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Cameron MH, Bethoux F, Field-Fote E, Lenderking WR, Zaiser E, Cutts KN, Wagner JM, Berwaerts J, Steinerman JR. Development of an integrated conceptual model of multiple sclerosis spasticity. Disabil Rehabil 2024; 46:2955-2965. [PMID: 37480330 DOI: 10.1080/09638288.2023.2237403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/13/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Spasticity is common in multiple sclerosis (MS), often leading to functional limitations and disability. We developed a conceptual model of spasticity in MS integrating expert opinion, recent literature, and experiences of clinicians and people with MS spasticity. METHODS A conceptual model was developed based on a targeted literature review of articles published between 2014 and 2019, followed by input from clinicians, then input from participants with MS spasticity. Multidisciplinary experts on spasticity provided guidance at each step. RESULTS Key concepts of the integrated spasticity conceptual model included: moderators; triggers; modifiers; treatment; objective manifestations; subjective experience; physical, functional, social, and emotional/psychological impacts; and long-term consequences. Participants with MS spasticity most frequently endorsed spasms, tightness, and pain as descriptors of spasticity. Some participants with MS spasticity had difficulty distinguishing spasticity from other MS symptoms (e.g. muscle weakness). Some triggers, emotional/psychological impacts, and long-term consequences of spasticity reported by participants with MS spasticity were not previously identified in the published literature. CONCLUSIONS This conceptual model of spasticity, integrating published literature with the experience of clinicians, people with MS spasticity, and experts, demonstrates the complex, multidimensional nature of MS spasticity. This model may be used to improve clinician-patient dialogue, research, and patient care.
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Affiliation(s)
- Michelle H Cameron
- Department of Neurology, OR Health & Science University, Portland, OR, USA
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
| | - Edelle Field-Fote
- Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Joanne M Wagner
- Former employee of Greenwich Biosciences, Inc., now part of Jazz Pharmaceuticals, Carlsbad, CA, USA
| | - Joris Berwaerts
- Former employee of Greenwich Biosciences, Inc., now part of Jazz Pharmaceuticals, Carlsbad, CA, USA
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Nikolaidis I, Karakasi MV, Artemiadis A, Nteli E, Bakirtzis C, Boziki MK, Foley FW, Grigoriadis N. Translation, cross-cultural adaptation, and validation of the Greek version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19. Somatosens Mot Res 2024; 41:1-10. [PMID: 36538411 DOI: 10.1080/08990220.2022.2158801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) explores optimally impact of MS on sexual activity/satisfaction/intimacy. AIM The present study aims to provide the only validation of the Greek Version of MSISQ-19, and compare results to validation studies in other languages. METHODS The original/English version of the MSISQ-19 was translated into Greek according to standardized guidelines, while validity/reliability, correlations with other scales and sexual dysfunction prevalence were tested. Subjects were requested to complete all questionnaires and MSISQ-19, being re-tested three weeks later. Construct-validity of the Greek version of the MSISQ-19 was confirmed with principal-component-analysis. Bartlett's test assessed correlation-adequacy between items. Pearson's correlation explored internal-construct-validity between subscales and overall score, and external-construct-validity with disease-status variables, cognitive testing and patient-reported outcomes regarding fatigue, depression/anxiety, MS impact, and quality of life. RESULTS 201 PwMS (130 female). Mean age was 39.3 ± 11.8 years with median disease-duration 11.7 ± 7.9 years. 79.1% RRMS, PPMS (10.4%) and SPMS (10.4%). Cronbach's alpha coefficient was 0.949. MSISQ-19 correlations between items were large. Significant associations of sexual dysfunction were identified with age (rho = 0.392, p < 0.01), years of education (rho=-0.199, p = 0.006), the Expanded Disability Status Scale (rho = 0.518, p < 0.01) and MS duration (rho = 0.354, p < 0.01). Correlations were disclosed with the Brief International Cognitive Assessment for MS (rho=-0.247, p < 0.05), Modified Fatigue Impact Scale (rho = 0.374, p < 0.05), Depression Anxiety Stress Scale (rho = 0.375, p < 0.05), Multiple Sclerosis Impact Scale (rho = 0.442, p < 0.05), and EuroQoL-five-dimensional instrument (rho = 0.375, p < 0.05). Internal consistency of the Greek version of the MSISQ-19 was confirmed with Cronbach's alpha. Test-retest reliability (31 PwMS) was excellent with intraclass-correlation-coefficients > 0.90. CONCLUSION Besides Greek MSISQ-19 satisfactory validity/reliability/reproducibility and being first to include cognitive-testing, authors estimated sexual-dysfunction prevalence affecting half PwMS.HIGHLIGHTSThis study provides the only validation of the Greek Version of the MSISQ-19.The latter was found with satisfactory validity, reliability and reproducibility.50% of the Greek PwMS sample was found to be afflicted with sexual dysfunction.This is also the first validation study to examine associations with cognitive testing.Sexual function is still an underestimated functionality parameter upon examination.
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Affiliation(s)
- Ioannis Nikolaidis
- 2nd Department of Neurology, Multiple Sclerosis Center, Aristotle University of Thessaloniki - School of Medicine, Thessaloniki, GR, Greece
| | - Maria-Valeria Karakasi
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki - School of Medicine, Thessaloniki, GR, Greece
| | - Artemios Artemiadis
- Department of Neurology, University of Cyprus - Medical School, Nicosia, CY, Cyprus
| | - Elli Nteli
- 2nd Department of Neurology, Multiple Sclerosis Center, Aristotle University of Thessaloniki - School of Medicine, Thessaloniki, GR, Greece
| | - Christos Bakirtzis
- 2nd Department of Neurology, Multiple Sclerosis Center, Aristotle University of Thessaloniki - School of Medicine, Thessaloniki, GR, Greece
| | - Marina-Kleopatra Boziki
- 2nd Department of Neurology, Multiple Sclerosis Center, Aristotle University of Thessaloniki - School of Medicine, Thessaloniki, GR, Greece
| | - Frederick W Foley
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Multiple Sclerosis Center, Holy Name Medical Center, Teaneck, NJ, USA
| | - Nikolaos Grigoriadis
- 2nd Department of Neurology, Multiple Sclerosis Center, Aristotle University of Thessaloniki - School of Medicine, Thessaloniki, GR, Greece
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Brouchet M, Teng M, Chesnel C, Lagnau P, Amarenco G, Hentzen C. Expectations about the management of sexual dysfunction in women with multiple sclerosis and association with clinical characteristics. Mult Scler Relat Disord 2023; 79:104950. [PMID: 37657309 DOI: 10.1016/j.msard.2023.104950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/10/2023] [Accepted: 08/20/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Sexual dysfunction (SD) is common in women with multiple sclerosis (MS) and affects their quality of life. OBJECTIVES The primary aim is to assess their expectations concerning SD management. The secondary aim is to identify if expectations were associated with specific patient's characteristics. METHODS All women with MS who underwent a urodynamic assessment in a neuro-urology clinic and had a standardized assessment of SD expectations between June 2020 and November 2022 were retrospectively screened. Demographic data and assessment of bladder, bowel, and sexual dysfunctions with validated questionnaires were collected. RESULTS One hundred and sixty-seven patients were included in the study (mean age 47.9 ± 12.5 years). Expectations on SD information or management were reported by 112 (67.1%) patients. Interest in SD information and management was less frequent after menopause (56% vs 80%, p = 0.004), and in those with EDSS>6 (49% vs 74%, p = 0.03) and progressive type of MS (54% vs 71% p = 0.003). In multivariate analysis, the progressive type of MS was the only criterion related to a lack of interest (OR=2.9 IC95% [1.09; 7.72]). CONCLUSIONS Women with MS have high expectations on treatment and information about SD. A systematic screening of SD expectations should be encouraged.
