http://informahealthcare.com/dre ISSN 0963-8288 print/ISSN 1464-5165 online Disabil Rehabil, 2014; 36(17): 1483 ! 2014 Informa UK Ltd. DOI: 10.3109/09638288.2013.867370
LETTER
Sexual dysfunction in multiple sclerosis: still a neglected problem? Rocco Salvatore Calabro` and Placido Bramanti IRCCS Centro Neurolesi ‘‘Bonino-Pulejo’’, Messina, Italy
We read with great interest the work by Vitkova et al. [1] dealing with the impact of bladder, bowel and sexual dysfunction (SD) on health-related quality of life (HrQoL) in individuals with multiple sclerosis (MS). Indeed, the authors in their valuable work showed that bladder and SD are associated with a poorer HrQoL, even when the patients have had MS for a relatively short time. Multiple sclerosis (MS) is a relatively frequent inflammatory autoimmune illness of the central nervous system affecting about 2.5 million people around the world, and represents the most common cause of neurological disability among young adults. Sexuality is an integrant and fundamental part of QoL, and patient affected by neurological disorders, including MS, should always be investigated and treated for sexual disorders. Over the past decade, the studies on the prevalence of sexual problems in MS showed that 40–80%of women and 50–90% of men have sexual complaints [2]. Although there has been increased research interest in determining the factors that contribute to HrQoL in MS patients in recent years, these studies have mainly focused on disability status, demographic characteristics, and non-sexual clinical symptoms. Indeed, sexual function in patients with MS is often disregarded by researcher and even by healthcare professionals, though it is a topic of great importance either to the patients or to their partners. Patients with MS may challenge the physical ability to communicate, embrace, stimulate, engage in intercourse, and maintain urinary and bowel continence during sexual activity [3]. Thus, since bladder and bowel disorders are common symptoms of MS, occurring at any time during the disease’s course, more attention should be paid to these problems to prevent the development of more severe dysfunction. In fact, patients with MS, especially if young, may actually regard their sexual loss to be the most devastating aspect of their disease. Sexual function relies on a complex network of central and peripheral central pathways, involving a multifaceted integration of numerous spinal and supraspinal sites, with the limbic system playing a central role. MS-related SD can be divided into: (i) primary, i.e. directly due to MS-related neurologic deficits
Address for correspondence: Rocco Salvatore Calabro`, IRCCS Centro Neurolesi ‘‘Bonino-Pulejo’’, S.S. 113, Contrada Casazza 98124 Messina, Italy. Tel: +39-090-60128954. Fax: +39-090-60128950. E-mail: [email protected]
affecting the sexual response, (ii) secondary, which is attributed to MS-related physical impairments and symptoms that affect indirectly the sexual response, including spasticity and contractures, fatigue, bladder dysfunction and cognitive symptoms; (iii) tertiary, SD that is caused by the psychological, social and cultural issues of having a chronic disabling disease that affects sexual functioning [2,4]. Thus, because of the multifactorial nature of sexual problems in individuals with MS, regular multidisciplinary evaluation including neurologist, urologist and psychologist is needed while managing these patients and their partners. To this end, proper questionnaire scores, such as the Multiple Sclerosis Intimacy and Sexuality Questionnaire [4], should be included as an additional outcome measure in evaluating MS patient disability. In conclusion, given that the number of people who live with MS is increasing, there is a need for a better management of MSrelated problems, with regard to SD, which is still too often considered an issue to ‘‘neglect’’.
Declaration of interest The authors report no declarations of interest.
References 1. Vitkova M, Rosenberger J, Krokavcova M, et al. Health-related quality of life in multiple sclerosis patients with bladder, bowel and sexual dysfunction. Disabil Rehabil 2013 Aug 20. [Epub ahead of print]. doi:10.3109/09638288.2013.825332. 2. Guo ZN, He SY, Zhang HL, et al. Multiple sclerosis and sexual dysfunction. Asian J Androl 2012;14:530–5. 3. Rees PM, Fowler CJ, Maas CP. Sexual function in men and women with neurological disorders. Lancet 2007;369:512–25. 4. Foley FW, Zemon V, Campagnolo D, et al. The Multiple Sclerosis Intimacy and Sexuality Questionnaire: re-validation and development of a 15-item version with a large US sample. Mult Scler 2013; 19:1197–203.
