For example, spasticity can cause cramps or spasms in the legs making sexual intercourse physically difficult; fatigue and weakness can interfere with libido; sensory symptoms can make physical contact uncomfortable; bladder and bowel problems can cause anxiety or embarrassment which can affect intimacy; and cognitive symptoms can impair motivation, concentration or attention.

However, there are strategies that can help you manage your symptoms more effectively, for example, tailoring of treatment around anticipated sexual activity and new positions. These strategies, combined with open communication with your sexual partner, can lead to a more satisfying sex life. You will need to experiment and try out new ideas to see what works best for you. While this may initially seem a little mechanical, if both people are sensitive about each other’s needs, sex can continue to develop and be an enjoyable part of a relationship.

Fatigue and weakness

Fatigue can have an impact on libido or sex drive, and you may feel you do not have the energy or strength for sexual activity. This can be misinterpreted, and sometimes people report that their partners think they are no longer interested in sex. Being honest and discussing such feelings can prevent misunderstandings from arising.

MS related fatigue is typically treated with a combination of medications, occupational therapy and physiotherapy. If you are prescribed medications such as Amantadine (Symmetrel) or Modafinil (Provigil), it may help to take them just before sexual activity, but remember to discuss any changes in medication patterns with your doctor first.

Some people find that it is better to have sex in the morning, when energy levels are typically higher. Planning to rest before and after sex may help too. Experimenting with alternative positions that are less tiring and require less muscle strain can also make sexual intercourse more enjoyable for those with fatigue or weakness.  

Spasticity

Spasticity can make it harder to find comfortable sexual positions, and can sometimes cause pain during sexual activity. It may help to take antispasticity medications before sexual activity, though this will depend how quickly they take effect and their impact on sexual function. Again, ensure you discuss such changes in medication patterns with a doctor first.

You may also find other positions are more comfortable, and that massage can help whilst increasing the sense of closeness and intimacy. Again, everyone is different and the key is to explore new options with your partner.  

Pain and sensory symptoms

There are various types of pain associated MS which can affect sexual activity. Dysaesthesia is a continuous burning or aching sensations which can make the skin become hyper-sensitive so that even the gentlest touch can cause discomfort. Paraesthesias can include a tingling or 'electric shock' type sensation, numbness and pins and needles; and trigeminal neuralgia is severe facial pain. All these sensations in either the genital area or other parts of the body can make being touched painful, irritating and uncomfortable.

These sensations can often be successfully managed with medications such as amitriptyline (brand name Elavil), carbamazepine (Tegretol), gabapentin (Neurontin) and phenytoin (Epanutin). Body mapping (see Tips for managing MS and sexual relationships) can also help to identify areas that are less sensitive to touch. As with other sexual problems in MS, some experimentation and good communication between partners should help too.  

Bladder and bowel problems

People with MS may experience bladder and bowel problems during intercourse, as the nerve pathways that affect bladder, bowel and sexual function are either next to each other, or shared. Most people – with the help of urologists and continence nurses – are able to find ways of managing bladder and bowel problems.

Where sexual activity is concerned, it is a good idea to discuss your concerns with your partner so you can tailor your management strategies around anticipated sexual activity. If continence is an issue, you could make sure your bladder is empty just before sexual activity, for example by self-catheterising. Others may find using towels on the bed is sufficient. Men concerned about small amounts of urine leakage could wear a condom. Condoms can also help to keep an indwelling catheter in place. Women who have an indwelling catheter can manage by taping the catheter securely to the stomach, emptying the collecting bag before sexual activity, and putting additional tape around the top ring to minimise the chance of leakage. There are also different sexual positions you can use to avoid putting pressure on the collecting bag. It is important to ensure any new positions are comfortable for both partners and do not cause any anxiety during sexual activity.

While some people do not mind leakage of urine and are happy to find strategies to minimise bladder and bowel problems during sexual intercourse, others may not feel comfortable. Instead, other forms of physical closeness and sexual contact may feel better than sexual intercourse. Each couple is different, and it may take some trial and error to establish what suits you and your partner best. 

Cognitive difficulties

Many people with MS experience some changes in their concentration, thinking and memory. Sometimes these symptoms can cause people to 'drift away' during sex making it difficult for them to sustain interest. This can be very difficult in relationships, for example, partners may misinterpret this symptom and feel they are uninteresting lovers. It is important to accept this lack of concentration as a genuine symptom of MS, and discuss ways to compensate for it, for example, by avoiding potential distractions and creating a romantic mood and sensual environment. Again, talk to your partner to ensure you are both comfortable with any changes you are making. 

Can medication or drugs affect sexuality and sexual function?

Changes in sexual desire, performance and satisfaction can also be a side effect of some medications. For example, certain anti-depressants, including fluoxetine (Prozac) and sertraline (Lustral), can affect sexual function and cause problems such as decreased libido, delayed or absent orgasm and ejaculation, and menstrual irregularities. These side effects are noted by the drug manufacturers to be 'infrequent' or 'rare'. If you think any of your medications may affect you sexually, consult your doctor or MS nurse so they can assess the cause of the problem and ensure treatments are changed if appropriate.

Those people who inject disease modifying drugs may find the injection sites are tender and sensitive to touch. An MS nurse or drug manufacturers can advise on injection methods to ensure problems are kept to a minimum. 

Does MS affect the sort of contraception I can use?

As with everyone else, if you are sexually active, it is important to consider what sort of contraception is most appropriate for you and your partner, and what precautions you intend to take against sexually transmitted disease.

Women need to be aware that certain medications for MS symptoms, such as tegretol (Carbamazepine) used to treat spasms, can make the contraceptive pill less effective. The same applies for certain complementary therapies, such as St John’s Wort (Hypericum extract) used for depression. For more information about potential interactions between medications you are taking, consult your doctor.  

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