Sex and Multiple Sclerosis
Read about the author Samantha Evans
Research has suggested that up to 50%-80% of people with a vulva and vagina with Multiple Sclerosis (MS) and 70% of people with a penis may experience sexual problems at some point during their lives, compared to 40% of all women and 22% of men in the UK. Many of these problems can be alleviated but are often under reported by people who have MS or are misdiagnosed or not even discussed by their medical practitioners.
People living with MS and their partners often report that the symptoms of the condition affects their physical and emotional well being, causing changes in their relationship.
For some couples, MS can cause a breakdown in communication and intimacy where one or both involved feel lonely, isolated, rejected or just confused. Often the person with MS feels guilty for not being able to have sexual intercourse with their partner, thus increasing their sexual anxiety and their partner worries that they will cause them pain so avoid having sexual intercourse.
Changes in levels of desire
Changes on levels of desire can affect any gender, either as a direct result of having MS or as a consequence of having to live with the disease. When first diagnosed with MS or new symptoms of the disease develop, feelings of sadness and anger can occur, impacting upon both physical and emotional needs of the body. This can lead to a decrease in sexual libido.
How you feel about having MS can impact upon your desire and the way in which you feel about your body and your sexuality. Your partner will feel worried about your condition and might avoid having sexual intercourse as they fear it will cause you pain, thus increasing your anxiety.
Levels of sexual desire can drop at any time throughout your life, including during the menopause, periods of stress, having children or caring for elderly parents. All these can impact upon our libido whether we have MS or not.
MS and sexual function
Having MS can cause physical sexual difficulties due to interruption of the electrical impulses being sent from the brain to the sexual organs via the spinal cord. Sexual arousal, response and orgasm need messages to be sent through this pathway and any nerve damage in the brain and spinal cord can cause problems.
Sex and single people
You still have sexual needs and desire even if you are not in a relationship. Having MS can affect you forming relationships, dating and meeting new people due to any concerns you may have about your sexual performance. You may feel anger and sadness at the break up of a former relationship, perhaps as a result of you developing MS. Problems can occur when masturbating, due to limited mobility or manual dexterity.
How MS affects sexuality
Primary sexual function
This relates directly to the changes in the brain and spinal cord bought about by the onset of MS which impact upon sexual pleasure. Many people can experience a decrease or loss in libido and genital sensation. Those with a penis can have difficulty in maintaining or achieving an erection and a decrease or loss of ejaculation. People with a vulva and vagina may experience reduced vaginal secretions leading to vaginal dryness, loss of vaginal muscle tone and diminished clitoral engorgement.
Secondary sexual function
This stems from MS symptoms that do not directly related to the nerve pathways for sexual pleasure or response. They can include bladder and bowel problems, fatigue, tremors, limited attention and concentration span and non genital sensory changes.
Tertiary sexual function
This is related to the mental and emotion aspects of MS and the feelings it creates, such as depression, sadness, loss of sexuality, mood swings and feeling less confident about their body image. The change of lover to caregiver puts tremendous strain on both the MS sufferer and their partner, which can ultimately lead to break down in communication, at a time when good communication is essential.
Sexual problems affecting people with a vulva and vagina
Our sexual response and arousal relies upon messages being sent along the nerve pathways between the spinal cord and brain. MS can interrupt these pathways, and the sexual response messages never arrive at their destination.
Many people with MS can suffer from some of the following sexual problems throughout their lives but there is help available to alleviate some of these problems.
Vaginal dryness
This is a common problem, not just those with MS, as hormonal changes throughout a person’s life, such as childbirth, the menopause, ageing and side effects of medication, can have an effect upon the secretions of the vagina.
Thrush can often be a problem, therefore avoid lubricant and vaginal moisturisers that contain glycerin or glycols as these are known vaginal irritants. Many commercial lubricants and vaginal moisturisers and even some available on prescription contain glycerin and glycols so always check the label or ask your GP what the ingredients are.
Vaginal dryness can make sexual intercourse uncomfortable or painful. Using a good lubricant can greatly alleviate this problem. Choose an organic lubricant such as YES which contains only plant extracts and is approved by the Soil Association. Offering both water based and oil based formulations, YES lubricates and nourishes the delicate tissues of the vaginal walls, making them more flexible.
Supplied in handy applicators, using YES is easy to use, if you have restricted mobility or manual dexterity problems. YES waterbased lubricant and YES VM are both available on prescription.
SUTIL LUXE is a silky smooth water-based lubricant that moisturises, nourishes and soothes our most intimate areas, as well as lubricating for sexual pleasure. Feeling like a silicone lubricant without the silicone, this fabulous water based lubricant gently cushions and glides, blending seamlessly with your own natural lubrication during sex. Being water based it is easy to wash off too.
Free from irritating ingredients, it can be used as a vaginal moisturiser and with any sex toy or dilator.
