Sexual Function

• Communicate your feelings, thoughts, and desires.
• Express yourself sexually in a positive, healthy way.
• Experience sexual pleasure with and without orgasms.
• Use your sense of sight, sound, smell, and taste to heighten your sexual pleasure so you are less dependent on touch alone.
• Have a good sense of humor with your partner.

• Discuss all your MS-related symptoms, including sexual function, with your MS provider.
• By altering the time of day and body positioning, individuals are often able to climax more easily.
• The addition of medications, lubricants, hormone replacement, and/or devices can promote sexual function.
• Counselors, psychologists, and sexual therapists are available to work through any sexual concerns you are having.
• A sex therapist can review your current routine and provide options to enhance your sexual pleasure.

If you are living with multiple sclerosis, you may feel differently about yourself or have questions about dating. If your MS symptoms are invisible, one of the biggest questions can be when to reveal your diagnosis to someone you are dating. This is a very personal decision and can vary from person to person.

Experts generally recommend sharing early, but not too early, which may mean waiting until the second or third date. Thinking about when and how you would want someone to share similar information with you is one way to help guide your decisions. If you have questions or concerns about this aspect of your life, talk to your provider or therapist.

The common characteristics of good relationships are respect and safety. This means respect for self and others. It also means that both people in the relationship feel physically and emotionally safe. Let’s begin with respect.

Respect for self and others

• If you want to spend time with someone, try approaching him/her in a friendly, confident manner.
• Avoid attitudes like, “You don’t really want to go out with me, do you?” You probably will not get many positive responses with that line. If you do not respect and value yourself, the other person will likely share your beliefs.
• On the other hand, avoid overdoing it with too much confidence. Using an approach like you are doing the person a favor by dating them will generally assure rejection.
• Remember that relationships grow slowly. It takes time to nurture feelings and for love and friendship to grow. Go slowly.
• Avoid talking about intense or very serious topics on the first few dates. Try talking about more usual topics such as sports, current events, music, community activities, etc. This would also include not talking about your personal physical care.
• Do not plan a heavy conversation about sex until you both are feeling relaxed and safe. Feelings of safety and relaxation do not happen on the first date. Remember to take things slowly.
• Pay close attention to the messages the other person is sending you. Ask questions and listen to the answers. Get to know each other.

Feeling safe in the relationship

• Feelings of safety involve knowing that one is not expected to do something that one is not ready or prepared to do.
• It means saying “no” or taking “no” for an answer without pouting, begging or coercing. It means enough trust exists between two people that saying “no” is okay.
• It means you and your partner keep private things about your relationship private. Neither one of you will “kiss and tell” or make up stories to others about your dates. Safety also involves being honest with your partner. Have courage to tell the truth about issues in your relationship. Avoid not telling the truth because you don’t want to hurt their feelings.

What if something embarrassing happens on the date?

• It is possible that something unexpected could happen while you are on a date. Since your diagnosis, you have may have relapses that cause sudden changes in your mobility, energy levels, or body functions. These may never happen during your dating, but if they do, be prepared on how you would like to handle them.

Things to keep in mind

• Remember that not all dates will become lasting romantic relationships.
• Before you were diagnosed with MS, some dates were fun and some dates were duds. Some first dates turned into second dates and others did not. Someone may have rejected you. Everyone experiences rejection at some time in their life, so be careful not to assume rejection is due to your MS.
• If you always get rejected, it may be helpful to look at why.
• There are many factors that determine if a relationship will work.

Birth control

• There are multiple types of birth control include medicines, devices, and procedures. Some types need to be used every time you have sex, i.e.: condoms. Other types can prevent pregnancy for long periods of time.
• Discuss birth control options that would be best for you with your primary care provider or gynecologist. One consideration with an intrauterine device (IUD) is to select one which is compatible with MRI testing.

Bladder program with indwelling urinary catheter

• Coat the catheter with a lubricant and then tape it to your left or right side before having sex.

Bladder program with intermittent catheterization (IC)

• Empty your bladder before and after having sexual intercourse.
• Decrease the amount of caffeine and alcohol before sex because it may cause urinary leakage.
• Remember to practice good hygiene before and after sexual activity to help prevent bladder infections.

Bowel program adjustments

• If you have difficulty controlling your bowels, use manual evacuation or digital stimulation for your bowel program and wait two hours after finishing your bowel program before sexual activity.
• If the person who helps with your bowel program is also your sexual partner, do not talk about sex during your bowel program.

Fertility

• The ability to become pregnant and give birth is usually not affected by multiple sclerosis. However, there may be some physical symptoms of MS which may make pregnancy and delivery more challenging.
• If you are desiring pregnancy, it is best to inform your neurologist even if it is months or years prior to attempting to get pregnant. Many of the disease-modifying therapies available to manage MS are not studied and/or not safe in pregnancy. Regular family planning discussions are important throughout the course of your MS treatment during your childbearing years.
• Choose a doctor who is familiar with MS and pregnancy or is willing to learn. It is important to let a doctor check your overall health before getting pregnant.

Lubrication

• MS may stop the body’s ability to lubricate the perineal area during sexual arousal. This is easily corrected by using lubricants like Astroglide and KY jelly.

Orgasm

• If MS has decreased your sensation below the waist, you may have difficulty reaching a full orgasm. However, the pleasure leading up to and after an orgasm is likely to remain.
• The addition of a vibrator or clitoral stimulator has shown to help women can reach orgasm despite neurological issues.
• Discuss your symptoms with your neurologist because medications can be added or changed to help with your sexual health. For example, there are some medications that may decrease your ability to reach orgasm such as antidepressants and muscle relaxants. There are also numbing gels to reduce painful sensations during intercourse.

Pregnancy

• Typically, women are protected or have no MS disease activity while pregnant.
• However, after delivery when the pregnancy hormones are declining, women may be at an increased risk of MS disease activity.
• It is important to develop a plan with your doctors for the weeks following delivery. The discussion should include whether or not you plan to breastfeed and when to restart your MS disease modifying therapy (DMT).

Sexual positions

• “Anything you can do, you can do.” Act safely to prevent falls, but otherwise sexual positions are up to you.
• Some people find changing positions to be more comfortable and help reach orgasm easier. Feel free to try new positions as long as they are safe.

Barrier methods

• Condoms (external and internal)

Barrier methods block sperm from getting into the uterus and reaching an egg. Condoms are the only form of birth control that can also protect against infections you can get through sex.

Long-acting methods

• Implantable rod
• Intrauterine device (IUD) with progestin
• IUD with copper

The implantable rod and the IUD with progestin both use hormones to prevent pregnancy. The IUD with copper releases copper to prevent pregnancy. These stay in the body and keep working for three to ten years, depending on the type chosen.

Pericoital methods

• Diaphragm
• Cervical cap
• Sponge
• Spermicides

Pericoital means methods that are used every time you have sex. The diaphragm, cervical cap and sponge are used along with spermicide. Spermicide is a cream or gel that kills sperm before it can get to an egg. It can be used alone, but it is less effective this way.

Permanent methods

• Vasectomy
• Tubal litigation

These methods involve procedures or surgery and are permanent.

Short-acting hormonal methods

• Injection
• Progestin-only pill
• Estrogen-progestin pill
• Patch
• Vaginal ring

These methods all use hormones to cause changes in the body that reduce the chance of pregnancy. The different options require different amounts of attention. If you get the shot, you must see your doctor every three months. If you take pills, you must take a pill every day. If you use the patch or the ring, you must change it once a week.