Multiple Sclerosis and Erectile Dysfunction: Causes and Impact on Sexual Health

Living with multiple sclerosis (MS) brings many challenges, and one that often goes unspoken is erectile dysfunction (ED). For many men, this can affect confidence, intimacy, and overall sexual quality of life.

Multiple sclerosis causes erectile dysfunction by damaging nerves in the brain and spinal cord that control erections. This disrupts signals between the brain and penis, affecting blood flow and arousal. Fatigue, depression, and bladder problems from MS can further worsen sexual dysfunction.

Let’s explore what research says about the link between multiple sclerosis and erectile dysfunction, how it happens, and what can be done about it.

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Does MS Cause Erectile Dysfunction?

Yes, multiple sclerosis can cause erectile dysfunction, and it’s far more common than most people realize. Studies show that 50–90% of men with MS experience some form of sexual dysfunction, with ED being the most frequent. [1]

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A 2022 review reported that men with MS are about three times more likely to experience erectile problems compared with men without MS. [2]
Another study found that more than 70% of men with relapsing-remitting multiple sclerosis (which is the most common type of MS) experienced ED [3]

Despite this high rate, sexual issues are underreported, and many men never discuss them with their neurologist as they are often embarrassed or believe nothing can be done. But early diagnosis and open discussion can make a huge difference.

 Let’s understand how MS can cause sexual dysfunction, like ED, in men.

How Does MS Cause Erectile Dysfunction?

The connection between multiple sclerosis and erectile dysfunction is complicated and happens for several reasons:

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1. Neurological Damage

MS is a disease where the body’s immune system attacks the brain and nerves. This damages the protective layer (called myelin) around the nerves, creating scars or damaged spots (demyelinating lesions )that disturb the signals between the brain, spinal cord, and sexual organs, like the penis. [4] 

Studies show that damage to the spinal cord, especially in the lower part that controls feeling and erections, can disturb the signals needed for a normal sexual response. [5]

2. Autonomic Dysfunction

Autonomic dysfunction means the body’s automatic systems, like heart rate, blood pressure, or sexual response, don’t work properly. 

MS can affect the nerves that control automatic body functions (autonomic disturbances), such as blood flow and sexual response. [6] This disturbance can reduce blood flow to the penis, making it harder to get or keep an erection.

3. Psychological Effects

Psychological causes of ED, like stress and anxiety, arise due to the emotional impact of living with a chronic neurological condition. Side effects from medications (like selective serotonin reuptake inhibitors, tricyclic antidepressants, venlafaxine, or steroids) can also worsen sexual problems. [7]

4. Other Factors

MS can cause tiredness, bladder dysfunction, bowel issues, muscle stiffness, and thinking difficulties that lower sexual desire and energy. [8] Pain, shaking, and urinary issues can also make intimacy and confidence harder.

Symptoms of Erectile Dysfunction in Men with MS

Men with MS may notice a variety of changes related to sexual dysfunction, including:

• Difficulty achieving or maintaining an erection
• Reduced libido or sexual pleasure
• Altered genital sensation (numbness or tingling)
• Orgasmic dysfunction: delayed or absent orgasm
• Ejaculatory problems
• Reduced satisfaction or intimacy with a partner

When to See a Doctor

If you have multiple sclerosis and erectile dysfunction, it’s important not to ignore the issue.
See your doctor if:

• You notice ongoing erection problems lasting more than a few weeks
• Sexual issues affect your confidence or your relationship
• You experience bladder, bowel, or sensory changes during intimacy
• Your medications seem to worsen sexual dysfunction

A neurologist, urologist, or sexual-health specialist can perform a neurophysiological evaluation.

Doctors also use tools like the IIEF diagnostic tool to measure the severity of ED and track progress. Magnetic resonance imaging (MRI) helps visualize lesions in the brain and spinal cord.

Many men hesitate to bring up sexual issues, but open conversations with your doctor can make a big difference. We can tailor treatments that fit your MS symptoms and overall health.

How to Treat ED Caused by MS?

Managing multiple sclerosis and erectile dysfunction involves addressing physical, neurological, and emotional factors together.

1. ED Medications

• PDE-5 inhibitors like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are the first-line treatments. They improve blood flow to the penis.
• If these aren’t effective, alprostadil injections or suppositories may help.
• Always consult your doctor to check for contraindications with your current MS or bladder medications.

2. Assistive Devices

• Vacuum devices or penis pumps help draw blood into the penis using gentle suction, making it easier to get and keep an erection.
• For severe erectile problems, doctors may suggest nerve stimulators or a penile implant as long-term solutions.

3. Psychological Support

• Psychotherapy can help manage both ED and MS. It helps strengthen emotional health and improves confidence, making it easier to cope with the challenges of both conditions.
• Sex therapy techniques like sensate focusing exercises can reduce performance anxiety.
• Cognitive-behavioral therapy (CBT) helps manage depression and relationship stress.

Prevention & Long-Term Management

While ED can’t always be completely prevented, these steps can help maintain sexual health:

• Keep MS symptoms like fatigue, spasticity, and bladder symptoms under control with regular check-ups.
• Communicate openly with your partner about challenges and expectations.
• Address depression or anxiety early.
• Exercise regularly, maintain a balanced diet, avoid smoking and alcohol, and get adequate sleep.
• Seek medical advice to review medications that may worsen ED or before changing/stopping any MS medication.

Early detection and proactive management improve not just erections but overall sexual quality of life and emotional well-being.

Conclusion

Multiple sclerosis and erectile dysfunction are closely linked through nerve damage, symptom burden, and psychological stress, but the condition is highly treatable. Phosphodiesterase inhibitors, counseling, and lifestyle adjustments can restore function and intimacy for most men.

If you or your partner is experiencing sexual dysfunction due to MS, don’t stay silent. Talk to your doctor, explore safe treatments, and remember that healthy sexual relationships are still absolutely possible. With the right support, men with multiple sclerosis can continue to lead fulfilling, confident, and intimate lives.

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