Made with eco certified ingredients, SUTIL is committed to creating natural and organic cosmetics that are not only great for your skin, but also derived from renewable resources and manufactured using environmentally friendly processes.
Some people prefer a silicone lubricant which feel more slippery and can be used with condoms, making it a great alternative to oil based lubricants. Silicone lubricants should not be used with silicone sex toys as they can damage the material of the toy.
Ditch Intimate Hygiene Products
Many intimate hygiene products exacerbate vaginal dryness and can cause thrush, bacterial vaginosis, irritation and soreness. Just wash your vulva with water. If you feel you need to use soap or an intimate wash, speak to your GP who can prescribe or recommend an gentle emollient to use instead.
Many people can experience a myriad of vagina health issues, from itching, soreness, discharge, vaginal dryness and vaginal atrophy, the majority of which should be diagnosed and treated by your GP. Too embarrased to speak to their GP they turn to the heaving shelves on the high street in well known retailers and online to buy a product they think will alleviate their symptoms. However people have no idea the products they are using are actually contributing to their symptoms, exacerbating them and prolonging their existence.
Difficulty reaching orgasm
You may find it takes longer to reach an orgasm , you require more stimulation or they do not feel as strong. Using a vibrator can help, as the waves of vibrations can help to trigger an orgasm by stimulating the nerve endings in the clitoris and vagina as well as your G-spot.
Desensitisation of the nerves within the vagina and clitoris may mean you are unable to orgasm through sexual intercourse, or manual stimulation. Using a body massager such as the Doxy or Doxy 3 which is a smaller, lighter version of the Doxy can help as these products offer much stronger vibratory power than conventional vibrators in addition to being body massagers too, so ideal for giving you an orgasm and easing your aches and pains! If you prefer a rechargeable product,there is always the DoxyDie Cast R3. These massagers can be positoned on a pillow or cushion between your legs, whatever position you find comfortable and pleasurable.
75% of people with a vulva and vagina require clitoral stimulation to achieve orgasm, therefore you may prefer an external or clitoral toy which stimulates the clitoris. Many are small in dimensions making them light weight and easy to handle.
Classic vibrators can be used both internally and externally, some of which are designed to stimulate the G-spot, located just inside the vagina which can produce strong orgasms.
Rabbit vibrators offer both internal and external stimulation at the same time, producing both clitoral and vagina orgasms simultaneously. The Rocks Off Enigma is completely flexible and had an ergonomic handle making it easier to control , it also stays in position for hands free play. The Everygirl is a lightweight yet powerful flexible rabbit vibrator that is easy to use with simple button controls
The Fun Factory Stronic range of sex toys use a thrusting motion for sexual stimulation, ideal if you want to experience a similar sensation to sexual intercourse whilst the Fun Factory Sundaze not only pulsates, it vibrate, taps, flutters, shakes and shimmies!
The Satisfyer Pro 2 uses Air Pulse Technology instead of vibrations which gently caresses your clitoris, ideal if you experience decrease sexual sensation which can be exacerbated by using a vibrator for long periods of time. Satisfyer Pro 2 is easy to use, lightweight and you just leave it in place, no need to move it.
The LELO SONA 2 uses sonic wave technology to gently suck the clitoris. The silicone absorbs sonic waves and pulses and transmits them back to the clitoris. These waves stimulate the internal and external parts of the clitoris, gently teasing and caressing you to an all consuming climax, just leave it in place on your clitoris, lie back and enjoy!
Remote controlled sex toys are another great way to enjoy sexual pleasure as they can be controlled either with a remote or via an app and some can be left in place.
Many vibrators are well designed and come in different shapes and sizes, so finding one to suit your needs can be easy. Some require batteries which can be fiddly to insert if you have problems with manual dexterity, others are rechargeable, thus removing the need for batteries and will not stop working at the most crucial moment! If you suffer from fatigue, there are several lightweight products which are easy to use and will not cause your hand to tire. Some can be worn in your knickers against your clitoris or just rested between your thighs.
If vaginal tightness is an issue, the Inspire Dilator Kit can really help to stretch the vagina to ease discomfort or pain during penerative sex. Alternatively you can use. a slim vibrator
Many of our sex toys are gender neutral so can be used with a partner with a vulva or penis.
Drug therapy can alleviate decreased sensation and counselling can help to enhance intimacy and communication.
Body mapping involves identifying parts of the body and types of touch that feel good and increase sexual arousal. This process needs to be practised to enable the person to become aware of what works for them. They can then communicate this information to their partner to increase their intimacy and sexual pleasure. Experimenting with different positions can help. Using cushions and pillows to support your body can enable you to find the most comfortable position. You may not be swinging from the chandeliers but you should be able to find the best position to have pleasurable sex.
