May 31, 2012

Sex and Multiple Sclerosis

by Dr. Kat in Sex No Comments

Dear Dr. Kat,

My wife & I have been sexually active for many years.  She is 65 & I am 66.  She now is in the advanced stage of M.S. which has left her a quadriplegic and without any feeling in the sexual organs.  She has an indwelling catheter — yet she wants to have sex.  She cannot make a fist for
masturbation and her shallowness of breath has eliminated the possibility of oral sex.  We have exhausted our creativeness at this point and are looking for suggestions. Her body may be in trouble but she has a good mind.  I have great love for my lover and wife.  She has asked me to send you this request.  Hope you can help.

Bill

 

Dear Bill,

 

The sexual spirit will always shine through despite incredible challenges. A situation like this just demonstrates the power of intimate connection, and how everyone is deserving of the feeling sexual closeness. Sometimes it just doesn’t come in the package you expect or in the ways you’ve had it previously but it’s still there. Granted, there tend to be many nuances to an advanced stage Multiple Sclerosis (MS) diagnosis. So, please be aware that I can’t give you medical advice. Please check with your doctor regarding anything new you might want to try.

 

First let’s bring everyone up to speed on what’s involved with this disease when it comes to sexuality. Sexual arousal begins in the nervous system, as the brain relays messages to the sex organs along nerves running through the spinal cord. MS has a tendency to damage these nerve pathways, meaning that sexual response can be affected. Other indirect symptoms can wreak havoc on a person’s sexuality as well, such as fatigue or muscle spasticity, and changes in mood. As a result, MS is a humbling disease, one that can really affect self esteem and the ability to feel sexually desirable. General sexual symptoms include:

 

• *Reduced sensation or painfully heightened sensation.
• *Vaginal dryness in women
• *Erection problems in men
• *Trouble reaching orgasm
• *Loss of sexual appetite
• *Positioning problems due to muscle spasms
• *Bowel or bladder incontinence
• *Overall weakness and fatigue

 

A many as 80% of women and 90% of men with MS state that their disease has negatively affected their sexuality. General treatments have included Viagra or the Muse system (which involves inserting a small suppository into the penis), inflatable devices and implants for men. For women, a good lube can address vaginal dryness. Usually both partners can benefit from using alternative methods of sexual stimulation, like vibrators and dildos. This can help to overcome slow arousal or impaired sensation. At various points through the disease medications can help with the spasms and mood swings. Intermittent catheterization can control urinary leakage during intercourse, and enemas can be used prior to sexual encounters.

 

This may sound daunting but all is not lost – even in the advanced stage of which you mention. Obviously, it sounds as if you have both been struggling with this issue for a long time. And as you’ve noted, it can be difficult to come up with strategies as the condition changes or progresses. Although your wife may not be able to physically feel genital stimulation, she obviously desires the bond that it has created between you over the years. I’m sure to a certain extent too, that she wants you to be taken care of sexually despite her condition. It varies by case but with the removal of the indwelling catheter on occasion, vaginal/penal penetration can be achieved as well as anal intercourse. A “side spooning” position is considered the best option for penetration — if such factors as spasms and vaginal irritation from the catheter aren’t an issue. It could be she is craving the sheer act of you treating her as close to the way as you always have sexually. Kissing and caressing are always possibilities, even if you have to give her some assistance.

 

Let’s not forget about everyone’s favorite sexual organ either: the mind, of which you say she has full capacity. Perhaps appealing to what turns her on mentally is the way to go. Light some candles, read her erotic novels, watch adult movies together. The more you focus on the other senses she does have, the more satisfaction you’ll both experience. Use aromatherapy to draw her a bath, or rub fragrant oils on her skin. Gently touch where she does have feeling – behind her ears, stroking her hair, nibbling her neck. Many people with limited movement have found that having sex in pools, with the freedom of buoyancy has allowed them to have sex more easily.

 

If you’re comfortable, go through the motions of helping her masturbate with a vibrator. Some quadriplegics have said that even by fantasizing they can recall the sensation of an orgasm in their mind. Perhaps you can masturbate in front of her, or using her breasts or hands. If it’s a turn on for her, ejaculate on her or in her when you can. Whatever you can do to reinforce that she is still is a sexual being, the more the both of you as a couple can still share erotic feelings with one another.

 

There are many MS and disability organizations out there now that are finally beginning to address sexuality for people with these kinds of challenges. Often, there are message boards where the individuals affected and their partners can swap ideas on positions and sexual products. There is now an MS Intimacy and Sexuality Questionnaire that can help you figure out where to begin in addressing the affects of MS on sexuality. Search the Multiple Sclerosis International Federation as well as the National Multiple Sclerosis Society for more information. It would be helpful to also have a doctor who is open to discussing these issues. A good doctor will always make time to discuss the sexual impact of your diagnosis. In addition, many Sexologists and Sex Therapists also specialize in sex and disability. At times, I know they have referred disabled clients to sexual surrogates to help these couples and individuals get some hands on help in the bedroom.

 

The important thing here is to focus on the sexuality you can still share and not hang on to the past. The more each of you can get comfortable with the disease and the bodily changes associated with it, the better. And like any couple don’t forget to communicate! If one of you is having a rough day talk about it. Communication will be especially helpful in helping you to both monitor the status of the disease and any changes sexually you may need to make along the way. A diagnosis of MS doesn’t have to mean that you lose all sexual options. It can be an opportunity to embrace the bond that you have and not take for granted the simple sexual pleasures that most unimpaired individuals do.