title: Determinants of sexual impairment in multiple sclerosis in male and female patients with lower urinary tract dysfunction: results from an Italian cross-sectional study.
abstract: BACKGROUND
  Sexual dysfunction (SD) is prevalent in multiple sclerosis (MS) patients and affects quality of life. Furthermore, lower urinary tract dysfunction (LUTD) is common in MS patients.
  
  
  OBJECTIVE
  This study aims to evaluate the relationship between SD, neurological disability, depression, anxiety, and urodynamic alterations in patients with MS and LUTD.
  
  
  METHODS
  From January 2011 to September 2013, 135 consecutive patients with MS in remission phase and LUTD underwent first urodynamic examination, according to the International Continence Society criteria. Depression and anxiety were evaluated with the Hamilton Depression Scale (HAM-D) and the Hamilton Anxiety Scale (HAM-A), neurological impairment was assessed using the Expanded Disability Status Scale (EDSS), and SD was investigated with the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF-15).
  
  
  METHODS
  Multivariate logistic regression analyses were carried out to identify variables for predicting female sexual dysfunction (FSD) (FSFI < 26.55), male SD (IIEF-15 < 60), or moderate-severe erectile dysfunction (IIEF-EF ≤ 16), after adjusting for confounding factors.
  
  
  RESULTS
  Total IIEF-15 and all subdomains (all P < 0.01), total FSFI, FSFI-arousal, FSFI-lubrication, and FSFI-orgasm (all P < 0.05) were lower in subjects with EDSS ≥ 4.5. We found inverse relationship between IIEF-15 and relative subdomains with EDSS (all P < 0.01) and between FSFI and relative subdomains with EDSS (all P < 0.01), HAM-D (all P < 0.01), and HAM-A (all P < 0.01). Continuous EDSS (odds ratio [OR] = 1.54; P = 0.03) and categorical EDSS (≥4.5) (OR = 6.0; P = 0.03), HAM-D (OR = 4.74; P = 0.03), and HAM-A (OR = 4.10; P = 0.02) were significantly associated with FSD (FSFI < 26.55). Detrusor overactivity (DO) was an independent predictor of moderate-severe ED (IIEF-EF ≤ 16) (OR = 2.03; P < 0.01), and of FSD (OR = 9.73; P = 0.04).
  
  
  CONCLUSIONS
  Neurological disability, depression and DO are significantly predictive of SD in MS patients, irrespective of gender. An EDSS ≥ 4.5 may significantly predict the presence of SD.
authors.affiliation: Department of Urology, University of Catania, Catania, Italy.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Fragalà
authors.forename: Salvatore
authors.initials: S
authors.lastname: Privitera
authors.forename: Raimondo
authors.initials: R
authors.lastname: Giardina
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Rosa
authors.forename: Giorgio Ivan
authors.initials: GI
authors.lastname: Russo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Favilla
authors.forename: Andrea
authors.initials: A
authors.lastname: Caramma
authors.forename: Francesco
authors.initials: F
authors.lastname: Patti
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Cimino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morgia
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D007172:Erectile Dysfunction / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D009948:Orgasm; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology* / Q000209:etiology; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000453:epidemiology; D014563:Urodynamics; D014570:Urologic Diseases / Q000453:epidemiology / Q000209:etiology
keywords: Erectile Dysfunction; FSFI; IIEF; LUTD; Multiple Sclerosis; Urodynamic