Sexual Effects of MS Brain Changes

Ann Crickmer, MSW
July, 2002

At the recent Consortium of MS Centers meeting in Chicago I was impressed with the reported incidence of sexual symptoms in MS: up to 80% of women, and 90% of men. The urologist, Philip Aliotta, MD, also noted that "what was in the back of the magazines has moved to the front of the journals. "Fred Foley PhD, a specialist in MS and Sexuality also summarized many studies and presented some coping mechanisms. MS changes in the brain and spinal cord can cause diminished clitoral engorgement, vaginal lubrication and muscle tone in women, and erectile dysfunction in men. Other MS symptoms also interfere: fatigue, bladder or bowel problems, spasticity, mood swings. We have learned that sexual desire (libido) can be affected by the progression of MS. Desire involves initiating and/ or being receptive to sexual behavior. However, even if these pathways are impaired, there are numerous other CNS pathways for experiencing sexual pleasure (sensory, perceptual, emotional) that remain largely intact. The goal is to enhance sexual pleasure by mentally uncoupling it from desire per se. Orgasm may not be the primary goal - expectations change with lowered libido. Have you told your neurologist that your are experiencing sexual symptoms? The doctor will find this neither unusual nor uncomfortable. Perhaps now is the time to ask for a referral to an MS specialist urologist as there have never been more treatments and products available to restore a pleasure to your life that you may have thought gone forever. [http://www.aswechange.com]

Medication Management

Some prescription drugs also adversely affect desire. If your physician feels that it will not affect the efficacy of your antidepressant medication, try a dose reduction to see if it improves libido. If you are taking Prozac (now available in an inexpensive generic form), the half-life is so long that your physician may ok a "drug holiday" over weekends. Sometimes very low doses of several drugs in combination will work. Wellbutrin has the reputation of being less sexually-inhibiting than other SSRIs: consider switching drugs. 

Hormone Replacement Therapy (estrogen) improves sexual responsiveness in women, and helps vaginal dryness and bladder problems. (Many also find that topical Astroglide, available at drugstores, adds to their pleasure.) DHEA has been used to treat low libido and fatigue. There is a new generation of oral therapies for both sexes that work more quickly than Viagra (which must be taken on an empty stomach, and no food or alcohol within three hours.) Vardenafil (Bayer) and Cialis (Eli Lilly) are effective within 10 minutes and have an 18 hour life span in the body. Dupoxitene (ALZA) is more effective in treating premature ejaculation than Zoloft or Paxil. 

Exercising your Sensuality

The importance of the experience of sensual pleasure and soothing afterglow to our "sense" of well-being cannot be overestimated. Research has shown that couples who share sexual feelings several times a week have better communication. And, of course, experiencing sexual pleasure is vital for everyone, regardless of their couplehood status. With the sensory changes MS brings, it is important to use the senses that are most acute to bring sensual stimulation to the body. Hearing is infrequently affected - and everyone should have a collection of compact disks that relax them and put them in a sensual mood. Scents are especially important to women - and have powerful sensual connotations. Studies have shown that men respond sensually to the smell of cinnamon! Even if eyesight is not sharp, colors continue to enhance moods. Romantic movies "put us in the mood" for sensual pleasure. Sexy videos lead to sexual dreaming and fantasies that can increase pleasure. [Love Pantry (206-523-5683) and Love Zone (206-782-3763) both recommend the Candida Royale movies by the feminist filmmaker for women. They combine a story line, humor, attractive locations, and a focus on the whole body, facial expressions and emotional responsiveness of people in love, making love. [review on http://www.erotica-readers.com] Other resources to explore include http://www.womansource.com. 

The doctors also suggest "body mapping" to identify where contact is most pleasurable. Talk to your partner about varying the rate, rhythm and pressure of touch. Increasing stimulation to other erotogenic zones enhances orgasmic response. Vibrators do work. Massage can be an important survival practice. Establish relaxing, sexually stimulating activity incorporating massage and prolonged foreplay. Timing adjustments will have to be made because one partner will be more goal oriented than the other. You can work out a win-win experience.