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Affiliation(s)
- Maximilien Brouchet
- GRC 01, Service de Neuro-Urologie, Green Group of Clinical Research in Neuro-Urology AP-HP, Sorbonne Université, AP-HP, Hôpital Tenon, 4, rue de la Chine, Paris F-75020, France.
| | - Maëlys Teng
- GRC 01, Service de Neuro-Urologie, Green Group of Clinical Research in Neuro-Urology AP-HP, Sorbonne Université, AP-HP, Hôpital Tenon, 4, rue de la Chine, Paris F-75020, France
| | - Camille Chesnel
- GRC 01, Service de Neuro-Urologie, Green Group of Clinical Research in Neuro-Urology AP-HP, Sorbonne Université, AP-HP, Hôpital Tenon, 4, rue de la Chine, Paris F-75020, France
| | - Philippe Lagnau
- GRC 01, Service de Neuro-Urologie, Green Group of Clinical Research in Neuro-Urology AP-HP, Sorbonne Université, AP-HP, Hôpital Tenon, 4, rue de la Chine, Paris F-75020, France
| | - Gérard Amarenco
- GRC 01, Service de Neuro-Urologie, Green Group of Clinical Research in Neuro-Urology AP-HP, Sorbonne Université, AP-HP, Hôpital Tenon, 4, rue de la Chine, Paris F-75020, France
| | - Claire Hentzen
- GRC 01, Service de Neuro-Urologie, Green Group of Clinical Research in Neuro-Urology AP-HP, Sorbonne Université, AP-HP, Hôpital Tenon, 4, rue de la Chine, Paris F-75020, France
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Di Pauli F, Zinganell A, Böttcher B, Walde J, Auer M, Barket R, Berek K, Egger A, Griesmacher A, Sukalo N, Deisenhammer F, Hegen H. Sexual dysfunction in female and male people with multiple sclerosis: disability, depression and hormonal status matter. Eur J Neurol 2023; 30:991-1000. [PMID: 36694294 DOI: 10.1111/ene.15696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/30/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Sexual dysfunction (SD) in people with multiple sclerosis (pwMS) is common and an often underestimated issue in the care of pwMS. The objective of the study was to evaluate risk factors for SD in pwMS, correlate its prevalence with patient-reported measures (quality of life and physical activity) and analyse its association with hormonal status. METHODS Sexual dysfunction was determined in 152 pwMS using the Multiple Sclerosis Intimacy and Sexuality Questionnaire 19. A logistical regression model was used to identify independent risk factors for SD. RESULTS The prevalence of SD in pwMS was 47%. Independent risk factors for the development of SD were ever-smoking (odds ratio [OR] 3.4, p = 0.023), disability as measured by the Expanded Disability Status Scale (OR 2.0, p < 0.001), depression (OR 4.3, p = 0.047) and bladder and bowel dysfunction (OR 8.8, p < 0.001); the use of disease-modifying treatment was associated with a lower risk for SD (OR 0.32, p = 0.043). SD was associated with worse quality of life (Multiple Sclerosis Impact Scale 29: physical score 6.3 vs. 40.0; psychological score 8.3 vs. 33.3; both p < 0.001) and lower physical activity (Baecke questionnaire, p < 0.001). Laboratory analysis revealed significantly higher luteinizing hormone and follicle-stimulating hormone levels and lower 17-beta oestradiol, androstenedione, dehydroepiandrosterone sulfate, oestrone and anti-Mullerian hormone levels in female pwMS with SD. In male pwMS and SD, there was a significant decrease in inhibin B levels. CONCLUSIONS Our findings highlight the requirement of a holistic approach to SD in MS including physical, neurourological and psychosocial factors. Active screening for SD, especially in patients with disability, depression or bladder and bowel dysfunction, is recommended.
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Affiliation(s)
- Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anne Zinganell
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Böttcher
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Janette Walde
- Department of Statistics, Faculty of Economics and Statistics, University of Innsbruck, Innsbruck, Austria
| | - Michael Auer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Robert Barket
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Berek
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander Egger
- Central Institute of Medical and Chemical Laboratory Diagnostics (ZIMCL), University Hospital of Innsbruck, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute of Medical and Chemical Laboratory Diagnostics (ZIMCL), University Hospital of Innsbruck, Innsbruck, Austria
| | - Natasa Sukalo
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Al-Khawajah MM, Al-Barakati RG, Al-Jedai AH, Al-Malik YM, Al-Mudaiheem HY, Al-Omari BA, Al-Thubaiti IA, Al-Yafeai RH, Bunyan RF, Cupler EJ, Hakami M, Kedah HM, Makkawi S, Saeed LH, Saeedi JA, Shosha E, Al-Jumah MA. Saudi Consensus Recommendations on the Management of Multiple Sclerosis: Family Planning within the Management of MS. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2023. [DOI: 10.3390/ctn7020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
This review article addresses the complex issues faced by individuals with Multiple Sclerosis (MS) who are planning a family, becoming pregnant, or wishing to breastfeed their baby. Recommendations and guidelines were discussed and agreed upon by neurologists, neuroradiologists, nurses, and pharmacists involved in the management of MS in the Kingdom of Saudi Arabia (KSA). MS itself does not harm a pregnancy, and people with MS of childbearing age can be encouraged to enjoy family life. Family planning should be a part of the initial conversation with a newly diagnosed patient of childbearing age. Interferons and glatiramer acetate can be continued throughout pregnancy and can be administered during breastfeeding if the benefits outweigh the risks. These DMTs may be considered for a woman with well-controlled MS who is planning a pregnancy or otherwise not using contraception, according to an individualized risk-benefit analysis. The use of contraception should be maintained during the administration of other disease-modifying therapies (DMTs). Natalizumab can be administered at a reduced administration frequency to women with high MS disease activity up to 30 weeks gestation (this agent may induce hematological abnormalities in the fetus). Other DMTs should be withdrawn for variable periods before contraception is stopped and immediately after the discovery of a pregnancy (beware of rebound disease activity after withdrawing natalizumab or fingolimod). Resumption of treatment should not be delayed in women at risk of relapse during the postpartum period and especially in those who do not wish to breastfeed.
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Baghbanian SM, Khalili B, Bakhshi A, Azizi H, Ghazaeian M. The effects of bupropion on sexual dysfunction in female patients with multiple sclerosis: A double-blind randomized clinical trial. Mult Scler Relat Disord 2023; 69:104399. [PMID: 36410223 DOI: 10.1016/j.msard.2022.104399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/08/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sexual dysfunction (SD) is one of the most common complications of multiple sclerosis (MS). The aim of this study was to evaluate the effects of bupropion on SD among female patients with MS. METHODS This double-blind placebo-control randomized clinical trial was conducted on MS patients with SD complaint. Diagnosis was based on the secondary SD subscale scores of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19). Accordingly, individuals scoring above 27 based on this scale were diagnosed with SD. The subjects were randomly assigned to the bupropion and placebo groups. Bupropion was administered 75 mg twice daily for twelve weeks. As for the study outcomes, besides MSISQ-19, quality of life (Multiple Sclerosis Quality Of Life-54 (MSQOL-54)), fatigue (Multidimensional Fatigue Inventory (MFI)), depression and anxiety (Hospital Anxiety and Depression Scale), and bupropion tolerability were assessed at baseline as well as at weeks 6 and 12. RESULTS From 84 patients who met the inclusion criteria, 64 patients completed the trial and were analyzed. Demographics and baseline clinical characteristics were not significantly differed between the two groups. The results showed the mean score of MSISQ-19 from baseline to the end of the study period significantly improved in the bupropion group compared with the placebo (week 6: P: 0.03; week 12: P: 0.03). Similarly, MFI scores showed significant improvement in the bupropion group compared with the placebo group (P: 0.001). Both anxiety and depression scores showed significant alterations at study interval between the two groups (Anxiety: weeks 6 and 12: P:0.04; depression: week 6: 0.01, week 12: 0.02). However, there was no significant change in the MSQOL-54 score between the two groups. CONCLUSION The results of the study substantiated that bupropion can be an effective agent for SD improvement in female patients with MS. Further clinical trials with larger sample sizes can more accurately evaluate the observed findings.
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Affiliation(s)
| | - Behnam Khalili
- Department of Neurology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Atieh Bakhshi
- Department of Neurology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hanieh Azizi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Monireh Ghazaeian
- Pharmaceutical Sciences Research Center, Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
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Peres DS, Rodrigues P, Viero FT, Frare JM, Kudsi SQ, Meira GM, Trevisan G. Prevalence of depression and anxiety in the different clinical forms of multiple sclerosis and associations with disability: A systematic review and meta-analysis. Brain Behav Immun Health 2022; 24:100484. [PMID: 35856061 PMCID: PMC9287158 DOI: 10.1016/j.bbih.2022.100484] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/26/2022] [Accepted: 06/28/2022] [Indexed: 10/31/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic neurodegenerative and autoimmune disease. Motor, sensory and cognitive deficits in MS are commonly accompanied by psychiatric disorders. Depression and anxiety affect the quality of life of MS patients, and the treatment is still not well-established. Prevalence rates in MS patients for depression and anxiety vary widely between studies. However, the prevalence of these psychiatric disorders in the subgroups of MS patients and their association with a disability has not been studied yet. Therefore, this systematic review and meta-analysis proposes to estimate the prevalence of depression and anxiety in MS and to perform subgroup analyses (study type, Extended Disability Status Scale/EDSS, duration of MS, region, type of MS) on observational studies. The protocol was registered in PROSPERO (4202125033). A computerized search on PubMed, EMBASE and Scopus for studies on depression and anxiety in MS was performed from 2015 to 2021, and 12 articles were included. Most of the studies in the meta-analysis had a low risk of bias. The prevalence of depression was 27.01% (MS), 15.78% (relapsing-remitting multiple sclerosis/RRMS), and 19.13% (progressive multiple sclerosis/PMS). For anxiety the prevalence was 35.19% (MS), 21.40% (RRMS), and 24.07% (PMS). The prevalence of depression/anxiety for patients with EDSS <3 was 26.69/45.56% and for EDSS >3 was 22.96/26.70%. Using HADS-A (8) the prevalence was 38.5% and for depression was 22.4%. Then, our study brought together current data regarding psychiatric disorders in MS patients, which are comorbidities that affect the quality of life of these patients. Prevalence of depression/anxiety for the MS patients was 27.01%/35.19%. Prevalence of depression was 15.78% (RRMS) and 19.13% (PMS). Prevalence of anxiety was 21.40% (RRMS) and 24.07% (PMS). Prevalence of depression/anxiety for the patients with EDSS <3 was 26.69/45.56% and for EDSS >3 was 22.96/26.70%. Prevalence of anxiety using HADS-A (8) was 38.5% and for depression was 22.4%.
