Sexual function in multiple sclerosis and associations with demographic, disease and lifestyle characteristics: an international cross-sectional study.
BACKGROUND
Sexual dysfunction (SD) is very common in people with multiple sclerosis (PwMS) and contributes a significant burden of disease, particularly for young people. SD has direct neurological contributions from depression and fatigue, which occur commonly in PwMS. Modifiable factors may represent potential targets for treatment and prevention of SD. We aimed to assess the prevalence of SD and explore associations between SD and demographic and modifiable risk factors, as well as depression and fatigue in a large cohort of PwMS.


METHODS
We analysed self-reported data from a large, international sample of PwMS recruited via Web 2.0 platforms, including demographic, lifestyle and disease characteristics. Specific sexual function questions included 4 items from the sexual function scale and 1 item regarding satisfaction with sexual function, part of the MS Quality of Life-54 instrument.


RESULTS
2062 PwMS from 54 countries completed questions on sexual function. 81.1 % were women, mean age was 45 years, most (62.8 %) reported having relapsing-remitting MS. The majority (54.5 %) reported one or more problems with sexual function and were classified as having SD. Lack of sexual interest (41.8 % of women), and difficulty with erection (40.7 % of men) were most common. The median total sexual function score was 75.0 out of 100, and 43.7 % were satisfied with their sexual function. Regression modeling revealed independent associations between sexual function and satisfaction and a range of demographic factors, including age, as well as depression risk, antidepressant use, and fatigue in PwMS.


CONCLUSIONS
This cross-sectional study shows that SD and lack of satisfaction with sexual function are associated with depression risk and fatigue, as well as modifiable lifestyle factors diet and physical activity (after adjusting for depression and fatigue). Planned longitudinal follow-up of this sample may help clarify these associations and the underlying mechanisms. There is potential to prevent and treat SD in PwMS by addressing depression and fatigue and their determinants. Clinicians and PwMS should be aware of SD and associated factors as part of a comprehensive preventive approach to managing MS.
Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3065, VIC, Australia. Claudia.marck@unimelb.edu.au.
Claudia H
CH
Marck
School of Medicine, Notre Dame University, Fremantle, WA, Australia.
Pia L
PL
Jelinek
Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3065, VIC, Australia.
Tracey J
TJ
Weiland
Sexual Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
Jane S
JS
Hocking
Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3065, VIC, Australia.|Biostatistics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
Alysha M
AM
De Livera
Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3065, VIC, Australia.
Keryn L
KL
Taylor
Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3065, VIC, Australia.
Sandra L
SL
Neate
Emergency Department, Box Hill Hospital, Box Hill, VIC, Australia.
Naresh G
NG
Pereira
Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3065, VIC, Australia.
George A
GA
Jelinek
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology*; D055815:Young Adult
Epidemiology; Multiple sclerosis; Prevalence; Sexual dysfunction; Sexual function