A lack of, or reduced, interest in sex is an issue for many people, not just those with MS. Desire can fluctuate for a variety of reasons. For example, it tends to be higher at the start of a relationship than in a more established partnership. Life circumstances may also have an effect. Having young children or other caring commitments can reduce desire. As can feeling under pressure or living with illness. Hormonal changes due to pregnancy, menopause, hormone treatments or ageing can also impact how you feel about sex.
Living with MS may affect your sex drive too. This might be:
- directly – because of the location of lesions in your brain
- indirectly – if you’re feeling anxious, fatigued, have experienced a loss of self-esteem, or as a side effect of medication.
MS can challenge your sense of self, sexual identity, and enjoyment of sex. Which, in turn may affect your confidence as a sexual partner or potential partner. This may lead to occasional, temporary episodes where you're less interested in sex. For some people it can result in an ongoing reduction in their sex drive.
Desire, or your libido or sex drive, is an important part of your sexual response. It's behind the urge to engage in sexual activity. Your level of desire is very connected to your state of mind. A whole range of psychological factors can affect how you feel about engaging in sexual activity. How you view yourself, your mood, stress levels, and any previous sexual experiences are all important.
Physiological factors can also influence whether you feel like having sex or not. This could include any hormone imbalances or increased nerve activity in the brain and muscles in the body.
A range of factors can have a role in reducing your desire for sex.
- A loss of self-confidence may add to your doubts about expressing your sexuality. Or make you feel self-conscious about how others view you. It can make you feel isolated, less attractive and result in less interest in sex. You may worry that you're no longer fulfilling your sexual role in a relationship – even if your partner doesn't agree.
- MS symptoms may affect your sex drive. For instance, fatigue and depression can impact on desire. Pain and spasms may make sex uncomfortable. Fear of symptoms can also play a role. For example being anxious about losing control of your bladder or bowels during sex. This might mean you don't look forward to sex, and the pleasure it can bring, in the same way as before.
- Reduced sexual desire is common in the general population and issues unrelated to your MS can play a part. Feeling under pressure or stress, anxiety and depression can all have an effect. So can worrying about things like work or finances. Physical factors such as hormone imbalances can lower your sex drive, as can alcohol or drug use.
Research studies suggest that in the general population between three to four people in ten have a decreased interest in sex. It's difficult to know how many people with MS are affected as sexual problems are usually underreported.
Difficulty in satisfying your sexual needs can be frustrating, disappointing or even distressing. A good starting point for managing any sexual issues is a willingness to talk about them. Read more about talking about sexual issues.
Be positive
Negative thoughts about yourself as a sexual partner can lead to a vicious circle. If you have a poor image of yourself, you may feel less inclined to initiate or engage in sexual activity. Which can make you feel worse. Choosing to challenge these feelings and make changes takes time and effort. But the cycle can be stopped, and you can have a satisfying sex life despite them.
Approaches such as CBT (cognitive behavioural therapy), acceptance and commitment therapy (ACT) or mindfulness may help. With practise you can learn to recognise negative thoughts, feelings, and behaviours. Whilst developing new, positive ways of managing.
Stay active
Staying as active as you're able to is vital for both your physical and mental health. Regular exercise can help reduce stress, low mood, and fatigue. This doesn't have to mean following an exercise regime or taking up a sport. Activities such as gardening or photography still get you out and can help you feel better about yourself.
Physical confidence
Our physical confidence can be knocked by a variety of life events. Childbirth, illness, or the ageing process often alter how you feel about your body. If you’ve lost confidence because of your MS, it can take time to learn to be comfortable with your body again. Make the most of the things you love about yourself and learn to embrace your imperfections. This can give your self-esteem a huge boost. Remember you don't need to be perfect to be sexually attractive.
Remember your strengths
Although MS may have affected what you can do, it can be helpful to focus on your strengths. You may even develop new strengths as a result of living with MS, such as resilience or adaptability.
Sexually this is important too. It's not always what you do, but how you do it. Are certain activities or positions difficult or no longer pleasurable? Then explore what does work for you and concentrate on that. Don't forget your partner's needs. What do they like and how might you achieve this together?
It's not all about orgasm
Remember sex can still be enjoyable without having an orgasm. Expressing love and affection, being intimate and feeling aroused are just as pleasurable. Try to enjoy the process. Explore sensuality and touch, without being distracted by the need to reach climax.
Taking the focus away from sex itself is an approach sometimes used by sex therapists. Intimacy is vital to a relationship. Maintain closeness by holding hands, kissing, cuddling or simply enjoying each other's company. Touch is also a good way to maintain intimacy if there are times when some sexual activities aren’t possible or what you want. This can reassure you both that you still find each other desirable.
Making time for foreplay, considering what will turn you on mentally and help you relax physically can help create the right mood. Some people find fantasising helpful. You might even be happy to share your fantasies with your partner(s).
Give yourself space to consider your erotic and sexual likes and dislikes without any pressure to instantly act them out.
Psychological barriers
You will also need to consider any issues unrelated to MS. For example, if you experience stress, anxiety, or depression. Or you feel guilty that you’re not fulfilling the role you want in your relationships. These worries can alter how you respond sexually. Techniques such as CBT or mindfulness may be beneficial, but some people find psychotherapy or relationship counselling helpful to explore these kinds of issues.