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Devis M, Stoquart G, Géonet M, London F, van Pesch V. Validation of the French version of the Multiple Sclerosis Intimacy And Sexuality Questionnaire-19: A preliminary study. Mult Scler Relat Disord 2022; 65:103986. [DOI: 10.1016/j.msard.2022.103986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/30/2022] [Accepted: 06/17/2022] [Indexed: 10/18/2022]
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Sabanagic-Hajric S, Memic-Serdarevic A, Sulejmanpasic G, Mehmedika-Suljic E. Influence of Sociodemographic and Clinical Characteristics on Sexual Function Domains of Health Related Quality of Life in Multiple Sclerosis Patients. Mater Sociomed 2022; 34:188-192. [PMID: 36310754 PMCID: PMC9559658 DOI: 10.5455/msm.2022.34.188-192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/14/2022] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Multiple sclerosis is a progressive inflammatory disease of the the central nervous system. Problems with sexual functions are the common features of multiple sclerosis and important factor that contribute to the quality of life among affected persons. OBJECTIVE The aim of the study was to evaluate the influence of sociodemographic and clinical characteristics on sexual functions domains of health related quality of life (HRQOL) in multiple sclerosis patients. METHODS This study included 100 MS patients treated at the Department of Neurology, Clinical Center University of Sarajevo. Inclusion criteria were an Expanded Disability Status Scale score between 1.0 and 6.5, age between 18 and 65 years, stable disease on enrollment. HRQOL was evaluated by the Multiple Sclerosis Quality of Life-54 questionnaire. Mann-Whitney and Kruskal-Wallis test were used for comparisons between sociodemographic and clinical characteristics and HRQOL scores. RESULTS Out of 60% of patients reported to have sexual dysfunction, and 55 % were female patients. Younger patients had statistical significant higher median value of sexual function score (91.68 vs. 58,28, p=0.001) and satisfaction with sexual life scores (62.5 vs 37.5 , p =0.019) comparing to older patients. Employed patients also showed statistical significant higher median value of sexual function score (82 vs. 66.7, p=0.003) comparing to unemployed patients and also statisticaly significant higher median scores considering satisfaction with sexual life among employed patients (p=0,001). There were no differences in sexual functions scores considering gender, marital status and education. Patients with higher level of disabilty, progressive type of disease, more relapses and longer diseas duration had statistical significant lower median value of sexual function score and also satifaction with sexual life scores, except for disease duration. CONCLUSION Aging, dysability and progression are major factors that contribute to lower sexual function scores and satisfaction with sexual life among multiple sclerosis patients. Althoug women reported sexual problems more often then men, impact of these problems on quality of life are similar in men and women with MS.
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Affiliation(s)
- Selma Sabanagic-Hajric
- Department of Neurology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amra Memic-Serdarevic
- Department of Psychiatry, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Gorana Sulejmanpasic
- Department of Psychiatry, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Enra Mehmedika-Suljic
- Department of Neurology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Audrey SB, Marion R, Béatrice M, Stéphane V, Katelyne H. Sexual Dysfunction in Women With Multiple Sclerosis: Expectations Regarding Treatment and Information, and Utility of the SEA-MS-F Questionnaire. Sex Med 2022; 10:100502. [PMID: 35378440 PMCID: PMC9177879 DOI: 10.1016/j.esxm.2022.100502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 01/17/2023] Open
Abstract
Introduction Sexual dysfunction is a common complaint in female with multiple sclerosis (MS), however this problem is not often considered in the medical and psychological care. Aim To evaluate expectations regarding treatment and information for sexual dysfunction in women with multiple sclerosis using the SEA-MS-F (Sexual Dysfunction Management and Expectations Assessment in Multiple sclerosis - Female) questionnaire, and to gain an understanding of the relationship between their expectations, demographic factors and medical factors known to promote sexual dysfunction. Methods A prospective epidemiological, descriptive, analytical, multicentre study was carried out over 15 months on adult women suffering from MS. The SEA-MS-F was used to evaluate expectations regarding their sexuality and sexual activity. Main Outcome Measure 87 women were included. Mean age was 47 years and the mean time since MS diagnosis was 14 years. Results 59.8% reported sexual dysfunction, but only 22.4% of the participants had raised the subject with a professional. With regards to expectations, 68% of the women wanted information about sexual dysfunction and 80% of women with sexual difficulties wanted treatment. High expectations correlated with the presence of sexual dysfunction, a regular sexual partner and with milder ambulatory handicap. There were no correlations between expectations and age, time since MS diagnosis, fatigue or being postmenopausal. The SEA-MS-F questionnaire was perceived as useful by 63.4% of the women and 90% felt that it could help doctors to treat sexual dysfunction. Conclusion To date, the SEA-MS-F is the only questionnaire validated in women with MS for the evaluation of sexual expectations and in the present study the women felt strongly that it represented a useful way for them to introduce and then discuss the subject of their sexual dysfunction with their doctor. Audrey S-B, Marion R, Béatrice M, et al. Sexual Dysfunction in Women With Multiple Sclerosis: Expectations Regarding Treatment and Information, and Utility of the SEA-MS-F Questionnaire. Sex Med 2022;10:100502.
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Affiliation(s)
- Schreiber-Bontemps Audrey
- Services de Médecine Physique et de Réadaptation et Explorations fonctionnelles, CHRU de Brest, Brest, France.
| | - Roquet Marion
- Services de Médecine Physique et de Réadaptation et Explorations fonctionnelles, Centre de Perharidy, Fondation Ildys Roscoff, Roscoff, France
| | - Médée Béatrice
- Services de Médecine Physique et de Réadaptation et Explorations fonctionnelles, CHRU de Brest, Brest, France
| | - Verdun Stéphane
- Biostatisticien, équipe de Délégation à la Recherche Clinique et à l'Innovation, Groupement des Hôpitaux de l'Institut Catholique de Lille & réseau coopératif de recherche en SSR FEHAP, Lille, France
| | - Hubeaux Katelyne
- Services de Médecine Physique et de Réadaptation et Explorations fonctionnelles, Centre de Perharidy, Fondation Ildys Roscoff, Roscoff, France
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Tools for comprehensive evaluation of sexual function in patients with multiple sclerosis. NEUROLOGÍA (ENGLISH EDITION) 2022; 38:197-205. [PMID: 35260364 DOI: 10.1016/j.nrleng.2020.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/15/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) that affects young adults, causing a variety of symptoms (motor alterations, visual alterations, loss of sphincter control, gait alterations) that impair the patient's functional status. However, other symptoms, such as sexual dysfunction, can also have an effect on quality of life. DEVELOPMENT Sexual dysfunction can occur at any time during the course of the disease; its prevalence varies between 50% and 90%, and it can be secondary to demyelinating lesions in the spinal cord and/or brain or caused by symptoms that do not directly involve the nervous system (fatigue; psychological, social, and cultural factors; etc.). Although its prevalence and impact on quality of life are well known, sexual dysfunction is still frequently underestimated. Therefore, in this article we review the different scales for assessing presence or severity of sexual dysfunction, in order to offer early multidisciplinary management. CONCLUSION We evaluated 5 questionnaires that could identify the presence of sexual dysfunction in patients with MS and determine its aetiology, assisting in treatment decision making. MS must be understood as a complex disease that encompasses and compromises different aspects of patients' health, and goes beyond simply measuring disability.
