title: Sexual disorders in women with MS: assessment and management.
abstract: OBJECTIVE
  Summarize the data on sexual disorders in women with multiple sclerosis (MS).
  
  
  METHODS
  Review of 99 Pubmed articles covering sexual dysfunction in women with MS.
  
  
  RESULTS
  Prevalence of dysfunction in women with MS varies from 34% to 85%. They include poor vaginal lubrication, poor clitoral erection, and anorgasmia, which correlate with level of disability. Specific brain stem and pyramidal lesions appear to correlate with anorgasmia. Age and duration of the disease correlate with sexual disorders, but not age at onset. Secondary consequences of MS, including bladder and bowel dysfunction, spasticity, pain, fatigue, depression, anxiety, and side effects of medication contribute to sexual dysfunction. Treatments can involve alpha-blockers or phosphodiesterase-5 inhibitors to increase smooth muscle relaxation, while lubricants and oestrogen therapy can help vaginal dryness, burning and dyspareunia. Antidepressants can delay (or abolish) orgasm, suggesting reducing dosage or combining them with PDE5 inhibitors. Counselling should emphasize planning sexual activities, reducing fatigue, managing positions, preventing incontinence, promoting sexual aids, extra-genital and other sexual options to achieve pleasurable and intimacy. Psychosocial interventions should include couples' relationship and communication skills to increase satisfaction.
  
  
  CONCLUSIONS
  Sexual dysfunctions in women with MS are amenable to treatments covering primary, secondary and tertiary consequences of the disease.
authors.affiliation: Department of sexology, université du Québec, CP 8888 succursale centre ville, H3C 3P8 Montreal, Quebec, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Cordeau
authors.affiliation: Department of sexology, université du Québec, CP 8888 succursale centre ville, H3C 3P8 Montreal, Quebec, Canada. Electronic address: courtois.frederique@uqam.ca.
authors.forename: F
authors.initials: F
authors.lastname: Courtois
mesh_terms: D005260:Female; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications; D012735:Sexual Dysfunction, Physiological / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*
keywords: Dysfonctions sexuelles; Femmes; Multiple sclerosis; Prevalence; Prévalence; Sclérose en plaques; Sexual assessment; Sexual dysfunction; Women; Évaluation sexuelle