nine percent of the physicians did not ask their patients about sexuality. The majority indicated that they lacked knowledge on FSD or found discussing sexuality not relevant for their practice. The response rate of the patient survey was 28% (n = 85). According to the FSFI questionnaire 32% of the sexually active MS patients experienced FSD. Women with FSD scored low on all subdomains of the FSFI questionnaire. In particular, desire, arousal, lubrication, and the ability to achieve orgasm were affected. The prevalence of FSD in MS patients in our center is about 32%. Overall, many members of the DUA do not screen for sexual dysfunction in female patients because of lack of knowledge on FSD. Better and more structured education of urologists and residents in urology on FSD in The Netherlands is urgently needed. Neurourol. Urodynam. 36:116-120, 2017. © 2015 Wiley Periodicals, Inc.