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Stamoula E, Siafis S, Dardalas I, Ainatzoglou A, Matsas A, Athanasiadis T, Sardeli C, Stamoulas K, Papazisis G. Antidepressants on Multiple Sclerosis: A Review of In Vitro and In Vivo Models. Front Immunol 2021; 12:677879. [PMID: 34093579 PMCID: PMC8173210 DOI: 10.3389/fimmu.2021.677879] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/06/2021] [Indexed: 01/03/2023] Open
Abstract
Background Increased prevalence of depression has been observed among patients with multiple sclerosis (MS) and correlated with the elevated levels of proinflammatory cytokines and the overall deregulation of monoaminergic neurotransmitters that these patients exhibit. Antidepressants have proved effective not only in treating depression comorbid to MS, but also in alleviating numerous MS symptoms and even minimizing stress-related relapses. Therefore, these agents could prospectively prove beneficial as a complementary MS therapy. Objective This review aims at illustrating the underlying mechanisms involved in the beneficial clinical effects of antidepressants observed in MS patients. Methods Through a literature search we screened and comparatively assessed papers on the effects of antidepressant use both in vitro and in vivo MS models, taking into account a number of inclusion and exclusion criteria. Results In vitro studies indicated that antidepressants promote neural and glial cell viability and differentiation, reduce proinflammatory cytokines and exert neuroprotective activity by eliminating axonal loss. In vivo studies confirmed that antidepressants delayed disease onset and alleviated symptoms in Experimental Autoimmune Encephalomyelitis (EAE), the most prevalent animal model of MS. Further, antidepressant agents suppressed inflammation and restrained demyelination by decreasing immune cell infiltration of the CNS. Conclusion Antidepressants were efficient in tackling numerous aspects of disease pathophysiology both in vitro and in vivo models. Given that several antidepressants have already proved effective in clinical trials on MS patients, the inclusion of such agents in the therapeutic arsenal of MS should be seriously considered, following an individualized approach to minimize the adverse events of antidepressants in MS patients.
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Affiliation(s)
- Eleni Stamoula
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyridon Siafis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Dardalas
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra Ainatzoglou
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alkis Matsas
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Chrysanthi Sardeli
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Jamalianfar F, Riazi H, Firoozi A, Nasiri M, Montazeri A. The Effectiveness of ‘Good-Enough Sex Model’ on Sexual Satisfaction and Sexual Intimacy in Women with Multiple Sclerosis: A Randomized Trail. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09691-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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The Impact of Epigallocatechin Gallate and Coconut Oil Treatment on Cortisol Activity and Depression in Multiple Sclerosis Patients. Life (Basel) 2021; 11:life11040353. [PMID: 33920655 PMCID: PMC8073508 DOI: 10.3390/life11040353] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 12/21/2022] Open
Abstract
(1) Background: Multiple sclerosis (MS) is pathogenically characterized by high oxidative stress and symptomatically by progressive muscle loss and increased body fat associated with the presence of depression. Epigallocatechin gallate (EGCG) (particularly present in green tea) and ketone bodies (in particular beta-hydroxybutyrate (BHB)), whose main source is coconut oil, have shown emotional benefits and body fat loss. The aim of this study was to assess the impact of EGCG and coconut oil on cortisol activity related to fat loss and depression in MS patients. (2) Methods: The study involved 51 MS patients who were randomly divided into an intervention group or a control group. The intervention group received 800 mg of EGCG and 60 mL of coconut oil, which were included in their daily diet for four months. The control group received placebo and all patients followed an isocaloric diet. A blood sample was collected before and after the four-month period, and levels of cortisol, albumin and BHB were measured in serum. In addition, immediately before and after the intervention, anthropometric variables were measured: waist-to-hip ratio (WHR), body fat mass percentage, fat weight, total weight, and muscle mass percentage. Depression was assessed with the Beck Depression Inventory II (BDI-II). (3) Results: No significant changes were obtained in cortisol levels in any of the groups, and there was a significant increase in albumin in the blood of the intervention group only that could lead to a decrease in serum free cortisol. In addition, it was observed a significant decrease in levels of depression and abdominal fat. (4) Conclusions: EGCG combined with coconut oil increase the concentration of albumin in blood and produce less depression in MS patients.
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Altmann P, Leithner K, Leutmezer F, Monschein T, Ponleitner M, Stattmann M, Rommer PS, Zrzavy T, Zulehner G, Berek K, Berger T, Bsteh G. Sexuality and Multiple Sclerosis: Patient and Doctor Perspectives. J Sex Med 2021; 18:743-749. [PMID: 33744180 DOI: 10.1016/j.jsxm.2021.01.178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/11/2020] [Accepted: 01/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Little is known on how to address sexuality in clinical care for patients with multiple sclerosis (pwMS). AIM To describe and contrast the perception of sexuality and associated aspects of communication in pwMS and their treating neurologists ("MSologists") and provide a standard of care. METHODS Patients were surveyed using a 13-item questionnaire investigating perception on their own sexuality and opinions on communication about sexuality in context with MS. Certified MSologists in Austria received an 18-item survey regarding their approach to taking a sexual history of their patients. OUTCOMES We report the frequency of answers given in this survey and propose a possible standard of care how sexuality could be addressed in clinical routine. RESULTS Ninety-three pwMS (mean age 39 ± 11 years, 57% female) and 75 MSologists (mean age 43 ± 9 years, 63% male) completed this survey. Seventy-six percent of patients report their own sexuality as being (very) important to them and 95% think that sexual dysfunction would influence their quality of life. 84% would like to be asked about their sexuality by their MSologist. In contrast, only 15% of MSologists reported discussing sexuality with every patient. The most common reason for not doing so was a fear of crossing personal borders (34%). There is a strong desire for further medical education on this subject (76%). CLINICAL IMPLICATIONS Discussing sexuality is important to pwMS and MSologists should consider their patients' wishes and needs to talk about it. STRENGTHS & LIMITATIONS This is the largest survey contrasting the views of patients and their treating physicians on the topic of communication about sexuality. The use of an empirical unvalidated questionnaire may have introduced bias. Moreover, patients that are open to talk about their sexuality may be potentially overrepresented in this study. CONCLUSION MSologists should offer their patients an open opportunity and appropriate framework to discuss their sexuality during a consultation. Altmann P, Leithner K, Leutmezer F, et al. Sexuality and Multiple Sclerosis: Patient and Doctor Perspectives. J Sex Med 2021;18:743-749.
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Affiliation(s)
- Patrick Altmann
- Medical University of Vienna, Department of Neurology, Vienna, Austria
| | - Katharina Leithner
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, Vienna, Austria
| | - Fritz Leutmezer
- Medical University of Vienna, Department of Neurology, Vienna, Austria
| | - Tobias Monschein
- Medical University of Vienna, Department of Neurology, Vienna, Austria
| | - Markus Ponleitner
- Medical University of Vienna, Department of Neurology, Vienna, Austria
| | - Miranda Stattmann
- Medical University of Vienna, Department of Neurology, Vienna, Austria
| | | | - Tobias Zrzavy
- Medical University of Vienna, Department of Neurology, Vienna, Austria
| | - Gudrun Zulehner
- Medical University of Vienna, Department of Neurology, Vienna, Austria
| | - Klaus Berek
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Thomas Berger
- Medical University of Vienna, Department of Neurology, Vienna, Austria
| | - Gabriel Bsteh
- Medical University of Vienna, Department of Neurology, Vienna, Austria.
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Sadeghi Bahmani D, Motl RW. Rate, burden, and treatment of sexual dysfunction in multiple sclerosis: The case for exercise training as a new treatment approach. Mult Scler Relat Disord 2021; 51:102878. [PMID: 33761411 DOI: 10.1016/j.msard.2021.102878] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 12/29/2022]
Abstract
Multiple sclerosis (MS) is a prevalent immune-mediated and neurodegenerative disease of the central nervous system (CNS) among adults in the United States and worldwide. This disease results in impairments of physical, psychological, and social functions that compromise quality of life. This review focuses on sexual dysfunction, including its prevalence, burden, and management, in persons with MS. Sexual dysfunction is defined as sexual behaviors and experiences characterized as insufficient in quality, duration and frequency. Sexual dysfunction occurs in 40-80% percent of women and 50-90% percent of men with MS. The presence of sexual dysfunction is seemingly predicted by psychological and psychiatric issues such as depression and anxiety; sociodemographic dimensions such as older age, unemployment and lower socioeconomic status; and MS-related issues such as fatigue, higher degree of disability and motor impairments. Sexual dysfunction in persons with MS is further associated with decreased psychological and psychosocial wellbeing and impaired quality of life. There is limited research supporting pharmacological and other approaches for managing sexual dysfunction in MS, and we make the case for exercise training based on recent evidence from randomized controlled trials in MS and putative mechanisms of action targeted by exercise training in MS. This paper concludes by providing a research agenda for a deeper and broader understanding of exercise training and sexual function in MS.