Pelvic floor exercises
Everyone can benefit from doing pelvic floor exercises whatever their gender. Strengthening pelvic floor muscles can increase orgasmic response, erectile function and improve urinary incontinence. If you are unsure how to do these exercises, seek help from a pelvic health physiotherapist, trained healthcare professionals who can teach you how to do your pelvic floor exercises correctly, assess your pelvic floor muscles ( some people have a tight pelvic floor so need to relax them) and track your progress.
For those who may find it difficult, using kegel exercisers can help. LELO Luna balls consist of weighted balls which can be inserted daily for 2 hours. When worn, the clay balls inside the outer shell move around as you go about your daily routine and cause the pelvic floor muscles to involuntarily tense. Using the 16 week exercise regime, a person can strengthen their muscles which can improve orgasms. Kegel exercisers are useful for all people, whatever their age and state of health pelvic floor link.
The Lelo Luna Smart Bead is a vibrating pelvic floor exerciser which offers a daily 5 minutes exercise programme to follow and tracks your progress by increasing the strngth of the vibrations, the stronger you PC muscles become.
Combining both vibratory power and electrical stimulation, the MyStim range of vibrators offer both a vibrator and pelvic floor exerciser in one product. They all offer a pelvic floor exercise programme to follow, using electircal impulses to exercise the PC muscles.
Sexual problems affecting people with a penis and prostate
About 70% of people with a penis with MS experience erectile dysfunction, with some symptoms appearing several years after the onset of the disease. Problems can occur as a result of side effects from medication too. The degree of erectile dysfunction is dependant upon where the nerve damage occurs. A person may get an erection in response to genital stimulation but not as a response to sexual arousal if this pathway is disrupted due to MS related nerve damage.
Erectile problems
Medication in the form of tablets, intravenous therapy and intra urethral suppositories can help to enhance the blood flow to the penis as can topical medication, applied directly to the penis and should be discussed with a medical professional. However, some people do not find drug therapy helpful or that they are not able to get a natural erection, so using penis pumps can help to prolong an erection by creating a vacuum around the penis improving blood flow, then placing a constriction ring such as cock rings around the base of the penis can help to maintain the erection. A combination of medical treatment, using a pump and suitable sex toys can really help.
Sex toys which can help increase sexual sensations include penis sleeves, ideal when it may take some time to reach orgasm and offer a vagina-like sexual experience. Stimulating the prostate gland with prostate massagers can offer experience sexual sensation and produce strong prostate orgasms.
Sex toys, such as Fun factory Cobra Libre 2 and the Pulse Solo III enable a person to enjoy sexual sensations even when they are unable to gain an erection as they sit either over the head of the penis or around the shaft. Using vibratory pulse plates, the Pulse offers different sexual sensations. It can be used hands-free so ideal for those with imited motor ability.
The Fun Factory Manta is a male masturbator with flexible wings that sit comfortably around the shaft of the penis, on the head or at the base. The “wings” and the cleft in the center also enhance the power of the motor, adding movement to the vibration, allowing you to enjoy precision stimulation over and under the head, along the shaft, and against the base. It’s also an amazing blowjob accessory, circling the base of the penis offering vibratory stimulation.
Limited mobility or reduced manual dexterity can be a symptom of MS but the use of penis sleeves or male masturbator, such as the Pulse Solo Essential can aid masturbation, either for the person or their partner. It can reduce fatigue and increase stimulation to the penis. The internal moulded sheath of the penis sleeve can produce intense sexual sensations. Some vibrating sleeves increase the sensations felt, thus increasing the intensity of sexual pleasure.
Prostate massagers can help a person to achieve an orgasm by stimulation of the prostate gland or P-spot, a chestnut sized swelling, situated about 2 inches inside the anus. Some massagers can be manually manipulated to massage the prostate, others vibrate, sending waves of pleasure to this erogenous zone.
If getting or maintaining an erection is not possible, using a strap on harness with a dildo is an alternative way to enjoy intimacy with a partner.
Urinary catheters can be folded inside a condom during sex to avoid getting in the way or try to self catheterise or void before sex. Use towels to protect your bed sheets or a specially designed absorbant sheet or blanket that can be popped in the washing machine..
Body mapping, asmentioned above can help too.
Sex without intercourse
Not everyone has penetrative sex but if you are someone who enjoys penetration but are no longer able to, you can have great sex without intercourse. Sex is so much more than just penetration and exploring new ways to enjoy intimacy, being imaginative with your sex play and enjoying different sexual sensations with sex toys and bondage can feel great.
Massage
A sensual massage can help to arouse sexual feelings and bring you closer together as well as easing muscle spasm. It can reinforce positive feelings about your changing body image and make you feel loved and cherished. Try taking antispasmodic drugs 60 minutes before having a massage to help to relieve any pain.
