The tertiary sexual dysfunction in MS is related to the psychological, social and cultural issues of people with MS. These physical changes suffered by people with MS can alter the way they view themselves as sexual beings, and the way other perceive them to be.

Self-image and body image

Especially in western society, women are affected by a negative body image, because the media shows women as thin and sensual. However, this is untrue, most women never being like that – nobody is perfect after all. The downside is the fact that women with Multiple Sclerosis have difficulties enjoying their sexual and sensual nature because of the MS-related physical changes.

 
Men are also affected. They are depicted as being aggressive, potent and powerful. The erectile dysfunctions associated with MS may make them feel like they failed or that they are not men enough.

Changing roles

When a person is diagnosed with Multiple Sclerosis, he or she won’t be able to fulfill his or hers designated work, and thus won’t feel like an equal partner. This can threaten the intimate relationship. When one of the sexual partners has a disability, he or she can be seen too fragile or ill and thus unable to be sexually active. If one partner is the care-giver, then separating the care giving activities from time to time and dedicating time to romantic and sexual activities can help minimize any conflicts that may occur. Also, communication is essential, and the partner with MS must not be afraid to express his or her wishes and sexual desires.

Cultural expectations regarding sexual behavior

 Our views and expectations about sexuality are shaped by the religious, social and cultural influences in our lives. In western society, sexuality is seen as having penile-vaginal intercourse, leading to orgasm. The foreplay is seen only as a step to intercourse, and not as satisfying activity in its own right. Thus, couples don’t consider they had sex until coitus, and sex is not considered successful until orgasm occurs.

This view of sexuality leads many MS couple focusing only on the goal of having penile-vaginal intercourse and achieving orgasm, rather than enjoying the physical and emotionally satisfying alternatives to intercourse. Being able to discover new and fulfilling ways to compensate for these sexual limitations is the key to having a satisfactory sex life with MS.

MS-related emotional challenges

Having MS means going trough periods of grief, demoralization and even clinical depression; all can temporally dampen the interest in sex.  There are several ways trough which one can cope with these emotional challenges.

In the case of clinical depression, the best alternative is treatment with antidepressant medications and psychotherapy, which combined offers relief and thus the restoration of sexual interest.

MS also brings changes in body-image and self-esteem. When this happens, a natural grieving process occurs. Also, the course of MS, which is sometimes unpredictable, can lead to anxiety and stress, which in turn has an impact on one’s sexuality.

The importance of communication

Throughout this website, an emphasis on communication has been placed several times. However, when dealing with ongoing emotional and body changes, one must realize the importance of intimate communication with one’s long-term sexual partner.

Discussing disappointments, exploring new options and expressing one’s wishes and desires can be difficult when coping with all the changes associated with MS. However, this can be difficult, but it is not impossible.

There are a few things that need to be known if good communication is desired. One of the first things that needs to be learned is active listening which means giving undivided attention, fully hearing each other’s message before answering or responding, observing each other’s body language and also asking for clarifications if and when necessary.  Once these skills are developed and used, both partners will be able to offer more empathy – one of the most important interpersonal skills in a harmonious relationship. Even in the most difficult moments, if there is mutual respect and understanding, emotional intimacy can be enhanced.