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Affiliation(s)
- Dena Sadeghi Bahmani
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
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Altmann P, Leutmezer F, Leithner K, Monschein T, Ponleitner M, Stattmann M, Rommer PS, Zrzavy T, Zulehner G, Berek K, Berger T, Bsteh G. Predisposing Factors for Sexual Dysfunction in Multiple Sclerosis. Front Neurol 2021; 12:618370. [PMID: 33633671 PMCID: PMC7900565 DOI: 10.3389/fneur.2021.618370] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/07/2021] [Indexed: 11/27/2022] Open
Abstract
Sexual dysfunction (SD) in people with multiple sclerosis (pwMS) has a detrimental impact on individual health-related quality of life (HRQoL). It is not clear whether SD in multiple sclerosis (MS) is an independent symptom or merely a byproduct of other symptoms such as depression or anxiety. This cross-sectional study of 93 pwMS determines risk factors for SD in MS based on prevalence, HRQoL, and associated disease outcomes. Diagnosis of SD was determined based on the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) and correlated with physical disability (measured by Expanded Disability Status scale, EDSS), depression and anxiety [Hospital Anxiety and Depression Scale (HADS)], and HRQoL [Multiple Sclerosis Quality of Life-54 (MSQoL-54)]. Multivariate regression models were performed to determine independent risk factors for SD in pwMS. Almost half of the participants in this study (46%) reported SD. HRQoL was significantly poorer in patients with MS suffering from SD (median [IQR] MSQoL-54 scores: physical subscale 52 [41–68] vs. 81 [69–89], p < 0.001; mental subscale 50 [38–82] vs. 86 [70–89], p < 0.001). In the multivariate model, EDSS was the only independent risk factor for SD (OR 18.1 for EDSS ≥4 [95% CI 3.3–31.4, p < 0.001]), while depression and anxiety were not. We conclude that the risk for SD is growing with increasing EDSS and is independent of depression or anxiety. Screening for SD becomes particularly relevant in patients with growing disability.
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Affiliation(s)
- Patrick Altmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Katharina Leithner
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Tobias Monschein
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Markus Ponleitner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Miranda Stattmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Tobias Zrzavy
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Klaus Berek
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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19
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Sexual Health in the Neurogenic Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Abstract
Vaginal dryness is common during and after menopause due to declining estrogen. It is one of the symptoms of vulvovaginal atrophy (VVA), which is part of the genitourinary syndrome of menopause. This can be distressing for women and cause pain, discomfort, and dyspareunia. Vaginal dryness affects over 50% of postmenopausal women but is under-reported and thus under-treated due to barriers to seeking help. Estrogen replacement can resolve symptoms, but may be contraindicated or not desired by all women. Over-the-counter vaginal moisturizers and lubricants can ease the symptoms of VVA. However, their chemical composition varies enormously and some are known to cause detrimental effects due to unphysiological pH, osmolality, and additives. The primary purpose of this review is to assess both their efficacy and safety. Women should be directed toward products that are as 'body-similar' as possible to vaginal secretions in terms of pH and osmolality. Products with potentially harmful ingredients should be avoided. Lubricants can be trialed for sexual activity and moisturizers for symptom control, even if topical or systemic menopause hormone therapy is being used.
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Affiliation(s)
- N Potter
- The Groves Medical Centre, New Malden, Surrey, UK
| | - N Panay
- Queen Charlotte's and Chelsea Hospital, UK Imperial College, London, UK.,Chelsea and Westminster Hospital, UK Imperial College, London, UK
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Gaviria Carrillo M, Ortiz Salas PA, Rueda Vergara KP, Cortes Bernal GA, Nava Mesa M, Moreno Medina K. Tools for comprehensive evaluation of sexual function in patients with multiple sclerosis. Neurologia 2020; 38:S0213-4853(20)30220-6. [PMID: 32917438 DOI: 10.1016/j.nrl.2020.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/28/2020] [Accepted: 04/15/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) that affects young adults, causing a variety of symptoms (motor alterations, visual alterations, loss of sphincter control, gait alterations) that impair the patient's functional status. However, other symptoms, such as sexual dysfunction, can also have an effect on quality of life. DEVELOPMENT Sexual dysfunction can occur at any time during the course of the disease; its prevalence varies between 50% and 90%, and it can be secondary to demyelinating lesions in the spinal cord and/or brain or caused by symptoms that do not directly involve the nervous system (fatigue; psychological, social, and cultural factors; etc.). Although its prevalence and impact on quality of life are well known, sexual dysfunction is still frequently underestimated. Therefore, in this article we review the different scales for assessing presence or severity of sexual dysfunction, in order to offer early multidisciplinary management. CONCLUSION We evaluated 5 questionnaires that could identify the presence of sexual dysfunction in patients with MS and determine its aetiology, assisting in treatment decision making. MS must be understood as a complex disease that encompasses and compromises different aspects of patients' health, and goes beyond simply measuring disability.
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Affiliation(s)
- M Gaviria Carrillo
- Neurología, Fundación Cardio Infantil Instituto de Cardiología, Universidad del Rosario, Bogotá, Colombia.
| | - P A Ortiz Salas
- Neurología y Epidemiología, Fundación Cardio Infantil Instituto de Cardiología, Bogotá, Colombia
| | | | | | - M Nava Mesa
- Grupo de investigación en Neurociencias (NEUROS), Universidad del Rosario, Bogotá, Colombia
| | - K Moreno Medina
- Epidemiología, Fundación Cardio Infantil Instituto de Cardiología, Bogotá, Colombia
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Epidemiology, diagnosis and management of sexual dysfunction in multiple sclerosis. Acta Neurol Belg 2020; 120:791-797. [PMID: 32162189 DOI: 10.1007/s13760-020-01323-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 02/27/2020] [Indexed: 12/12/2022]
Abstract
Multiple sclerosis (MS) is the most common chronic neurological disorder in young adults, with numerous potential effects on neurologic function. Sexual dysfunction (SD) is a common and very stressful one in persons with MS and represents a significant burden of disease. It has been shown that proportion of SD in MS is greater than in other neurological diseases, and almost five times higher than in the general population. Since there is no consistent definition in the literature for the diagnosis of SD, various studies reported a prevalence of SD of 40-80% in women and 50-90% in men with MS. The nature of sexual changes in this chronic illness is best defined as primary, secondary, and tertiary. Recently, it has been emphasized that detailed sexual history is crucial for all SD assessments and diagnoses. Committee 3 of the international consultation on sexual medicine suggested an updating algorithm for diagnostic evaluation of SD in both genders, with specific recommendations related to sexual history taking and diagnostic evaluation. Because treatments and preventive strategies might manage SD, it is necessary to increase the focus on these aspects of the disease when counselling patients. Management of SD should be comprehensive because the symptoms could be somatic, psychological, or related to relationship problems.
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Babany F, Coindreau V, Declémy A, Savard E, Charlanes A, Chesnel C, Amarenco G. [Female orgasm during neurological disorders]. Prog Urol 2020; 30:554-570. [PMID: 32417173 DOI: 10.1016/j.purol.2020.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sexual dysfunctions, particularly orgasm dysfunction, were not routinely assessed in daily practice in neurological women. OBJECTIVE To assess type, frequency and impact of neurological women orgasm dysfunction. METHOD A systematic review was conducted with Medline via Pubmed and The Cochrane Database of Systematic Review. RESULTS Neurological women's orgasm dysfunction is poorly assessed. The most of these were clinical small retrospective studies assessed by general questionnaires and some with electrophysiological assessments. Multiple sclerosis (MS) and Spinal cord injury (SCI) were the two most studied conditions. Orgasm dysfunction is observed in one third of neurological women, associated with arousal troubles, voiding and anal dysfunction. Orgasm alteration seriously impact quality of life of these patients. CONCLUSION Specific studies could be conducted in this specific field in order to increase quality of life of these neurogenic patients suffered from such sexual dysfunction.
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Affiliation(s)
- F Babany
- GREEN, groupe de recherche clinique en neuro-urologie, Sorbonne université, GRC 01, hôpital Tenon, AP-HP, 75020 Paris, France.
| | - V Coindreau
- GREEN, groupe de recherche clinique en neuro-urologie, Sorbonne université, GRC 01, hôpital Tenon, AP-HP, 75020 Paris, France
| | - A Declémy
- GREEN, groupe de recherche clinique en neuro-urologie, Sorbonne université, GRC 01, hôpital Tenon, AP-HP, 75020 Paris, France
| | - E Savard
- GREEN, groupe de recherche clinique en neuro-urologie, Sorbonne université, GRC 01, hôpital Tenon, AP-HP, 75020 Paris, France
| | - A Charlanes
- GREEN, groupe de recherche clinique en neuro-urologie, Sorbonne université, GRC 01, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Chesnel
- GREEN, groupe de recherche clinique en neuro-urologie, Sorbonne université, GRC 01, hôpital Tenon, AP-HP, 75020 Paris, France
| | - G Amarenco
- GREEN, groupe de recherche clinique en neuro-urologie, Sorbonne université, GRC 01, hôpital Tenon, AP-HP, 75020 Paris, France
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Kołtuniuk A, Przestrzelska M, Karnas A, Rosińczuk J. The Association Between Sexual Disorders and the Quality of Life of Woman Patients With Multiple Sclerosis: Findings of a Prospective, Observational, and Cross-Sectional Survey. Sex Med 2020; 8:297-306. [PMID: 32238329 PMCID: PMC7261679 DOI: 10.1016/j.esxm.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/31/2020] [Accepted: 02/20/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction Multiple sclerosis (MS) is a progressive, chronic inflammatory demyelinating disease of the central nervous system, whose symptoms include sexual disorders. Sexual dysfunctions can influence on quality of life (QOL) of patients with MS. Aim To evaluate the occurrence of sexual disorders among women with MS and correlations between QOL, prevalence of sexual disorders, and level of sexual satisfaction. Methods Polish women (n = 101) aged 22–66 years with diagnosed MS were included in the study. Main Outcome Measures The Female Sexual Function Index, the Sexual Satisfaction Questionnaire, the Satisfaction with Life Scale, and the Multiple Sclerosis International Quality of Life Questionnaire were used. In addition, an Authors-Designed Questionnaire was used to collect sociodemographic data. Results More than half of the patients surveyed were totally or somewhat unsatisfied with their sex life, and 44.55% of the patients were diagnosed with significant sexual disorders. It was shown that patients with diagnosed sexual disorders and a low level of sexual satisfaction rated their QOL the lowest among all the surveyed patients. Conclusion Our findings indicate that sexual disorders and the level of sexual satisfaction correlate significantly with QOL in patients with MS. Sexual dysfunctions are a significant problem in women with MS; thus, they should be considered with comprehensive care. Kołtuniuk A, Przestrzelska M, Karnas A, et al. The Association Between Sexual Disorders and the Quality of Life of Woman Patients With Multiple Sclerosis: Findings of a Prospective, Observational, and Cross-Sectional Survey. Sex Med 2020;8:297–306.
