Multiple sclerosis (MS) is categorized as a progressive chronic inflammatory disorder that negatively impacts both physical and mental health, with around 2.8 million individuals affected globally. It has been found that sexual dysfunction occurs in males with MS (MwMS) nine times more frequently than with any other neurological disease. In fact, many MwMS see sexual dysfunction as the most detrimental part of their disease, which then negatively impacts other aspects of their health and quality of life. It has been suggested in previous research that a combination of psychological, physical, and social factors may contribute to the onset of sexual dysfunction. Namely, the presence of disability, depression, anxiety, fatigue, and hormonal imbalances can cause erectile dysfunction.

Neuromyelitis optica spectrum disorder (NMOSD) is a common inflammatory disease that dissolves the protective tissue surrounding nerves in the central nervous system and targets the optic nerve and spinal cord. NMOSD may directly affect sexual function due to lesions in the genital system’s neural pathways and the presence of symptoms such as spasms, urinary dysfunction, and fatigue. Despite a significant lack of research into NMOSD and sexual dysfunction, previously identified as risk factors for sexual dysfunction are fatigue, depression, and the presence of disability.

Between both MS and NMOSD, there is not as much research on sexual function in biological males as there is in biological females. To remedy this, a group of researchers set out to investigate which factors may influence sexual function in MwMS and males with NMOSD (MwNMOSD).

A participant group of Iranian men of at least 18 years of age and with confirmed MS (49 men) or NMOSD (27 men) diagnoses who maintained regular sexual relations were included alongside a control group (40 men), otherwise known as healthy male controls (HCs). The participants were first asked several demographic questions, such as their age, income, education level, etc., followed by several marriage-related questions like partner’s general education level, age, etc., and lastly their method of sexual protection. They were then tasked with completing several questionnaires:

• The International Index of Erectile Function (IIEF) questionnaire: a 15-item questionnaire that looks at various facets of erectile function.
• Beck’s Depression Inventory-II (BDI-II) questionnaire: a 21-item multiple choice questionnaire looking at depression severity over the past 2 weeks.
• The Beck Anxiety Inventory (BAI) questionnaire: a 21-item questionnaire looking at the cognitive and physical symptoms of anxiety over the past week.

From these questionnaires, researchers found that the sexual function of MwMS can be influenced by depression, anxiety, and partner’s general education level, which is backed by existing research. It’s suggested that providing educational materials to partners on MS and sexual dysfunction would be beneficial to potentially improve symptoms of sexual dysfunction. Additionally, it is suggested that sexual counseling and education is a valuable form of treatment for improving the sexual function of people with MS.

Researchers found that the sexual function and quality of life for MwNMOSD can be influenced by presence of disability, and directly related to anxiety, on top of the previously mentioned symptoms and lesions. However, with inconsistent previous research on MwNMOSD, it is suggested that more research is conducted to truly understand the effects of these risk factors.

Despite its limitations, this study is a good starting point for future research into the sexual function of MwMS and MwNMOSD. Researchers suggest a longer version of this study be conducted, starting with participants in the earliest stages of MS and NMOSD and following them over time to evaluate the cause-and-effect relationship between risk factors and sexual dysfunction. Future studies should also consider using neuroimaging data, as that may help to examine levels of brain damage in participants.

In the end, both MwMS and MwNMOSD show worsened sexual function when compared to the HCs, suggesting a need for extra support in areas associated with sexual health. Risk factors found for sexual function in MwMS include depression, anxiety, presence of disability, and the education level of an individual’s partner. Subsequently, risk factors found for sexual function in MwNMOSD include depression, anxiety, and presence of disability. This is information that can be used by healthcare professionals to hopefully develop more comprehensive prevention and management strategies for sexual function in males with MS and NMOSD.

References:

• Vaheb, S., Yazdan Panah, M., Mohammadi, M., Sadri, M. A., Ebrahimi, N., Loghmani, S., Beigi, M., Shaygannejad, V., & Mirmosayyeb, O. (2024). Sexual function and related predictors in male with multiple sclerosis and Neuromyelitis Optica Spectrum Disorder: A case–control study. The Journal of Sexual Medicine, 22(2), 274–281. https://doi.org/10.1093/jsxmed/qdae188