How Men and Women Experience MS Differently

Men and women experience multiple sclerosis in different ways. While MS is not a "female disease," more than three out of four people with MS are women. Not surprisingly, few studies have been published about the management of MS in men or the experiences of men with MS. Recently I attended an entire session at the 30th Annual Consortium of MS Centers Conference held at National Harbor, Maryland, June 1-4, 2016, dedicated to men and MS.

Men tend to have a more progressive onset of disease, more rapid accumulation of disability, and need help with mobility more quickly than women do. Men with MS typically have fewer relapses, but the relapses they do have are more likely to affect motor function and less likely to be sensory in nature. However, men and women tend to reach disability milestones at overall similar ages. How MS affects the brain differs in men versus women. For example, men experience a greater ratio of T2 Gd-enhancing lesions that evolve into T1 hypointense lesions (i.e., “black holes”).

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Men Experience MS Differently Than Women Do

Primary Sexual Dysfunction in WOMEN with MS

The most frequently described symptoms in women include decreased sexual desire, diminished orgasm, difficulties with vaginal lubrication, and fatigue that interferes with sexual activity. Decreased vaginal lubrication can be treated with water-soluble lubricants, and dysesthesias may be relieved with medication for nerve pain.

Decreased Vaginal Lubrication

Vaginal lubrication is controlled by multiple pathways in the brain and spinal cord, similar to the erectile response in men. Decreased vaginal lubrication can be addressed by using generous amounts of water-soluble lubricants, such as K-Y Jelly®, Replens®, or Astroglide®. It is not advisable to use petroleum based jellies (e.g., Vaseline®) for vaginal lubrication due to the greatly increased risk of bacterial infection.

Decreased Libido

Diminished libido is much more common in women with MS than men. To date, there are no published clinical trials of medications that restore libido in MS. Hormone replacement therapy has helped in some post-menopausal women without MS. Testosterone replacement in persons with abnormally low physiological levels has been tried in non-MS populations. However, there is research currently underway that is evaluating medicines that enhance sympathetic arousal, to see if this impacts libido in women with MS. Also, there is research evaluating clitoral vacuum devices and vibrators to see if blood flow, libido, and sensation are enhanced in women with MS.

Pelvic floor or Kegel exercises are sometimes prescribed to enhance female sexual responsiveness. However, in women with significantly reduced sensation, EMG biofeedback is required to help them identify and contract the appropriate pelvic floor muscles in the prescribed manner. The rationale for Kegel exercises is that sensation and contraction of the muscles around the vagina are important parts of the female sexual response.

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Sexual Dysfunction in Women Living with Multiple Sclerosis