Living with MS can have a profound impact on your sex drive and sexual desire. It can undermine your sense of self, sexual identity and enjoyment of sex, and in turn your confidence as a sexual partner or potential partner. For some people this may lead to occasional, temporary episodes when it's difficult to be motivated or interested in sex. For others it can result in a lasting reduction in their sex drive.
There are lifestyle approaches that may help you challenge some of the effects of reduced sexual desire.
What is sexual desire?
Sexual desire or sex drive (libido) is an important aspect of your sexual response as it's behind the urge to engage in sexual activity. Although it's not fully understood, desire is thought to be a combination of psychological factors - including how you view yourself, how you see a partner, any previous positive or negative sexual experiences, cultural or religious factors, your mood - together with physiological factors such as hormone imbalances and increased nerve activity in the brain and muscles in the body.
What causes reduced sexual desire?
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 you look to others. This 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 think there's an issue. Although you might not experience desire before sex, this doesn't mean you can't become aroused or still respond to and enjoy intimacy or sexual activity.
- MS symptoms may affect your sex drive. For instance, fatigue and depression can impact on desire, or pain and spasms may make sex physically uncomfortable. Fear of symptoms can also play a role. For example being anxious about losing control of your bladder or bowels during sex might mean you don't anticipate 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 also play a part. Stress, anxiety and depression can all have an effect, as 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.
How many people have reduced sexual desire?
Research studies found that between three and four people in ten in the general population have a decreased interest in sex. It's difficult to know how many people with MS are affected as sexual problems are usually underreported.
What can I do if I have reduced sexual desire?
Difficulty in satisfying your sexual needs can be a source of frustration, disappointment or distress. The most important starting point for managing any sexual issues is a willingness to talk about them. Read more about talking about sexual issues
Negative thoughts about yourself as a sexual partner can lead to a vicious circle - if you have a poor image of yourself you may generally be less inclined to initiate or engage in sexual activity, which in turn can make you feel worse. Choosing to make changes to challenge these feelings takes time and effort, but the cycle can be stopped.
Approaches such as CBT (cognitive behavioural therapy), acceptance and commitment therapy (ACT) and mindfulness can help you learn to recognise negative thoughts, feelings and behaviours and help to find new, positive ways of managing. With practise you can learn to manage these thoughts and have a satisfying sex life despite them.
If MS is reducing your confidence, you may feel like shutting yourself off from the world - particularly if relationships suffer setbacks. Keeping in regular contact with friends and meeting other people helps to keep difficulties in proportion. If you are looking for a partner, dating websites can be a good way to build up your confidence before arranging a face-to-face meeting.
Staying as active as you're able to is vital for both good 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 about and can help you to feel better about yourself.
Our physical confidence can be knocked by a variety of life events, such as childbirth, illness or the general ageing process. If your body image has changed because of your MS, it can take time to learn to be comfortable with your body again. Making the most of the things you love about yourself, whilst learning to embrace your imperfections 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 some of the things you can do, try to focus on the things you like about yourself and what you see as your strengths. You may find you have new strengths that have arisen from living with MS, such as resilience, adaptability or a sense of humour.
Sexually this is important too. It's not always what you do, but how you do it. If certain activities or positions are difficult or no longer pleasurable, 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 that sex can still be very enjoyable without having an orgasm. Expressing love and affection, being intimate and feeling aroused are just as pleasurable. Try to enjoy the process, exploring 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. Simple closeness, such as holding hands, kissing, cuddling and enjoying each other's company are vital to a relationship and can reassure both partners that you are still desirable. This distance can help you to reassess what's important to your relationship and also consider your erotic and sexual likes and dislikes without the pressure to try to instantly act them out.
Talking about sexual problems
The most important starting point for managing sexual problems due to MS is to be willing to talk about them.
Sex and MS: depression, fatigue and disability
1 September 2017
This research looks at the relationship between sexual problems in MS and symptoms, such as depression, fatigue and level of disability.
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