Sexual dysfunction in patients with multiple sclerosis: a multidisciplinary approach to evaluation and management


Multiple sclerosis (MS) is the most common cause of progressive neurological disability in young adults. In addition to spasticity, tremors, weakness, sensory disturbances, depression, cognitive problems, and bladder or bowel dysfunction, sexual dysfunction (SD) is also a prevalent and destructive manifestation of the disease that severely affects quality of life. Evaluation of this disorder requires insight into the primary (changes that directly affect libido, sexual response and orgasm due to direct damage to the nervous system), secondary (complaints which are related to the physical disability of MS, such as fatigue, muscle rigidity, weakness and spasms), and tertiary (emotional, social and cultural aspects of MS) components of MS-associated SD. Given the complexity and multifactorial nature of SD, a multidisciplinary approach is necessary when treating patients with MS. The aim of this Review is to provide a holistic approach to the evaluation and management of SD in patients with MS, incorporating the latest data from the fields of urology, neurology, nursing, social work, and psychology. What is currently known regarding the evaluation and management of SD in patients with MS will be presented from the perspective of these specialties.

Key Points

  • Sexual dysfunction is common in patients with multiple sclerosis (MS)

  • A variety of factors, including MS-related disease activity, MS symptoms, depression, and effects of pharmacological therapy, can contribute to sexual dysfunction in patients with MS

  • All MS patients should be specifically queried about sexual function

  • Physicians, nurses, extenders, social workers, case mangers and psychologists represent the core team that can help orchestrate a truly multidisciplinary approach and management scheme for the complex problem of sexual dysfunction in patients with MS

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This project was supported by the Once Upon A Time Foundation, the Cain/Denius Comprehensive Center for Mobility Research, the Irene Wadel and Robert Atha Fund, the Kenney Marie Dixon Pickens fund, and the Jean Ann and Steve Brock Fund for Medical Sciences (all to EM Frohman). SG Fletcher would like to acknowledge The Felecia Cain Fellowship Endowment for Female Pelvic Medicine, Reconstructive Surgery and Neurourology.

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Correspondence to Elliot M Frohman.

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Fletcher, S., Castro-Borrero, W., Remington, G. et al. Sexual dysfunction in patients with multiple sclerosis: a multidisciplinary approach to evaluation and management. Nat Rev Urol 6, 96–107 (2009).

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