Dealing with sexuality in multiple sclerosis

Transcription

1 Instructional Course Sex and disability 27 August 2012 Dealing with sexuality in multiple sclerosis Woet Gianotten, MD psychotherapist, Consultant in physical rehabilitation sexology, the Netherlands

2 MS Some basic facts: MS usually starts in the yr age range F - M difference F ± 60-68% M ± 32-40% For most patients, life expectancy is normal Cause(s) still unknown: MS happens more in regions with a cooler climate Various forms of MS Benign MS Unknown

3 MS & sexuality: The statistical perspective Different forms of MS, Different questionnaires Different groups Much variety in recorded incidence of sexual disturbances Sexual disturbances in MS patients Females Males Disturbed desire 29-59% 12-80% Disturbed erection 17-62% Disturbed lubrication 34-62% Disturbed orgasm 24-38% 34-61% Premature ejaculation 5% Dyspareunia 6-40% At least 1 disturbance 45-80% 64-91% Vermote et al: 2008

4 MS & sexuality: behind the sexual disturbances 1. Direct effects on sexual function 2. Indirect effects 3. Sexual side effects of (MS) treatment 4. Effect of the changing partner relationship

5 1. Direct effects of MS on sexual function Sexual desire: decreasing in relation to depression can temporarily increase (sign of cerebral MS activity) males with progressive forms of MS have hypogonadotrophic hypogonadism (and low T) Safarinejad MR. J Neuroendocrinol 2008; 20:

6 1. Direct effects of MS on sexual function Erection / lubrication: Difficulties are strongly related to bladder problems (MS plaques in same area) Some men with MS can have REM-sleep erections, while they are not able to get erection during genital stimulation (Yang: damage to dorsal penile nerve) Part of the MS-women experience vaginal dryness and diminished genital sensations. MS-women can experience periods with increased clitoral / genital sensitivity Such clitoral hyperesthesia is sometimes accompanied by easier / more intense orgasm Yang CC ea. Mult Scler 2001;7:

7 1. Direct effects of MS on sexual function Orgasm in female: The dorsal clitoridal nerve is easily damaged by MS gradually the common stimulation fails to sufficiently activate the orgasm centre at S2-S4. this is typically the indication for a strong vibrator Orgasm in male: Orgasm more difficult due to lowered genital sensitivity In 5% premature ejaculation apparently caused by MS Probably a result of cerebral damage (as in stroke and TBI) Autonomous nerve damage can cause retrograde ejaculation Orgasm benefits: After orgasm, some patients experience a period of several hours with less muscular spasm Yang CC ea. J Urol. 2000;164:2010-3

8 1. Direct effects of MS on sexual function Female dyspareunia: spasm in hypertonic pelvic floor during orgasm clitoral hyperesthesia

9 2. Indirect effects of MS on sexuality Fatigue Weakness can sometimes ask for a vibrator Muscle stiffness / spasms. Is sometimes reduced for some hours after orgasm Walking / balance Depression or mood swings

10 2. Indirect effects of MS on sexuality Cognitive changes Changed sensitivity / paraesthesia / numbness Difficult when the patient rejects being caressed at such a place ( because it doesn t cause excitement ) whereas the partner likes to caress that area. Pain Bowel or Bladder Problems (incontinence) Especially very disturbing in the patient who prefers oral stimulation to get maximum excitement (or even needs that to reach orgasm!) Heat Sensitivity

11 3. Sexual side effects of (MS) treatment Since the cause of MS is unknown: treatment cannot cure Tr focus on: 1. slowing disability progression 2. reduce relapse rates 3. prevent / decrease brain damage Interferon depression & emotional changes low desire Besides: Treatment to diminish side effects of medication Anticholinergics decreased erection / lubrication Antidepressants decreased desire decreased erection / lubrication decreased orgasm capacity

12 4. Effect of the changing partner relationship Changing roles in household : fatigue of partner Difficulties in finding balance between asking too much and too little Changed relationship when personality and cognitive changes (included depression & mood swings)

13 The toolbox of rehabilitation sexology Providing clarity in the female-male confusion. Restructuring roles and patterns. Dealing with fatigue. Dealing with pain. Renegotiating sexual intimacy. Dealing with loss and mourning. Assisting in development of new erogenic zones.

14 The toolbox of rehabilitation sexology Teaching on tools and toys. Stoma & continence management. Dealing with sexual side effects of medication (included antidepressants) Dealing with hormonal deficiencies Partner relation therapy Medication for disturbed sexual functions (PDE5 inhibitors, PE medication) Lubricants, vaginal moisteners, etc

15 Let me give you a homework task For a patient with MS with a relationship. wiith sexual disturbance, some fatigue; urinary incontinence & some amount of pain. In 3 weeks we will have our wedding anniversary. Then we like to have a pleasurable sexual encounter with some activity, without pain, and without incontinence. Please, could you help us with some do s and dont s.

16 Thank you! gianotten. com