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Affiliation(s)
- Aleksandra Kołtuniuk
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland.
| | - Monika Przestrzelska
- Department of Gynecology and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Aleksandra Karnas
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Rosińczuk
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
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Sexual Life Under the Shadow of Multiple Sclerosis in Women: A Qualitative Study in Iran. SEXUALITY AND DISABILITY 2020. [DOI: 10.1007/s11195-020-09626-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Nazari F, Shaygannejad V, Mohammadi Sichani M, Mansourian M, Hajhashemi V. Sexual dysfunction in women with multiple sclerosis: prevalence and impact on quality of life. BMC Urol 2020; 20:15. [PMID: 32085755 PMCID: PMC7035744 DOI: 10.1186/s12894-020-0581-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual function is a component of quality of life, and sexual dysfunction entails reduced satisfaction with life and impaired mood and quality of relationships and affects not only the individual's quality of life, but her partner's life as well. Since Sexual Dysfunction (SD) is among the most common complaints of patients with Multiple Sclerosis (MS), this study was conducted to determine the prevalence of SD among women with MS and its effect on quality of life. MATERIALS AND METHODS This cross-sectional study was conducted in 2018 on 300 women with MS aged 22-50 years in Isfahan, Iran, selected through systematic random sampling. Data were collected using the standard Female Sexual Function Index (FSFI) and MSQOL-54 and analyzed in SPSS using descriptive and analytical statistics. RESULTS The overall prevalence of SD was found as 69.8% in women with MS, with the dimension of sexual desire being affected in 38.6% of the cases, sexual arousal in 38.6%, lubrication in 23.7%, orgasm in 37.3%, satisfaction in 23.4% and pain in 16.9%. SD was found to have significant relationships with age, duration of marriage, fatigue, EDSS and the combined physical and mental health aspects of quality of life (P < 0.05). Moreover, logistic regression analysis revealed that there was a higher probability of a sexual dysfunction among patients with MS and a high fatigue score [1.228(1.003 to 1.504); P = 0.047]. The mean score of the combined physical and mental health aspects of quality of life was lower in the group of women with MS and SD compared to those without SD, and the difference between the two groups was statistically significant (P < 0.05). CONCLUSION Sexual dysfunction is highly prevalent among women with MS and affects various dimensions of quality of life. Greater attention should be paid to the sexual problems faced by MS patients in order to improve their quality of life.
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Affiliation(s)
- Fatemeh Nazari
- Isfahan neurosciences Research center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan neurosciences Research center, Isfahan University of Medical Sciences, Isfahan, Iran. .,Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mehrdad Mohammadi Sichani
- Isfahan Kidney Transplantation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Epidemiology & Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Valiollah Hajhashemi
- Isfahan Pharmaceutical Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Prevalence, dimensions, and predictor factors of sexual dysfunction in women of Iran Multiple Sclerosis Society: a cross-sectional study. Neurol Sci 2020; 41:1105-1113. [PMID: 31897948 DOI: 10.1007/s10072-019-04222-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Sexual dysfunction (SD) is a stressful and common symptom in women with multiple sclerosis (MS) and affects different aspects of their life, seriously. The purpose of this study was to determine the prevalence, dimensions, and predictor factors of SD in Iranian women with MS. METHODS This cross-sectional study was conducted in Iran MS Society. Participants were 260 married women who had definite MS. Data were collected using self-report questionnaires, including Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19); Fatigue Severity Scale (FSS); Depression, Anxiety, and Stress Scale-21 (DASS-21); Questionnaire for Urinary Incontinence Diagnosis (QUID); ENRICH Marital Satisfaction Scale (EMS); Sexual Self-Efficacy Questionnaire; and socio-demographic and disease information questionnaire. Pearson correlation coefficients, independent sample t-test, one-way analysis of variance (ANOVA), and multiple linear regression model were used for data analysis. RESULTS Majority (76.2%) of the participants had SD, and according to the dimensions of SD in MS, primary SD was found in 176 (67.7%), secondary SD in 158 (60.7%), and tertiary SD in 126 (48.5%) of the participants. The most important and common problem was delayed orgasm (60%). According to the results of multiple linear regression model, the predictor factors of SD were sexual self-efficacy (B = -0.721, P < 0.001), disability status (B = 2.714, P < 0.001), urge incontinence (B = 0.367, P = 0.029), depression (B = 0.446, P = 0.007), anxiety (B = 0.332, P = 0.037), fatigue (B = 0.177, P = 0.002), duration of disease (B = -0.463, P = 0.014), and duration of DMT use (B = 0.662, P = 0.002). CONCLUSION According to the results of this cross-sectional study, SD was a very common and complex problem in women of Iran MS Society, and a number of physical, neurological, and psychological factors, such as sexual self-efficacy, disability status, urge incontinence, depression, anxiety, fatigue, duration of DMT use, and duration of disease, play a role in SD of these patients. So, in the treatment procedure of SD in MS women, adopting a multidisciplinary approach, as well as considering all contributory factors and their impact on sexual function, is recommended.
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Alehashemi A, Mostafavian Z, Dareini N. Sexual Function in Iranian Female Multiple Sclerosis Patients. Open Access Maced J Med Sci 2019; 7:1303-1308. [PMID: 31110574 PMCID: PMC6514335 DOI: 10.3889/oamjms.2019.283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND: One of the typical complaints in females with multiple sclerosis (MS) is Sexual dysfunction (SD). AIM: This study aimed to compare the sexual function of women with and without MS and to recognise factors that possibly related to sexual dysfunction of women with MS. MATERIAL AND METHODS: Sexual function of 64 women with MS as a case study group were compared to a group of control comprised of 64 women. Female Sexual Function Inventory (FSFI) and Beck Depression Inventory (BDI) were used accordingly to assess sexual function and severity of depression of case and control groups. Functional status of MS Patients was assessed by the Expanded Disability Status Scale (EDSS). The data were analysed using chi-square, independent Samples t, Pearson’s correlation coefficients, and multiple linear regression tests. RESULTS: There were no differences in the Total FSFI and 4 FSFI subscale scores (i.e. sexual desire, arousal, lubrication and satisfaction) between women with MS and controls. The only significant difference between the two groups was the dimension of orgasm (p = 0.016). Multivariate analysis demonstrated that only BDI and FSFI total scores have significantly related (B = -0.436, P < 0.001). In women with MS, a significant negative correlation was found between FSFI and EDSS scores (rho = -0.35, P = 0.032), as well as between FSFI scores and disease duration (rho = -0.25, P = 0.01). CONCLUSION: Depression was associated to sexual dysfunction in women. It could be advantageous to evaluate and treat depression in women with MS who suffer from sexual dysfunction.
