Sexual dysfunction SD is a common reported problem in patients with multiple sclerosis MS. A total of MS women age: The most common SD-related complaint was orgasmic problem No significant relationship was found between primary SD and disease duration.
SD, a common multifactorial problem among MS women, can arise at any time during the disease and with any Sexual problems caused by ms of disability. However, we found relationships between SD and some of clinical variables and symptoms. Understanding these relationships would help us to develop practical approach and treatment for SD.
Multiple sclerosis MS is a chronic progressive neurological disease, which is most likely to develop in young adult; at the age that is an important time of life for sexual activity. Sexual dysfunction SD is a common reported problem among patients with MS. Unfortunately, it often remains under-diagnosis. It described SD as having three levels of responsible factors, in terms of primary, secondary, and
Sexual problems caused by ms. Symptoms of this dimension include decreased sexual desire, arousal and orgasmic problems, decreased vaginal lubrication and change in genital sensation.
Secondary SD occurs as a result of physical symptoms which indirectly impact on sexual activity. Some examples of these symptoms are fatigue, muscle weakness, spasticity, tremor, cognitive problems, bladder and bowel dysfunction, numbness or sensational change in non-genital areas, and incoordination.
Tertiary SD derived from psychological and social aspects of MS that affect sexual feeling negatively, such as negative self-image, lowered Sexual problems caused by ms, fear of being rejected, feeling of dependency, anger, and depression.
Sexual problems caused by ms is a multidimensional subject. There has been less attention paid to frequency and characteristics of sexual complaints among women with MS, in comparison with men. No relationship was
Sexual problems caused by ms between disease duration, secondary progressive MS, and bowel dysfunction. Because of a religious and male-dominant culture in some countries like Iran, women have difficulties expressing their Sexual problems caused by ms feelings and Sexual problems caused by ms experiences; consequently, female SD may not consider as an important issue.
According to important role of sexual function on quality of life, and developing new medical and psychological treatment for SD, early diagnosis in MS patient is necessary. Furthermore, understanding characteristics and contributing factors for
Sexual problems caused by ms lead to improve treatments and Sexual problems caused by ms. Previous studies investigated SD based on primary-secondary-tertiary model were limited and done with a small sample size.
The Sexual problems caused by ms of present study were to examine frequency, distribution and interrelation of Sexual problems caused by ms three SD Sexual problems caused by ms, and to determine whether Sexual problems caused by ms are relationships between various clinical and demographic variables and different levels of SD in women with MS. We conducted this cross-sectional study from August to March in the Ayatollah Kashani Hospital in Isfahan after Isfahan University of Medical Sciences Ethic committee institutionally approved our Sexual problems caused by ms. Women with an exacerbation during the last 6 months, postmenopauseal or sexually inactive women and women who had other concomitant or use medications like beta-blockers and anti-depressants could affect sexual activity were not included in the study.
We selected women non-randomly and consecutively according to inclusion and non-inclusion criteria. Written informed consent was obtained from each of them. We excluded four patients who did not complete the interview. Therefore, our final sample comprised women. The mean age of participants was The mean duration of disease was They had mean EDSS score of 2.
A female physician interviewed each woman with a structured demographic and clinical questionnaire about age, relationship status, child number, educational level and occupation, medical and sexual histories, such as quality of relationships, sexual function, and the
Sexual problems caused by ms of any physical symptom or psychological disorder. It is a valid, reliable self-reported questionnaire which contains 19 items. This questionnaire rates how various MS symptoms have impaired sexual activity, sexual satisfaction, and relationship intimacy of patient during the last 6 months.
From these 19 items, there are five items regarding primary, nine items for secondary, and five items for tertiary SD. Sexual problems caused by ms
Score 4 or 5 for each item is considered as SD. All women underwent a full neurological examination. Neurological impairment and disability were rated by Expanded Disability Status Score EDSS assessing pyramidal, cerebellar, sensory, bowel and bladder, visual and mental functions.
All data were recorded in the computer and were analyzed by SPSS version Pearson correlation was also used to Sexual problems caused by ms relationships between quantifiable variables. We divided women into two groups according to the presence of SD. Statistical analysis demonstrated that women with SD were significantly older To characterize three levels of influence, patients were reported particularly, presence of primary, secondary and tertiary SD by using MSISQ subscales.