Copyright of Disability & Rehabilitation is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
LETTER
Sexual dysfunction in multiple sclerosis: still a neglected problem? Rocco Salvatore Calabro` and Placido Bramanti IRCCS Centro Neurolesi ‘‘Bonino-Pulejo’’, Messina, Italy
We read with great interest the work by Vitkova et al. [1] dealing with the impact of bladder, bowel and sexual dysfunction (SD) on health-related quality of life (HrQoL) in individuals with multiple sclerosis (MS). Indeed, the authors in their valuable work showed that bladder and SD are associated with a poorer HrQoL, even when the patients have had MS for a relatively short time. Multiple sclerosis (MS) is a relatively frequent inflammatory autoimmune illness of the central nervous system affecting about 2.5 million people around the world, and represents the most common cause of neurological disability among young adults. Sexuality is an integrant and fundamental part of QoL, and patient affected by neurological disorders, including MS, should always be investigated and treated for sexual disorders. Over the past decade, the studies on the prevalence of sexual problems in MS showed that 40–80%of women and 50–90% of men have sexual complaints [2]. Although there has been increased research interest in determining the factors that contribute to HrQoL in MS patients in recent years, these studies have mainly focused on disability status, demographic characteristics, and non-sexual clinical symptoms. Indeed, sexual function in patients with MS is often disregarded by researcher and even by healthcare professionals, though it is a topic of great importance either to the patients or to their partners. Patients with MS may challenge the physical ability to communicate, embrace, stimulate, engage in intercourse, and maintain urinary and bowel continence during sexual activity [3]. Thus, since bladder and bowel disorders are common symptoms of MS, occurring at any time during the disease’s course, more attention should be paid to these problems to prevent the development of more severe dysfunction. In fact, patients with MS, especially if young, may actually regard their sexual loss to be the most devastating aspect of their disease. Sexual function relies on a complex network of central and peripheral central pathways, involving a multifaceted integration of numerous spinal and supraspinal sites, with the limbic system playing a central role. MS-related SD can be divided into: (i) primary, i.e. directly due to MS-related neurologic deficits
Address for correspondence: Rocco Salvatore Calabro`, IRCCS Centro Neurolesi ‘‘Bonino-Pulejo’’, S.S. 113, Contrada Casazza 98124 Messina, Italy. Tel: +39-090-60128954. Fax: +39-090-60128950. E-mail: [email protected]
affecting the sexual response, (ii) secondary, which is attributed to MS-related physical impairments and symptoms that affect indirectly the sexual response, including spasticity and contractures, fatigue, bladder dysfunction and cognitive symptoms; (iii) tertiary, SD that is caused by the psychological, social and cultural issues of having a chronic disabling disease that affects sexual functioning [2,4]. Thus, because of the multifactorial nature of sexual problems in individuals with MS, regular multidisciplinary evaluation including neurologist, urologist and psychologist is needed while managing these patients and their partners. To this end, proper questionnaire scores, such as the Multiple Sclerosis Intimacy and Sexuality Questionnaire [4], should be included as an additional outcome measure in evaluating MS patient disability. In conclusion, given that the number of people who live with MS is increasing, there is a need for a better management of MSrelated problems, with regard to SD, which is still too often considered an issue to ‘‘neglect’’.
Declaration of interest The authors report no declarations of interest.
References 1. Vitkova M, Rosenberger J, Krokavcova M, et al. Health-related quality of life in multiple sclerosis patients with bladder, bowel and sexual dysfunction. Disabil Rehabil 2013 Aug 20. [Epub ahead of print]. doi:10.3109/09638288.2013.825332. 2. Guo ZN, He SY, Zhang HL, et al. Multiple sclerosis and sexual dysfunction. Asian J Androl 2012;14:530–5. 3. Rees PM, Fowler CJ, Maas CP. Sexual function in men and women with neurological disorders. Lancet 2007;369:512–25. 4. Foley FW, Zemon V, Campagnolo D, et al. The Multiple Sclerosis Intimacy and Sexuality Questionnaire: re-validation and development of a 15-item version with a large US sample. Mult Scler 2013; 19:1197–203.
Copyright of Disability & Rehabilitation is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