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Affiliation(s)
- Alireza Alehashemi
- Department of Neurology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Zahra Mostafavian
- Department of Community Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Najmeh Dareini
- Department of Medical School, Mashhad Branch, Islamic Azad University, Mashhad, Iran
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Van Der Walt A, Nguyen A, Jokubaitis V. Family planning, antenatal and post partum care in multiple sclerosis: a review and update. Med J Aust 2019; 211:230-236. [DOI: 10.5694/mja2.50113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Anneke Van Der Walt
- Monash University Melbourne VIC
- University of Melbourne Melbourne VIC
- Alfred Health Melbourne VIC
- Royal Melbourne Hospital Melbourne VIC
| | - Ai‐Lan Nguyen
- University of Melbourne Melbourne VIC
- Royal Melbourne Hospital Melbourne VIC
| | - Vilija Jokubaitis
- Monash University Melbourne VIC
- University of Melbourne Melbourne VIC
- Alfred Health Melbourne VIC
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Masmoudi R, Aissi M, Halouani N, Fathallah S, Louribi I, Aloulou J, Amami O, Frih M. [Female sexual dysfunction and multiple sclerosis: A case-control study]. Prog Urol 2018; 28:530-535. [PMID: 30076093 DOI: 10.1016/j.purol.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To compare the scores of the different dimensions of sexual function of women with multiple sclerosis to a group of control women and to identify possible factors associated with sexual dysfunction in women with multiple sclerosis. METHODS This is a descriptive and analytical case-control study. Twenty-six women with multiple sclerosis were compared to 26 control women matched for age and socioeconomic status. The evaluation focused on demographic and clinical data. Patients with multiple sclerosis were evaluated by Expanded Disability Status Scale (EDSS) for functional status, by Female Sexual Function Inventory (FSFI) for sexual function and by Beck Depression Inventory-Short Form (BDI-DF) for severity of depression. RESULTS Our results confirmed the high prevalence of sexual dysfunction among patients with multiple sclerosis (69.2%) compared to controls (26.9%) (P=0.002). Sexual desire, arousal and orgasm were the most altered sexual phases in our study. Total FSFI, and FSFI subscale scores (sexual desire, arousal, lubrication, orgasm and satisfaction) were lower in women with multiple sclerosis compared with controls. The analytical study showed that in women with multiple sclerosis, the total FSFI score was correlated with age (rs=-0.68; P<0.001), duration of marriage (rs=-0.57; P=0.002), level of disability (rs=-0.45; P=0.021) and BDI-SF score (rs=-0.51; P=0.008). FSFI score was also associated to low education level (P=0.02) and urinary dysfunction (P=0.04). CONCLUSION Our study highlighted the importance of sexual dysfunction in women with multiple sclerosis. The inclusion of this aspect in the clinical assessment will improve the quality of life of these patients. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- R Masmoudi
- Service de psychiatrie « B », CHU Hedi-Chaker, route El Ain 0,5km, 3000 Sfax, Tunisie.
| | - M Aissi
- Service de neurologie, CHU Fattouma-Bourguiba, Monastir, Tunisie
| | - N Halouani
- Service de psychiatrie « B », CHU Hedi-Chaker, route El Ain 0,5km, 3000 Sfax, Tunisie
| | - S Fathallah
- Service de psychiatrie, CHU Fattouma-Bourguiba, Monastir, Tunisie
| | - I Louribi
- Service de neurologie, CHU Fattouma-Bourguiba, Monastir, Tunisie
| | - J Aloulou
- Service de psychiatrie « B », CHU Hedi-Chaker, route El Ain 0,5km, 3000 Sfax, Tunisie
| | - O Amami
- Service de psychiatrie « B », CHU Hedi-Chaker, route El Ain 0,5km, 3000 Sfax, Tunisie
| | - M Frih
- Service de neurologie, CHU Fattouma-Bourguiba, Monastir, Tunisie
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Assessment of sexual function in women with neurological disorders: A review. Ann Phys Rehabil Med 2018; 61:235-244. [DOI: 10.1016/j.rehab.2017.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 04/29/2017] [Indexed: 11/21/2022]
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Sexual Function in Young Individuals With Multiple Sclerosis: Does Disability Matter? J Neurosci Nurs 2018; 50:161-166. [DOI: 10.1097/jnn.0000000000000367] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mosalanejad F, Afrasiabifar A, Zoladl M. Investigating the combined effect of pelvic floor muscle exercise and mindfulness on sexual function in women with multiple sclerosis: a randomized controlled trial. Clin Rehabil 2018; 32:1340-1347. [DOI: 10.1177/0269215518777877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To evaluate the combined effect of pelvic floor muscle exercise and mindfulness on sexual function in women with multiple sclerosis. Design: It was a three-arm parallel randomized clinical trial study. Setting: Outpatient clinic. Subjects: Patients with multiple sclerosis. Interventions: Participants in the intervention groups completed an eight-week program consisting of pelvic floor muscle exercise, mindfulness, and pelvic floor muscle exercise along with mindfulness. Main measures: The main measure was the Female Sexual Function Index. Results: In total, 70 patients completed the study. The results showed that the total mean scores of the participants’ sexual function in pelvic floor muscle exercise group before interventions (i.e. baseline), 8 weeks after the baseline, and 12 weeks after the baseline were 18.8 ± 6.3, 23.7 ± 5.1, and 22.3 ± 4.7, respectively, while total mean scores obtained for the sexual function of mindfulness group were 19.5 ± 6.4, 26.9 ± 4.8, and 25.6 ± 4.5, respectively. Moreover, mean scores obtained for pelvic floor muscle exercise along with mindfulness were 19.6 ± 5.9, 25.3 ± 5.4, and 25 ± 4.8, respectively. There was no significant difference in their effects on sexual function ( P > 0.05). Conclusion: Mindfulness and pelvic floor muscle exercise do not have any significant impact upon sexual dysfunction of people with multiple sclerosis.
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Affiliation(s)
- Fatemeh Mosalanejad
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
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“Life behind the mask”: Sexual life of Iranian women with multiple sclerosis. Disabil Health J 2018; 11:274-280. [DOI: 10.1016/j.dhjo.2017.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/06/2017] [Accepted: 10/16/2017] [Indexed: 11/18/2022]
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35
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Delaney KE, Donovan J. Multiple sclerosis and sexual dysfunction: A need for further education and interdisciplinary care. NeuroRehabilitation 2017; 41:317-329. [PMID: 29036844 DOI: 10.3233/nre-172200] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Kate E. Delaney
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Jayne Donovan
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
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Nathoo N, Mackie A. Treating depression in multiple sclerosis with antidepressants: A brief review of clinical trials and exploration of clinical symptoms to guide treatment decisions. Mult Scler Relat Disord 2017; 18:177-180. [PMID: 29141805 DOI: 10.1016/j.msard.2017.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/06/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
Depression is a common comorbidity in patients with multiple sclerosis (MS). Those with MS and concurrent depression have poorer quality of life and are also less likely to be compliant with disease-modifying treatment, which may ultimately affect their MS disease course. Treating depression in MS with pharmacological agents can improve not only depression, but may also impact the MS disease course. However, no guidelines exist around treating depression in MS. Few randomized-controlled trials using antidepressants in MS exist. Here, we briefly review trials using antidepressant medications to treat depression in MS. We also propose individualizing treatment of depression in MS, as the depressive symptoms and MS symptoms and disease course differ significantly between patients. We explore the heterogeneity in presentation of depression through different comorbid symptoms in MS, and discuss which antidepressant options would be appropriate in each situation. We propose that future clinical trials should incorporate differences in issues between those with depression (e.g. sexual dysfunction, urinary incontinence) into analysis. As MS is incredibly heterogeneous, treating concurrent depression on a case-by-case basis may enable for improving quality of life and the MS disease course.
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Affiliation(s)
- Nabeela Nathoo
- Department of Radiology & Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Aaron Mackie
- Departments of Psychiatry & Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Miletta M, Bogliatto F, Bacchio L. Multidisciplinary Management of Sexual Dysfunction, Perineal Pain, and Elimination Dysfunction in a Woman with Multiple Sclerosis. Int J MS Care 2017; 19:25-28. [PMID: 28243183 DOI: 10.7224/1537-2073.2015-082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disease that commonly affects young women and is associated with sexual dysfunction (SD) and lower anourogenital dysfunction, which affect quality of life. We evaluated the importance of an integrated multidisciplinary approach in the Lower Female Ano-Uro-Genital Network (LFAUGN) to manage a variety of complex symptoms. METHODS A 40-year-old woman with MS and primary concerns about perineal pain and SD was treated by a trained midwife from the LFAUGN and a physical therapist after a multidisciplinary diagnostic process that included gynecologic evaluation for perineal pain and SD, physiatric assessment, urologic assessment for bladder retention (BR), and surgical examination for obstructed defecation syndrome (ODS). Physical therapy was integrated with pharmacologic therapy for ODS and with self-catheterization for BR. RESULTS After 5 months of treatment, the patient reported improvement in functional perineal parameters and perineal pain (visual analogue scale score: 9 at T1 vs. 5 at T2), with resolution of pelvic floor hypertonia. Furthermore, ODS and BR symptoms improved (5-item score: 18 of 20 at T1 vs. 10 of 20 at T2; 1 self-catheterization daily, with postvoid residual volume [PRV] <200 mL at T1 vs. 1 self-catheterization weekly, with PRV <100 mL at T2) and sexual satisfaction increased (Female Sexual Function Index score: 18 of 36 at T1 vs. 23 of 36 at T2). CONCLUSIONS These results suggest that physical therapy, as an integral component of a multidisciplinary approach in a multiprofessional network, may play a pivotal role in improving anourogenital dysfunction and sexual satisfaction.
