Is There a Relationship Between Overactive Bladder and Sexual Dysfunction in Women With Multiple Sclerosis?

Unraveling the complex relationship: Multiple sclerosis, urinary tract infections, and infertility

BACKGROUND

Multiple sclerosis (MS) is an immune system disorder that affects the central nervous system (CNS) and progressively damages nerve fibers and protective myelin. People with MS often experience a wide range of complications, including lower urinary tract dysfunction, urinary tract infections (UTIs) and sexual dysfunction. MS is common in young people and can lead to sexual dysfunction (SD) and infertility, which becomes more pronounced as the disease progresses.

RESULTS

Over the past two decades, significant advances have been made in the management of MS, which may slow the progression of the disease and alter its course. However, UTI and SD remain significant challenges for these patients. Awareness of the underlying complications of MS, such as UTIs and infertility, is crucial for prevention, early detection and appropriate treatment, as there is a causal relationship between UTIs and the use of corticosteroids during an attack.

CONCLUSION

This article provides an overview of potential microbial pathogens that contribute to the development of MS, as well as an assessment of people with MS who report UTIs and infertility.

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.

Expectations about the management of sexual dysfunction in women with multiple sclerosis and association with clinical characteristics

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.

Sexuality experiences of women with multiple sclerosis reporting overactive bladder: a qualitative study

BACKGROUND

To effectively manage sexual dysfunction in women reporting overactive bladder, it is essential to know how patients perceive these problems, their lives, and their strategies.

AIM

In this study we aimed to understand the sexual life experiences of women with multiple sclerosis (MS) who report overactive bladder from their point of view.

METHODS

This study included 12 women with MS and was conducted as a qualitative study with a hermeneutic phenomenological framework. The data were evaluated by using Van Manen's thematic analysis method. The Consolidated Criteria for Reporting Qualitative Research checklist was used.

OUTCOMES

In this study, thematic codes of sexual symptoms in women with MS with overactive bladder were defined and evaluated.

RESULTS

As a result of the analysis of the data, four main themes and nine subthemes were identified. The main themes were "sexual self-concept," "sexual relationships," "sexual function," and "coping with problems". Subthemes such as body image, sexual esteem, the meaning of sexuality, communication, intimacy, coping with overactive bladder and sexual problems, and getting support showed that overactive bladder symptoms negatively affected women's sexual health.

CLINICAL IMPLICATIONS

Given the variety of sexual problems experienced by women with MS who report overactive bladder, these problems should be a routine part of clinical evaluation.

STRENGTHS AND LIMITATIONS

This study is to our knowledge the first to examine the sexual life experiences of MS women reporting overactive bladder in depth based on the holistic view of sexuality theory. However, the sample is small and includes only women with MS who have reported overactive bladder.

CONCLUSIONS

The sexual experience of women with MS who reported overactive bladder was multi-dimensional. Women with MS cope with their sexual problems alone and cannot receive the necessary support from their husbands, nurses, or other health professionals.

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.