Hidden Challenges: A Cross-Sectional Study on Prevalence and Determinants of Sexual Dysfunction in Men and Women with Multiple Sclerosis

TL;DR

This study finds that sexual dysfunction is common in people with multiple sclerosis, especially affecting quality of life and fatigue more in women.

Contribution

The study quantifies sexual dysfunction in relapsing-remitting MS patients and identifies sex-specific patterns and associations with fatigue and quality of life.

Findings

Most participants reported sexual dysfunction across all assessed domains.

Women experienced higher fatigue and worse physical health outcomes compared to men.

Secondary sexual dysfunction was most common in both men and women.

Abstract

Background and Objectives: Sexual dysfunction (SD) is common in multiple sclerosis (MS) but remains under-recognized in routine care. This study aimed to quantify the burden of SD in men and women with relapsing–remitting MS (RRMS), describe sex-stratified patterns across primary/secondary/tertiary domains, and examine associations with fatigue and MS-related health-related quality of life (HRQoL). Materials and Methods: In this cross-sectional observational study, RRMS participants were voluntarily recruited online via a QR code linking to a Google Forms survey. Men completed the International Index of Erectile Function-5 (IIEF-5), and women the Female Sexual Function Index (FSFI). MS-specific SD domains were assessed using the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ), alongside the Fatigue Severity Scale (FSS) and the Multiple Sclerosis Quality of Life questionnaire (MSQOL-54). Sex differences were tested using parametric/non-parametric methods as appropriate, with false discovery rate (FDR) and Bonferroni adjustments for multiple comparisons. Results: Thirty-seven participants were included (16 men; 21 women). Mean age did not differ by sex (35.9 ± 4.0 vs. 38.9 ± 10.4 years; p = 0.23). All participants reported at least some degree of difficulty across MSISQ domains. Among men, 87.5% screened positive for erectile dysfunction within this sample (mild 37.5%, mild-to-moderate 12.5%, moderate 12.5%, severe 25.0%). When dysfunction type was defined as the highest MSISQ domain score, secondary SD was most frequent in both sexes (75.0% men; 76.2% women; p = 0.49). Women showed higher secondary domain scores at the uncorrected level (p = 0.04), but this did not survive FDR correction. In HRQoL and symptom measures, women reported markedly higher fatigue (FSS 46.1 ± 12.4 vs. 25.5 ± 12.7; p_FDR < 0.001) and poorer physical health indices, including pain-related outcomes. Conclusions: SD has represented a substantial burden within this RRMS sample, with secondary domain predominance in both sexes, highlighting the clinical relevance of symptom-related and functional interference. These findings support the value of multidimensional sexual health assessment in clinical research settings and may be relevant for clinical assessment and future research in MS.

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