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Dehghan-Nayeri N, Khakbazan Z, Ghafoori F, Nabavi SM. Sexual dysfunction levels in iranian women suffering from multiple sclerosis. Mult Scler Relat Disord 2017; 12:49-53. [DOI: 10.1016/j.msard.2017.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
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Marck CH, Jelinek PL, Weiland TJ, Hocking JS, De Livera AM, Taylor KL, Neate SL, Pereira NG, Jelinek GA. Sexual function in multiple sclerosis and associations with demographic, disease and lifestyle characteristics: an international cross-sectional study. BMC Neurol 2016; 16:210. [PMID: 27814701 PMCID: PMC5097380 DOI: 10.1186/s12883-016-0735-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/27/2016] [Indexed: 02/07/2023] Open
Abstract
Background Sexual dysfunction (SD) is very common in people with multiple sclerosis (PwMS) and contributes a significant burden of disease, particularly for young people. SD has direct neurological contributions from depression and fatigue, which occur commonly in PwMS. Modifiable factors may represent potential targets for treatment and prevention of SD. We aimed to assess the prevalence of SD and explore associations between SD and demographic and modifiable risk factors, as well as depression and fatigue in a large cohort of PwMS. Methods We analysed self-reported data from a large, international sample of PwMS recruited via Web 2.0 platforms, including demographic, lifestyle and disease characteristics. Specific sexual function questions included 4 items from the sexual function scale and 1 item regarding satisfaction with sexual function, part of the MS Quality of Life-54 instrument. Results 2062 PwMS from 54 countries completed questions on sexual function. 81.1 % were women, mean age was 45 years, most (62.8 %) reported having relapsing-remitting MS. The majority (54.5 %) reported one or more problems with sexual function and were classified as having SD. Lack of sexual interest (41.8 % of women), and difficulty with erection (40.7 % of men) were most common. The median total sexual function score was 75.0 out of 100, and 43.7 % were satisfied with their sexual function. Regression modeling revealed independent associations between sexual function and satisfaction and a range of demographic factors, including age, as well as depression risk, antidepressant use, and fatigue in PwMS. Conclusion This cross-sectional study shows that SD and lack of satisfaction with sexual function are associated with depression risk and fatigue, as well as modifiable lifestyle factors diet and physical activity (after adjusting for depression and fatigue). Planned longitudinal follow-up of this sample may help clarify these associations and the underlying mechanisms. There is potential to prevent and treat SD in PwMS by addressing depression and fatigue and their determinants. Clinicians and PwMS should be aware of SD and associated factors as part of a comprehensive preventive approach to managing MS.
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Affiliation(s)
- Claudia H Marck
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3065, VIC, Australia.
| | - Pia L Jelinek
- School of Medicine, Notre Dame University, Fremantle, WA, Australia
| | - Tracey J Weiland
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3065, VIC, Australia
| | - Jane S Hocking
- Sexual Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Alysha M De Livera
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3065, VIC, Australia.,Biostatistics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Keryn L Taylor
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3065, VIC, Australia
| | - Sandra L Neate
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3065, VIC, Australia
| | - Naresh G Pereira
- Emergency Department, Box Hill Hospital, Box Hill, VIC, Australia
| | - George A Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, 3065, VIC, Australia
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Taskin Yilmaz F, Karakoc Kumsar A, Demirel G, Yesildağ B. The Effect of Urinary Incontinence on Sexual Quality of Life in Women with Chronic Physical Diseases. SEXUALITY AND DISABILITY 2016. [DOI: 10.1007/s11195-016-9457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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Salhofer-Polanyi S, Wöber C, Prohazka R, Dal-Bianco A, Bajer-Kornek B, Zebenholzer K. Similar impact of multiple sclerosis and migraine on sexual function in women : Is the multiple sclerosis impact scale questionnaire useful? Wien Klin Wochenschr 2016; 129:115-120. [PMID: 27596229 PMCID: PMC5318470 DOI: 10.1007/s00508-016-1066-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 07/29/2016] [Indexed: 01/03/2023]
Abstract
Background Sexuality is an integral part of overall health but the impact of neurological diseases on sexual function still receives too little attention. Aim The aim of this case control study was to compare frequencies and characteristics of sexual dysfunction in women with stable relapsing-remitting multiple sclerosis (MS) and migraine. Methods Sexually active women aged 18–50 years were recruited at the MS and headache outpatient clinics of a university hospital and asked to complete questionnaires on sexual function using the multiple sclerosis intimacy and sexuality questionnaire (MSISQ-19) adapted for patients with migraine, depression using the Beck depression inventory (BDI-II) and quality of life using the short form-36 questionnaire (SF-36). Results At least one symptom of sexual dysfunction was “almost always” or “always” present in 35.7 % of 42 patients with MS and in 22.6 % of 30 patients with migraine (p = 0.3). The MSISQ-19 total score did not differ between the two groups (31.6 ± 10.8 vs. 28.2 ± 11.6, respectively, p = 0.2). Sexual dysfunction was categorized as primary, secondary and tertiary in 66.7 %, 40 % and 33.3 % of MS patients and in 57.1 % (p = 0.7), 71.4 % (p = 0.2) and 71.4 % (p = 0.1) of migraine patients, respectively. Depressive symptoms were more common in women with sexual dysfunction than in those without both in MS (p = 0.001) and migraine (p = 0.006). The SF-36 showed decreasing quality of life with increasing MSISQ-19 sum scores (mental subscale p < 0.001 and physical subscale p = 0.04). Conclusions Sexual dysfunction is a major problem both in women with MS and in women with migraine and is strongly associated with comorbid depression and impaired quality of life. Thus, categorizing sexuality as done by MSISQ-19 is limited by its complex biopsychosocial interactions.
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Affiliation(s)
- Sabine Salhofer-Polanyi
- Medical University of Vienna, Vienna, Austria. .,Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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In Reply:. Menopause 2016; 23:698-9. [DOI: 10.1097/gme.0000000000000671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Edwards D, Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? Climacteric 2015; 19:151-61. [PMID: 26707589 PMCID: PMC4819835 DOI: 10.3109/13697137.2015.1124259] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Vaginal dryness is a common condition that is particularly prevalent during and after the menopause, and is one of the symptoms of vulvovaginal atrophy/genitourinary syndrome of menopause. The impact of vaginal dryness on interpersonal relationships, quality of life, daily activities, and sexual function can be significant, but is frequently underestimated. Furthermore, barriers exist to treatment-seeking, and this condition is often underreported and undertreated. Greater education about vaginal dryness and the range of available treatments is essential to encourage more women to seek help for this condition. Personal lubricants and moisturizers are effective at relieving discomfort and pain during sexual intercourse for women with mild to moderate vaginal dryness, particularly those who have a genuine contraindication to estrogen, or who choose not to use estrogen. However, there is a distinction between lubricants and moisturizers, and notable differences between commercially available products. Women should be advised to choose a product that is optimally balanced in terms of both osmolality and pH, and is physiologically most similar to natural vaginal secretions. A series of recommendations for the use of vaginal lubricants and moisturizers, either on their own or in combination with systemic or topical hormone replacement therapy, is presented.
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Affiliation(s)
- D Edwards
- a Claridges Barn , Charlbury Road, Chipping Norton , Oxon , UK
| | - N Panay
- b Queen Charlotte's & Chelsea Hospital and Chelsea & Westminster Hospital, and Honorary Senior Lecturer, Imperial College , London , UK
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Sexual dysfunction in multiple sclerosis: A 6-year follow-up study. J Neurol Sci 2015; 358:317-23. [DOI: 10.1016/j.jns.2015.09.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/22/2015] [Accepted: 09/09/2015] [Indexed: 11/19/2022]
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Shah P. Symptomatic management in multiple sclerosis. Ann Indian Acad Neurol 2015; 18:S35-42. [PMID: 26538847 PMCID: PMC4604696 DOI: 10.4103/0972-2327.164827] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 06/26/2015] [Accepted: 06/15/2015] [Indexed: 02/02/2023] Open
Abstract
Multiple sclerosis (MS) is the commonest cause of disability in young adults. While there is increasing choice and better treatments available for delaying disease progression, there are still, very few, effective symptomatic treatments. For many patients such as those with primary progressive MS (PPMS) and those that inevitably become secondary progressive, symptom management is the only treatment available. MS related symptoms are complex, interrelated, and can be interdependent. It requires good understanding of the condition, a holistic multidisciplinary approach, and above all, patient education and empowerment.
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Affiliation(s)
- Pushkar Shah
- Department of Neurology, Institute of Neurosciences, South Glasgow University Hospital NHS Trust, Glasgow, G51 4TF, United Kingdom
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Eisenberg NW, Andreski SR, Mona LR. Sexuality and Physical Disability: A Disability-Affirmative Approach to Assessment and Intervention Within Health Care. CURRENT SEXUAL HEALTH REPORTS 2015. [DOI: 10.1007/s11930-014-0037-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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