One hundred and forty-two women A total of Table 1 shows the difference between women with and without primary SD in relation to clinical variables and some of physical symptoms. They reported primary SD with the same symptoms as women with higher level of disability.
Although decreased sensation of Sexual problems caused by ms 9. Unlike most of clinical variables, disease duration was not significantly different between women with Sexual problems caused by ms without primary SD. One hundred and two Common problems of this dimension in increasing order, included weakness and mobility difficulty Notable significant relations were
Sexual problems caused by ms between some symptoms of secondary SD and primary SD [ Table 1 ].
As you see a positive correlation was found between decreased genital area sensation, orgasmic Sexual problems caused by ms disorders, and urinary symptoms. MSISQ subscale item regarding memory and concentration was also more correlated with decreased libido and difficulty reaching orgasm. Secondary and tertiary SD was significantly more reported in women with any progressive form of disease.
We also performed correlation analysis between the MSISQ total and subscale scores and some clinical features [ Table ]. A significant correlation was found between secondary SD and both disease duration and courses. Our study was designed to investigate frequency and distribution of SD dimensions, and to identify contributory factors for SD in women with MS.
The high frequency of SD in present study appears that, SD is a common problem among female MS patients consistent
Sexual problems caused by ms the previous knowledge. Primary SD was reported as the most common SD dimension. It was consistent with a previously performed study by demirkiran et al.
Nevertheless, relatively high percentage of secondary and tertiary SD in present study emphasizes the multi-causal and multidimensional nature of SD in women as it was shown in previous studies.
According to the literature, the frequency of sexual problems is variable from study to study. Association between SD and degree of disability has been reported by some of the past studies. On the other hand, frequency of primary SD is notable in less disable women. These findings indicate that in spite of the strong relationship between SD and EDSS score, SD can present even without a severe physical or neurological impairment.
Significant correlations between secondary and tertiary SD and disease duration were shown in the present study. But such a relation was not observed between primary SD and disease duration. It Sexual problems caused by ms consistent with some previous reports.
Sexual problems caused by ms studies revealed that the frequency of SD and deterioration of sexual activity in patient with MS increase over time. Tzortzis et alevaluated primary SD in 63 newly Sexual problems caused by ms MS women with no major neurological impairment or risk factor. Primary SD was reported more frequently in MS patients in comparison with control group The relationship between tertiary SD and EDSS suggests that women with more severe disability experience significantly lower level of sexual confidence.
It is in concordance with the strong correlation between primary SD and some symptoms of secondary SD, such as fatigue, memory and concentration problems, urinary dysfunction, and celleberal complaints.
The strongest relationship was observed between fatigue and primary SD in women with MS. All these findings suggest fatigue as an important risk factor for SD in MS female patients.
Hence, any practical treatment for SD in women
Sexual problems caused by ms MS should contain strategies to manage fatigue. Depression, anxiety, and other psychosocial factors symptoms of tertiary SD found to be associated with sexuality among MS patients in most of the previous studies.
High percentage of MS women experience urinary symptoms. An association between sphincteric dysfunction and SD was documented in some studies. Such these selective relations between bladder dysfunction and symptoms of primary SD was reported previously. They suggested that the correlation is due to sharing the same autonomic segment.
They found that patients with progressive forms of MS had more primary SD symptoms. They suggested the presence of a relationship between SD and progressive nature of disease. However, secondary SD and tertiary SD are more common in women with progressive types of disease significantly. There were some limitations in our study. For better understanding the role of each Sexual problems caused by ms factor, which was investigated in current study, it would be better to evaluate them separately, neutralizing the confounding effects of other variables and risk factors.
Sexuality is a two-sided issue and MS also impacts upon other members of patient's family. The self-reported questionnaire applied in this study would help physicians to find targets for further investigations; and it would provide a convenient way for patients to talk about their sexual
Sexual problems caused by ms. Although using additional objective measures could increase the accuracy of our results. In conclusion, due to variable presentations and multifactorial nature of SD among women with MS, developing a symptomatic therapy for SD based on the symptoms and underlying causes could be more beneficial.
We also demonstrated relationships between SD and some aspects of disease. Hence, in order Sexual problems caused by ms provide an effective approach and management for SD all the mentioned symptoms and clinical variables should be kept in mind.
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