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Multiple sclerosis is a chronic disease that affects the brain and spinal cord. According to MedlinePlus.gov, MS “damages the myelin sheath, the material that surrounds and protects your nerve cells.”
This degenerative effect on the protective coating of nerve cells ultimately interferes with messages sent between various parts of the body and the brain, leading to the symptoms of the disease.
Among the more widely known symptoms of MS are difficulty with coordination and balance, cognitive problems, degraded vision, muscular weakness, and sensations of numbness and/or pins and needles. Although less widely discussed, MS can also lead to sexual dysfunction in both men and women. In men, such dysfunction most often manifests itself as an inability to get and keep an erection suitable for intercourse.
Impotence Widespread Among Men with MS
In an article posted at VeryWell.com in late 2017, Julie Stachowiak, author of “Multiple Sclerosis Manifesto,” wrote that an estimated 91 percent of men with MS suffer from some degree of erectile dysfunction. Within the general population, ED is most often caused by insufficient blood flow to the penis. Psychological factors, such as depression and anxiety, are probably the next biggest cause of ED, although they are said to account for only 10 to 20 percent of all male impotence, compared with as much as 80 percent for blood flow-related ED.
In men with MS, as in men with advanced symptoms of type 2 diabetes, it is the progressive damage to nerves that most directly affect erectile function. Genital stimulation that would ordinarily trigger a message to the brain might not lead to the normal sequence of arousal if MS’s damage to the nerves garbles communications between the brain and the nerve endings in the pelvic region.
MS Targets More Women Than Men
Although women are twice as likely as men to be diagnosed with MS, a significant number of men suffer from the disease. The Multiple Sclerosis Association of America estimates that 400,000 Americans have been diagnosed with MS, with an additional 10,000 new cases being diagnosed every year.
While ED in and of itself is a worrisome problem for men who suffer from it, writes Stachowiak, erection problems that arise as a result of an underlying cause of MS point to additional questions that should be taken into consideration. These include:
- Has penile sensation been reduced, perhaps making it more difficult to achieve ejaculation?
- Are fatigue and/or spasticity, both common MS symptoms, contributing to ED problems?
- Is urinary leakage occurring during intercourse?
- Could anticholinergics, prescribed to treat MS-related urinary problems, be exacerbating erection problems?
- To what degree are psychological factors, such as low self-esteem or a mood disorder, contributing to erection problems, and should they not be addressed separately?
Oral ED Medications Can Help Too
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On a more hopeful note, Stachowiak notes that treatment directed specifically at MS symptoms can sometimes help to improve erectile function.
However, even absent such response to MS medications, most men with MS can take one of the popular oral ED medications such as Viagra or Cialis.
If the ED medications fail to deliver the desired result, penile injection therapy — the injection of a vasodilating drug directly into the shaft of the penis — offers yet another possibility.
In a recent study of the prevalence of ED among male MS patients, Italian researchers found that roughly three-quarters of the 101 MS patients they tested suffered from some degree of erectile dysfunction. Their findings were published in a 2017 issue of the “Central European Journal of Urology.” Although this study found a lower incidence of ED among male MS patients than that estimated by Stachowiak, both point to a strong link between MS and erection problems.
In yet another recent study, published in the February 2018 issue of the “Journal of Neurology,” German neurologic researchers conducted neuroimaging tests to see what areas of the brain were most involved in MS-related ED. They found that MS lesions in the left insular region of the brain were one of the primary culprits.
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