Sexual dysfunction among married multiple sclerosis patients in Kingdom of Saudi Arabia 2020

Zina Ali Alqahtani, Bayan Yahya Mushari, Rahaf Saeed Alsulayyim, Nouf Mohammed Al-Qahtani, Ameerah Khaled Alzailaie, Sara Khalid Al-Hasher, Lamya Ali Abumsmar, Raghad Salem Gohman, Dhay Mohammed Yahya, Hajar Alhussain Almozher, Shahad Hassan Al-Hayaza


Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system characterized by episodic and progressive neurologic dysfunction resulting from inflammatory and autoimmune reactions. Sexual dysfunction (SD) is a common disorder in both male and female patients complaining of multiple sclerosis (MS).

Methods: A descriptive cross-sectional study was conducted including patients with MS attending Arfa MS Society in Saudi Arabia. Data were collected from participants using electronic pre-structured questionnaire. The questionnaire was uploaded online using social media platforms. Multiple sclerosis intimacy and sexuality questionnaire (MSISQ-19) was used to assess sexual dysfunction. Patient health questionnaire (PHQ-9) was used to assess patient’s psychological health and depression.

Results: The study included 303 patients with multiple sclerosis whose ages ranged from 20 to 62 years old with mean age of 34.7±8.2 years old. About 75.6% took a long time to reach orgasm. Feeling sexual pleasure was reported by 73.3% of the patients and 70% reported that they had less interest or less desire for sexual activity. In general, the patients score regarding primary sexual dysfunction was 13.7 out of 25 (54.8%), 24.4 out of 45 for secondary sexual dysfunction (45.2%), and 12.6% out of 25 for tertiary sexual dysfunction (50.3%).

Conclusions: In conclusion, the study revealed that sexual dysfunction in multiple sclerosis patients is not a simple process. MS was associated with high sexual dysfunction with other psychological disorders affecting male and female patients equally regardless age and educational level.


Depression, Determinants, Multiple sclerosis, Sexual activity, Sexual dysfunction

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Pugliatti M, Rosati G, Carton H, Riise T, Drulovic J, Vécsei L, et al. The epidemiology of multiple sclerosis in Europe. Eur J Neurol. 2006;13(7):700-22.

Larkin M. Raised endothelial microparticles an early marker for multiple sclerosis? Lancet. 2001;357(9269):1679.

Dutta R, Trapp BD. Pathogenesis of axonal and neuronal damage in multiple sclerosis. Neurology. 2007;68(22 suppl 3):S22-31.

Compston A, Coles A. Multiple sclerosis. Lancet. 2008;372(9648):1502-7.

Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. Neurology. 1996;46(4):907-11.

Henze T. Managing specific symptoms in people with multiple sclerosis. Int MS J. 2005;12(2):60-8.

Moreira MA, Felipe E, Mendes MF, Tilbery CP. Multiple sclerosis: descriptive study of its clinical forms in 302 cases. Arquivos De Neuro-Psiquiatria. 2000;58(2B):460-6.

Berer K, Krishnamoorthy G. Microbial view of central nervous system autoimmunity. FEBS Letters. 2014;588(22):4207-13.

Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545-602.

Browne P, Chandraratna D, Angood C, Tremlett H, Baker C, Taylor BV, et al. Atlas of multiple sclerosis 2013: a growing global problem with widespread inequity. Neurology. 2014;83(11):1022-4.

Mortality and Causes of Death Collaborators. GBD 2013 Mortality and Causes of Death Collaborators Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2013;385:117-71.

Nichols E, Szoeke CE, Vollset SE, Abbasi N, Abd-Allah F, Abdela J, et al. Global, regional, and national burden of Alzheimer's disease and other dementias, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(1):88-106.

Cierny D, Lehotsky J, Hanysova S, Michalik J, Kantorova E, Sivak S, et al. The age at onset in Multiple Sclerosis is associated with patient's prognosis. Bratislavske Lekarske Listy. 2017;118(6):374-7.

Shafer LC. Sexual disorders or sexual dysfunction. In: Massachusetts General Hospital Handbook of General Hospital Psychiatry. E-Book. 2017:279.

Domingo S, Kinzy T, Thompson N, Gales S, Stone L, Sullivan A. Factors associated with sexual dysfunction in individuals with multiple sclerosis: implications for assessment and treatment. International J MS Care. 2018;20(4):191-7.

Kramer J. Sexual dysfunction in MS. Clinic Rev. 2019;29(7):14e-5e.

Sanders AS, Foley FW, LaRocca NG, Zemon V. The multiple sclerosis intimacy and sexuality questionnaire-19 (MSISQ-19). Sexual Disabil. 2000;18(1):3-26.

Löwe B, Kroenke K, Herzog W, Gräfe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord. 2004;81(1):61-6.

Bronner G, Elran E, Golomb J, Korczyn AD. Female sexuality in multiple sclerosis: the multidimensional nature of the problem and the intervention. Acta Neurologica Scandinavica. 2010;121(5):289-301.

Landtblom AM. Treatment of erectile dysfunction in multiple sclerosis. Expert Rev Neurotherap. 2006;6(6):931-5.

Lilius HG, Valltonem EJ, Wilkström J. Sexual problems in patients suffering from multiple sclerosis. Scand J Soc Med. 1976;4:41-4.

Betts CD, Jones SJ, Fowler CG, Fowler CJ. Erectile dysfunction in multiple sclerosis. Associated neurological and neuro-physiological deficits and treatment of the condition. Brain. 1994;117:1303-10.

McCabe MP, Mc Donald E, Deeks AA. The impact of multiple sclerosis on sexuality and relationships. J Sex Res. 1996;33:241-8.

Campagnolo DI, Foley FW, Sipski M. Sexual problems in persons with multiple sclerosis. MS Quarter Rep. 2005;24:5-10.

Orasanu B, Frasure H, Wyman A, Mahajan ST. Sexual dysfunction in patients with multiple sclerosis. Mult Scler Relat Disord. 2013;2(2):117-23.

Lew-Starowicz M, Gianotten WL. Sexual dysfunction in patients with multiple sclerosis. Handb Clin Neurol. 2015;130:357-70.

Kessler TM, Fowler CJ, Panicker JN. Sexual dysfunction in multiple sclerosis. Expert Rev Neurother. 2009;9(3):341-50.

Sanders AS, Foley FW, LaRocca NG, Zemon V. The multiple sclerosis intimacy and sexuality questionnaire-19 (MSISQ-19). Sexual Disabil 2000;18(1):3-26.

Katz A. Multiple sclerosis and sexuality. Am J Nurs. 2011;111(7):65-8.

Michael A, O'Keane V. Sexual dysfunction in depression. Hum Psychopharmacol Clin Exp. 2000;15(5):337-45.

Seidman SN, Roose SP. Sexual dysfunction and depression. Curr Psychiatr Rep. 2001;3(3):202-8.

Laurent SM, Simons AD. Sexual dysfunction in depression and anxiety: conceptualizing sexual dysfunction as part of an internalizing dimension. Clin Psychol Rev. 2009;29(7):573-85.

Zavoreo I, Gržinčić T, Preksavec M, Madžar T, Bašić Kes V. Sexual dysfunction and incidence of depression in multiple sclerosis patients. Acta Clinica Croatica. 2016;55(3):402-6.