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Sexual disorders in men with multiple sclerosis: Evaluation and management

J.G. Prévinaire, G. Lecourt, J.M. Soler, P. Denys

Annals of Physical and Rehabilitation Medicine, Available online 3 June 2014

Abstract
Sexual dysfunction (SD) is a common feature of men with multiple sclerosis. SD is often unrecognized as patients and physicians are reluctant to discuss these problems. Rates of symptoms range from 50% to 90% and include erectile dysfunction, ejaculatory dysfunction, orgasmic dysfunction and reduced libido. SD can arise at any stage of the disease, even without severe disability. While erectile dysfunction is thought to be related to impairment of the pathways in the spinal cord, fatigue, spasticity, bladder and bowel dysfunction, and pain, contribute to SD. Psychosocial and cultural issues also need evaluating, and include depression, performance anxiety, lowered self-esteem. A comprehensive assessment of all theses aspects must be taken into account. Erectile dysfunction can be treated with phosphodiesterase inhibitors and intracavernous injections, with good efficacy. Ejaculatory dysfunction is managed through penile vibratory stimulation and midodrine. Concerning fertility issues, the effects of or immunomodulating drugs on semen quality are largely unknown, whereas many immunosuppressive therapies have a negative effect on semen quality that may be definitive. Advanced methods of assisted reproduction may sometimes be the only option for conception. Physicians’ awareness of this problem may help to bring about appropriate treatments, and improve the quality of life for these patients.

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About the Editors

  • Prof Timothy Vartanian

    dsc_0787_400x400.jpg Timothy Vartanian, Professor at the Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College,...
  • Dr Claire S. Riley

    headshotcsr1_185x250.jpg Claire S. Riley, MD is an assistant attending neurologist and assistant professor of neurology in the Neurological Institute, Columbia...
  • Dr Rebecca Farber

    picforelsevier.jpg Rebecca Farber, MD is an attending neurologist and assistant professor of neurology at the Neurological Institute, Columbia University, in...

This online Resource Centre has been made possible by a donation from EMD Serono, Inc., a business of Merck KGaA, Darmstadt, Germany.

Note that EMD Serono, Inc., has no editorial control or influence over the content of this Resource Centre. The Resource Centre and all content therein are subject to an independent editorial review.

The Grant for Multiple Sclerosis Innovation
supports promising translational research projects by academic researchers to improve understanding of multiple sclerosis (MS) for the ultimate benefit of patients.  For full information and application details, please click here

Journal Editor's choice

Recommended by Prof. Brenda Banwell

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Gary R. Cutter, Jeffrey Zimmerman, Amber R. Salter, et al.

Multiple Sclerosis and Related Disorders, September 2015, Vol 4 Issue 5