Sexual problems affecting men
Sexual arousal, response and orgasm require messages to be sent between the brain and sexual organs, via the spinal cord.
If there is MS related nerve damage in the parts of the brain and spinal cord that are involved, men may have problems with erections and ejaculation.
Around 70 per cent of men with MS experience erectile problems, although these generally start some years after the first symptoms of MS appear (of course, there are other potential causes, like side effects of medication or an unrelated health condition).
Depending on where the nerve damage is, a man with MS may find that he can get an erection in response to genital stimulation, but not in response to anything else, or vice versa.
Viagra (drug name sildenaﬁl citrate), Levitra (vardenaﬁl) and Cialis (tadalaﬁl) can all be effective for some men. All three drugs work in a similar way, but vary in how quickly they take effect and how long they remain active.
The drugs work by enhancing blood flow into the penis, and increasing any erectile response that occurs – either through genital stimulation, or erotic thoughts and situations. Viagra takes between 30 minutes and two hours to take effect and lasts for up to four hours.
Not all men find pills effective in treating erectile dysfunction.
There are other treatments available:
Prostaglandins are a hormone-like substance naturally produced in the body. Synthetic versions of prostaglandins can be effective for treating erectile dysfunction. They work by enhancing blood flow into the penis, which leads to the penis becoming rigid and erect.
Vacuum devices work by fitting a plastic tube over the penis and use a hand pump to create vacuum pressure that results in blood flow into the penis. A ring is then placed around the base of the penis to maintain the erection created.
Ejaculation and orgasm
Although the treatments described above are all potentially effective for erectile dysfunction, there is no treatment as yet that really helps with ejaculation. Ejaculation and orgasm are much more complicated processes than genital arousal, and are almost impossible to achieve without intact connections between the spinal cord and brain.
Between 35 and 50 per cent of men with MS experience problems with ejaculation. Problems can include delayed ejaculation or not being able to ejaculate at all.
Being able to maintain an erection for longer can help, but ejaculation may remain a problem.
Although MS does not affect fertility itself, men who are unable to ejaculate might have a problem if trying to father a child.
If this is the case, you should ask to be referred to a fertility clinic for help.