Erectile dysfunction

Erectile dysfunction is the inability to achieve or maintain an erection of the penis during sexual activity. Erectile dysfunction (ED), sometimes called impotence, is a common symptom for men with MS. 

Although there are drugs that can help with the physical symptom, effective treatment involves looking at lifestyle, psychological and emotional factors that may be contributing.

There are a number of possible causes for erectile dysfunction in men with multiple sclerosis.

Arousal and erection require a complicated interaction of nerve messages. When MS damages these nerve pathways, messages from the brain can be delayed or blocked meaning that the erection doesn't last long or, in some cases, may not occur at all.

Several MS symptoms can make it difficult to get or keep an erection. If you have pain or numbness in the genital area, potentially pleasurable sensations can become uncomfortable. Depression or reduced attention span or concentration can lead to distraction.

Fear of symptoms can also play a role. For example worry that sexual activity will cause spasms or fatigue, or that you might wet the bed or soil yourself.

If MS has dented your self-confidence or self-image, or affected how you think partners see you, this may undermine your ability to enjoy sex and make erections harder to maintain.

Problems with erections are relatively common in the general population and the cause of your symptoms may be unrelated to MS.  Factors that can affect sexual response include:

• Lifestyle factors, such as drinking too much alcohol, taking drugs, being overweight or smoking.
• Other medical conditions, such as heart disease, diabetes, high blood pressure or kidney problems.
• Worries, anxiety or stress about other aspects of your life.
• Side effects of medication, such as from some anti-depressants or anti-spasticity drugs.
• Ageing - difficulties with erections are more frequent in older men.
• Venous leak - a physical condition in which the extra blood in the penis is not retained during an erection.

The cause of your symptom may involve several factors, some related to MS and others not. Effective management requires a thorough assessment of all the possible contributing issues.

It is estimated that nearly one in five men in the general population has a problem with achieving an erection at some point, either every now and again or more consistently over a prolonged period of time. Erectile dysfunction is thought to be more common amongst men with MS and research suggests anything from one quarter to two thirds of men with MS may be affected at some point.

The most important and most powerful starting point for managing sexual issues is a willingness to talk about them. You can find suggestions on how to do that in our page about talking about sexual problems.

Although there are treatments available that can restore the ability to achieve an erection, the effective management of ED requires an assessment of the whole person. For example, if fatigue is affecting your sexual activity, a pill that makes it easier to achieve an erection is not going to resolve the problem of physical stamina.  Similarly, medication alone won't resolve feelings of being less sexually desirable that can come from living with a long-term condition.

As well as considering medication, treatment may involve counselling and finding new ways of being intimate that are better suited to your situation.

Erectile dysfunction can be treated with a class of medicines known as PDE-5 inhibitors. These include sildenafil, tadalafil, vardenafil and avanafil. Viagra is perhaps the most well-known brand of sildenafil, but there are a number of generic versions available as well.

If these first line drugs are not effective, there are other approaches that can be tried.

• Alprostadil (Caverject, Viridal Duo, Muse and Vitaros) - a different type of drug that is applied directly to the penis either as an injection, as a pellet or as a cream
• Vacuum constriction devices (VCDs) - the penis is inserted into a tube and the surrounding air pumped out, causing an erection. A tight band is placed around the base of the penis, trapping the blood and maintaining the erection for up to 30 minutes
• Surgical implants (prosthesis) - implants create erections mechanically using flexible rods or pouches that are filled with fluid. This is usually only considered when other options have not been successful.

• Sexual problems for men with MS
• Talking about sexual problems
• Sex and MS: a guide for men - (book)