Masturbate together
This can be extremely arousing and will show your partner how and where you like to be touched. It takes confidence to do this which can be difficult to overcome initially, especially if you are struggling with body image issues but your partner loves you no matter how you look. Knowing that your partner still finds you desirable can go along way to boosting your confidence and sexual arousal.
Masturbate each other
Limited manual dexterity may be problematic when masturbating each other but the use of penis sleeves and vibrators can help and reduce fatigue.
Sex toys
As mentioned above, sex toys can really help with decreased sexual arousal and sensation. Using a vibrator, vaginally or clitorally, can induce intense orgasms. Playing together with toys is so much fun. Decide what sexual sensation will work for you, how easy a sex toy will be to control, how ehavy is it, where do you want to use it, alone or with a partner, is it made from skin safe materials, how easy is it to clean.
Oral sex
Great oral sex is essential for non penetrative sex. People with a penis enjoy oral sex and do not need a fully erect penis to enjoy the benefits it offers. Some people people with a vulva enjoy oral sex but are often let down by poor technique. Communicate to your partner what feels good and what to avoid. Knowing what turns you both on will enhance your sexual enjoyment. There are many flavoured lubricants you can use if you find the taste unpleasant.
Be aware that flavoured lubricants containing glycerin, which is sugar and can cause thrush so it is advisable to keep them just for oral sex and not for vaginal penetrative sex.
The Satisfyer Pro 2 does not mimic oral sex but gently caresses and teases the clitoris into submission, once it is in the right place, it goes quiet and works its magic.
The LELO SONA 2 uses sonic wave technology to gently suck the clitoris. The silicone absorbs sonic waves and pulses and transmits them back to the clitoris. These waves stimulate the internal and external parts of the clitoris, gently teasing and caressing you to an all consuming climax, just leave it in place on your clitoris, lie back and enjoy!
The Fun Factory Manta can take a blow job to another level by offering vibratory sexual stimulation at the same time.
Ties and blindfolds
Spice up your sex life using light bondage. Incorporating silk ties can bring an element of kinkiness to your sex life and hopefully ignite those flames of arousal. Being blindfolded can increase your sense of taste, touch, sound and smell. You can feel sexually aroused if you don’t know what if coming next!
Explore BDSM from bondage, “kink”: articles/sexploration/trying-kink,erotic rope tyng, temperature and fireplay, ice play
Watch erotic films and read erotic fiction
There is a wealth of erotic fiction available so read to your partner to get in the mood or read a naughty chapter to yourself before bedtime to trigger sexual arousal. By reading or watching erotica, you may both discover an idea or story line you want to use to spice up your lovemaking
Time your medication
Take your pain medication or anticholinergenics for bladder dysfunction 30 minutes before having sex to ensure that they have started working.
Massage before sex can help reduce the occurrence of muscle spasm. Take any antispasmodic medication one hour before having sex.
Medication for fatigue should be taken 1 hour before sexual activity. If you self inject your medication, ensure that you do it well in advance of sexual intercourse to ensure that any side effects of having an injection have passed and sex can be enjoyed. On the other hand, sex might just be the perfect thing to take your mind off unpleasant injections.
If you take antidepressants, these may have a negative effect upon your libido so speak to your GP about changing to an alternative drug to help your symptoms.
Psychosexual Therapy
You may find talking to a psychosexual therapist, either alone or with your partner, can help you enjoy better sexual intiamcy and pleasure. Ask to be referred by your GP or find one at the College of Sexual and Relationship Therapists.
Having MS should not stop you from enjoying sex. Your MS Nurse Specialist will be able to offer you advice about sexual issues and refer you for sex counselling. There are so many ways in which you can enjoy intimacy and sexual pleasure by incorporating sex toys, erotica, oral sex and masturbation into your lovemaking, it just may take time and experimentation to find out what works for you.
At Jo Divine we believe that sexual health and sexual pleasure go hand in hand and have created a health brochure with suitable products to help people with sexual issues. We also have our Jo Divine catalogue with products for a penis and prostate too. Working with medical professionals, we hope to encourage patients and HCPs alike in talking more freely about sexual problems. A health issue doesn’t mean your sex life will have to stop!
There are also several excellent free publications by the MS society including:
Sexuality: a guide for women by Nicki Ward-Abel and Janice Sykes
Sex and MS: a guide for men by Simon Webster and Sex, Intimacy and relationships by Sarah Westlake
The Ultimate Guide to Sex and Disability by Cory Silverberg et al (Cleis Press)
Useful Websites
MS Society : www.mssociety.org.uk
MS Trust : www.mstrust.org.uk
MS UK : www.ms-uk.org
MS National Therapy Centres : www.msntc.org.uk
MS Positive : www.mspositive.co.uk
Enhance the UK : www.enhancetheuk.org
College of Sexual and Relationship Therapists : www.cosrt.org.uk