The most common problems experienced by men are difficulty or inability to get or hold an erection, decreased genital sensation, rapid ejaculation, and difficulty or inability to ejaculate. Difficulty acquiring or maintaining satisfactory erections seems to be the most common male complaint in MS, with frequencies ranging from 25 percent to 75 percent of those surveyed.
In some cases it may be hard to tell what is causing the erectile difficulties. Demyelination may directly affect erectile function. Medications may also be factors. Stress and anxiety produced by living with MS may contribute to or even be the primary cause of erectile dysfunction. Understanding the mechanics may help you and your partner.
In the presence of sexual stimulation, nerves in the spongy tissue of the penis release the chemical nitric oxide, stimulation the production of something called cyclic GMP which relaxes the smooth muscle in the penis, compressing the veins. When this happens, blood flows in but cannot get back out, and an erection occurs. Drugs used to increase GMP include sildenafil (Viagra®), vardenafil (Levitra®), and tadalafil (Cialis®) All three drugs work by allowing an erection to occur when a man is adequately stimulated; they do not produce an erection in the absence of stimulation.
Additional Options Available
The vacuum tube and band device can be an effective alternative to medications. It consists of a plastic tube with a pump and band for the base of the penis. The tube fits over the penis. The hand pump produces vacuum pressure, and the band constricts the veins. This makes the penis fill up with blood, producing an erection. The tube is then removed. Because of its effectiveness and availability, the vacuum tube and band are widely used by men with MS.
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