Depression, sexual dysfunction, life satisfaction and marriage satisfaction in women with multiple sclerosis

Sexual function in people with multiple sclerosis: a systematic review and meta-analysis

INTRODUCTION

Sexual dysfunction is prevalent in people with multiple sclerosis (PwMS) and considerably affects their quality of life. Although sexual function (SF) is crucial in PwMS, its relationship with other characteristics remains insufficiently understood.

OBJECTIVE

This review aimed to consolidate the evidence comparing SF between PwMS and healthy controls (HCs) and to explore its correlation with various demographic, clinical, and psychological factors.

METHODS

The PubMed/MEDLINE, Embase, Scopus, and Web of Science databases were systematically searched up to July 28, 2024, to identify studies comparing SF between PwMS and HCs or assess its correlation with various demographic, clinical, and psychological characteristics. Random effects models were used in R software version 4.4.0 to estimate the pooled standardized mean difference (SMD) and pooled correlations, with their 95% CIs as the effect size metrics.

RESULTS

In this review, 61 studies comprising 16 266 PwMS were included. The meta-analysis indicated that SF was significantly reduced in PwMS compared to HCs, with females with MS (FwMS) showing lower Female Sexual Function Index scores (SMD: -0.41, 95% CI, -0.61 to -0.20, P < .0001) and males with MS (MwMS) demonstrating reduced International Index of Erectile Function scores (SMD: -0.77, 95% CI, -1.32 to -0.22, P < .01). Correlation analyses highlighted associations between reduced SF and higher Expanded Disability Status Scale (EDSS), longer disease duration, and depression in gender-aggregated analyses. Reduced SF was also found to correlate with older age, higher EDSS scores, depression, and fatigue in FwMS.

CONCLUSION

The findings of the included studies indicated that SF is lower in PwMS compared to HCs and is influenced by age, disease duration, depression, and the EDSS. Further studies on the effects of comorbidities, medications, and MS classification on the SF of PwMS are warranted.

Sexual dysfunction in female patients with multiple sclerosis: relationship with functional status, fatigue, depression, sleep quality, and quality of life

BACKGROUND

Although sexual dysfunction is one of the most common symptoms in patients with multiple sclerosis (MS), there are relatively few studies on this topic.

AIM

The aim of this study was to assess sexual function in female MS patients and investigate its association with functional state, fatigue, depression, sleep, and quality of life.

METHODS

This descriptive cross-sectional study was conducted between May and November 2019 with MS patients attending an MS outpatient clinic at a university hospital. Patients' sexual function was assessed using the Female Sexual Function Index (FSFI). Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and Multiple Sclerosis Quality of Life Scale (MSQoL-54) were used to determine their relationship to sexual function.

OUTCOMES

Sexual function, functional status, depression, sleep quality, and quality of life.

RESULTS

The mean age of the 83 patients included in the study was 41.8 (±8.5) years, and all were married. The mean FSFI score of the patients was 21.1 (±8.9) and 26.55, 72.3% of patients were found to have sexual dysfunction. FSFI scores were found to have a negative correlation with age (r = -0.398, P = .001), duration of diagnosis (r = -0.338, P = .001), and EDSS scores (r = -0.326, P = 0.040). Patients taking symptomatic medication (P = .032) and antidepressants (P = .012) had lower mean FSFI scores. Additionally, the FSFI score showed a significant negative correlation with the FSS (r = -0.368, P = .001), the BDI (r = -0.423, P < .001), the PSQI (r = -0.314, P = .004), and the MSQoL-54 (physical health: r = 0.509, P < .001 and mental health: r = 0.431, P < .001).

CLINICAL IMPLICATIONS

A comprehensive evaluation of sexual dysfunction and the development of tailored treatment plans, taking into account associated factors, will be beneficial for female patients with MS.

STRENGTHS AND LIMITATIONS

Small sample size and assessment of sexual function by a generic scale are the limitations of this study.

CONCLUSION

Considering the multifactorial nature of sexual dysfunction in female MS patients, it is recommended that patients be assessed multidimensionally during outpatient follow-up visits.

Sexual function and related predictors in male with multiple sclerosis and neuromyelitis optica spectrum disorder: a case-control study

BACKGROUND

Sexual dysfunction (SF) is a prevalent and distressing comorbidity in males with multiple sclerosis (MwMS) and neuromyelitis optica spectrum disorder (MwNMOSD).

AIMS

This study aimed to assess the SF in MwMS and MwNMOSD in comparison to male healthy controls (HCs) and identify its associated predictors.

METHODS

This case-control study was conducted from February 2023 to January 2024 at the MS clinic of Kashani Hospital, Isfahan, Iran. Participants included 49 MwMS, 27 MwNMOSD, and 40 HCs. Demographic, clinical, and psychological data were collected, and SF was evaluated by the International Index of Erectile Function (IIEF). Linear regression was used to assess relationships between variables.

OUTCOMES

SF was significantly worse in the MwMS and MwNMOSD compared to the HCs.

RESULTS

SF was significantly lower in MwMS and MwNMOSD compared to HCs. In MwMS, significant independent predictors of SF included partner's education (B = -2.7, P = .003), anxiety (B = -0.6, P = .003), and depression (B = -0.3, P = .026). In MwNMOSD, significant independent predictors of SF were EDSS (B = -5.7, P = .007) and anxiety (B = -1, P = .002).

CLINICAL IMPLICATIONS

Controlling risk factors such as depression and anxiety can improve SF of MwMS to a significant extent.

STRENGTHS AND LIMITATIONS

Despite limitations like the cross-sectional design and exclusion of certain variables, our study identifies significant associations between sexual dysfunction and various risk factors in MwMS and MwNMOSD, emphasizing the need for future longitudinal research.

CONCLUSION

MwMS and MwNMOSD exhibited worse SF than HCs. Multiple factors have been identified as independent predictors of SF within these patient groups.

The global prevalence of sexual dysfunction in women with multiple sclerosis: a systematic review and meta-analysis

BACKGROUND

Sexual function is often impaired following neurological disorders such as multiple sclerosis (MS). Young women with MS encourage disruptions in sexual function, sexual behaviors, and family formation as common global problems. Thus, the aim of the present systematic review and meta-analysis study was to investigate the global prevalence of female sexual dysfunction (FSD) worldwide.

METHODS

Various databases (PubMed, Scopus, Web of Science, Embase, and ScienceDirect) along with Google Scholar search engine were hired for systematic searching in the field of the prevalence of FSD (by July 2022). The heterogeneity of the studies was assessed using I2 index, and random effects model was used to perform the analysis (CMA software, v.2).

RESULTS

Following assessment of 14 included studies with the sample size of 2115 women, a total prevalence of sexual dysfunction (SD) in women with MS was reported 62.5% (95% CI 53.9-70.5). Meta-regression assessment also showed that FSD accelerates following increasing the sample size and the year of the studies.

CONCLUSION

The total prevalence of SD in women with MS was found considerably high (62.5%) in the world, which needs more serious attention by health policymakers. Correct implementation of health policies can potentially increase the society's awareness and successful treatment of SD in MS patients.