Girl-Talk

Why do cosmetic counters have trouble keeping a lipstick named Rapture, a peach-colored blush called Orgasm (NARS), a pink frost nail color called Intimacy (Sally Hansen), and purple Bliss (Liquid Euphoria) in stock? They fly off the shelf. Billions of dollars spent on focus groups should teach us something: the brain is the most important sexual organ: our feeling of "aliveness" is tied to our ability to experience our sensations. Tony & Tina claim that deep red helps you freely express your desires. The Romantic Reds, which include browny-mahogany, wine-maroon, and purple stimulate deeper passions and represent strong feelings. The pinks help you let love in. A sparkly mid-pink, Unconditional Love (TT), claims to promote greater self love - a primary requirement for sensual enjoyment. Natural Impulse (TT) is a taupe which encourages you to feel comfortable: I'd suggest those colors or one of two blue nail polishes named Guilt-free[72 colors of samplers @ $1.50 from http://www.sinfulcolors.com]or Libido (Moodmania) as a base coat under any dark color. As the lady in the restaurant said in the classic scene in the movie When Harry Met Sally "I'll have some of what she's having."

Distraction a Problem?

It is important for the partner of someone with attention/concentration problems to understand that distractability is not a function of their desirability, but an organic MS symptom. Do not take it personally. Help your mate to focus: create a stimulus-saturated, minimally distracting atmosphere. Create "re-entry" rituals when intimacy is interrupted: learn how to alter the pace of sexual touching and communication.

Stress and Sensuality

You are not "in touch with" your body when cortisol is racing through your system. Your whole body is on emergency alert and poised for "fight or flight" defensive action: sensual feelings take last place in this scenario. Stillness is a requisite for experiencing your body. Have you made time for regular stress management practice in your day? It is a survival tool, not a luxury for "someday." This is true for everyone, but MSers' brains are often no longer able to mediate overwhelming emotional responses to everyday circumstances. Their biochemistry tells them that every small frustration is a catastrophe. Physiological fear responses "trump" the reasoning part of the brain.

At the MSA we are conducting a project to see what effect a regular meditation practice will have on people with MS. There is extensive research showing that meditation works to reconnect awareness of the body, and reduce emotional reactivity which in turn also leads to improved relationships with others. This Theta Wave Training seems made to order for MS symptoms. In particular, most people with MS have experienced a split between their body sensations and their awareness. They've heard "there is no pain with MS"; "everybody forgets things: memory is not a problem in MS"; "we can't find any evidence of the sensory symptoms you describe"; "the tests show that there is nothing wrong with you"; "eat more red meat and it will take care of the fatigue." MSers have had a history of their bodily experiences not being "mirrored" as "meaningful" by others. The pre-diagnostic grail quest is often a devastating experience. Those with MS are of course not exempt from the human condition: they bring to active disease a life which may also have included insecure bonding, childhood trauma, neglect or abuse, or other brain impacts - putting them at a much higher risk for further emotional / cognitive disability from MS. It has been our experience 8 months into the project that MS "deficits" of short-term memory loss and emotional overreactivity may be assets to this training.

The Theta brain wave state is one of relaxation; training slows them down to 4-8 cycles per second. It is a "safety zone" where the perception of danger is eliminated. One experiences the soothing lullaby of the rhythms of the body as if a babe in arms. A repetitive phrase helps to focus. Practice involves the discipline of bringing the background of your life - your breathing - to the foreground. And letting the thoughts that will always come, recede into the background. You cannot fail! Training by someone who "lives" in that zone enables the development of the skill, and regular practice facilitates "unlearning" the intensity, pervasiveness and duration of externally induced imagery of worthlessness. It is in the theta state that one is aware of sensual experiences. In addition to being physiologically relaxing, this training is especially recommended for depressed patients, is good for those with concentration deficits, and is a powerful enhancement to individual counseling. It might also help those with sleep problems.   

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