The most effective sexual function and dysfunction interventions in individuals with multiple sclerosis: A systematic review and meta-analysis

Effect of expressive writing on the sexual self-concept in men with multiple sclerosis: a randomized clinical controlled trial

BACKGROUND

Previous studies have examined the various outcomes of expressive writing intervention in different populations. The purpose of this study was to evaluate the effect of expressive writing on the sexual self-concept of men with multiple sclerosis.

METHODS

This parallel randomized controlled clinical trial conducted on 70 men attending an MS clinic in Tehran in 2022. The participants were randomly assigned to expressive writing intervention and control groups. For two weeks, participants in the intervention group disclosed their emotions and expressed their feelings in writing twice a week. Sexual self-concept was evaluated using the Multidimensional Sexual Self-Concept Questionnaire on three occasions, before, after, and 4-week follow-up. The data ware analyzed using SPSS software version 22 (IBM Corp., Armonk, N.Y., USA). The analysis employed Chi-squared test, Fisher's exact test, independent t-test, and repeated measured ANOVA. A p-value < 0.05 was considered to be statistically significant.

RESULTS

The mean of age in the intervention group was 38.6 ± 6.85 years, while in the control group it was 38.94 ± 6.07 years. There were no significant differences between the two groups, in terms of these characteristics. According to the results, the dimensions of SSC did not change over time assessments, except for sexual problem self-blame (p = 0.011) and sexual fear/apprehension (p = 0.042) in the expressive writing intervention group, and sexual motivation in the control group (p = 0.002). On the other hand, before the intervention, sexual motivation was significantly higher in the control group compared to the expressive writing intervention group (p = 0.046).

CONCLUSIONS

Our findings did not support the general effectiveness of a 2-week expressive writing intervention on the sexual self-concept of the men with MS except for the sexual fear/apprehension and sexual problem self-blame dimensions. However, further research is needed to better understand the effects of expressive writing intervention on Sexual self-concept in men with multiple sclerosis, while controlling for the limitations of our study.

TRIAL REGISTRATION

The present study has been registered on the Iranian Registry of Clinical Trials (IRCT) at https://irct.behdasht.gov.ir/trial/59664 on November 17, 2021, with the code IRCT20211028052892N1.

The Effects of Transcutaneous Tibial Nerve Stimulation on Female Sexual Function in Multiple Sclerosis Patients: A Narrative Review

Female sexual dysfunction (FSD) is prevalent among women with multiple sclerosis (MS), leading to significant impairments in quality of life. Despite various available treatments, current approaches often fail to address the complex, multifactorial nature of FSD in this population. Transcutaneous tibial nerve stimulation (TTNS) has recently gained attention as a non-invasive neuromodulation therapy that has demonstrated potential benefits for neurogenic bladder dysfunction, with preliminary evidence suggesting overlapping improvements in sexual function. This narrative review synthesizes current evidence on the use of TTNS for managing FSD in women with MS. A comprehensive literature search of Medline, Web of Science, and Scopus was conducted, focusing on studies that explored TTNS interventions and outcomes in MS-related FSD. The findings indicate that TTNS likely modulates pelvic neural pathways, enhances genital blood flow, and improves key sexual function domains, including arousal, lubrication, and orgasm. Clinical studies using validated assessment tools, such as the Female Sexual Function Index (FSFI), have shown significant improvements in sexual outcomes, particularly when TTNS is combined with pelvic floor muscle training (PFMT). Experimental models further support the plausibility of these findings, linking TTNS to increased pelvic perfusion and more balanced neurogenic regulation of sexual response. Although initial evidence suggests that TTNS is safe, effective, and well-tolerated, limitations include small sample sizes, short follow-up periods, and variability in treatment protocols. Future research should focus on larger controlled trials, long-term follow-up studies, and standardized intervention parameters to optimize the application of TTNS for addressing FSD in women with MS.

Psychological and interpersonal dimensions of sexual function and dysfunction: recommendations from the fifth international consultation on sexual medicine (ICSM 2024)

INTRODUCTION

Sexual health concerns are common and significantly impact quality of life, but many people do not seek treatment due to embarrassment and other barriers. A biopsychosocial model of assessment and treatment acknowledges the biological, psychological, and social contributors to sexual difficulties and suggests that all these domains should be evaluated.

OBJECTIVES

This paper provides an overview of the major psychological factors contributing to sexual difficulties and offer an evidence-based approach for primary care clinicians to assess and treat these issues.

METHODS

A comprehensive literature review was undertaken focusing on articles published since the last consultation in 2016. The study findings were synthesized, critiqued, authors assigned a Grading of Recommendation as Weak or Strong following a year-long process of discussions among the committee. When a particular well-established psychological practice was not evaluated in the literature, we assigned an expert opinion recommendation.

RESULTS

Since the 2015 ICSM, there have been a number of high-quality trials of psychological treatments addressing sexual dysfunctions, as well as meta-analyses and systematic reviews. In some domains, there is strong evidence of psychological treatment, and primary care providers should be aware of such approaches and refer when appropriate.

CONCLUSIONS

This paper offers a practical guide for primary care clinicians to understand the psychological factors underlying sexual dysfunction and outlining what approaches may be appropriate for this clinician, and when the patient should be referred to a specialist. We emphasize an evidence-based approach to managing sexual dysfunctions in primary care, allowing for timely interventions. A comprehensive evaluation of biopsychosocial factors is recommended to personalize psychological interventions to overall context, including chronic diseases, mental health issues, and relationship conflicts. The initial assessment is key to developing an individualized intervention plan, which may include psychoeducation, referral for cognitive-behavioral therapy, mindfulness, or couple therapy, and consideration of medical or digital health interventions.

Reliability, validity and distribution of the Spanish female sexual function index in women with relapsing multiple sclerosis

BACKGROUND

The Female Sexual Function Index (FSFI) is a widely recognized tool for assessing sexual dysfunction (SD). However, its validation for Spanish women suffering from multiple sclerosis (MS) has not yet been conducted.

AIM

The study aimed to examine the psychometric properties of the 19-item Spanish version of the FSFI (svFSFI) in women with relapsing MS.

METHOD

A total of 137 women with relapsing MS from three Spanish centers participated in the study and completed the svFSFI. The psychometric properties of the questionnaire were evaluated. The prevalence of SD in the study cohort was determined, and its association with clinical and sociodemographic variables was analyzed using bi- and multivariate regression analyses.

RESULTS

The svFSFI demonstrated excellent test-retest reliability and substantial-to-excellent internal consistency in the context of relapsing MS. There was significant convergent validity in the intercorrelations of domains. Discriminant validity showed differences in SD between women with high and low neurological disability, as measured by the Expanded Disability Status Scale (EDSS) scores. An exploratory factor analysis indicated a five-factor structure for the svFSFI. The prevalence of SD in the MS cohort was found to be 42.6%, with the 'desire' and 'arousal' domains being the most affected. Factors such as EDSS score, fatigue, depression, and having a stable partner were found to influence the total svFSFI score.

CONCLUSION

The study validates the svFSFI as a reliable and valid instrument for evaluating sexual dysfunction in Spanish women with MS.

Sexual dysfunction in female and male people with multiple sclerosis: disability, depression and hormonal status matter

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.