The right to love and touch: sexuality and multiple sclerosis. Symptom management

Sexuality – what are we actually talking about?

Sexuality is an important element in our lives, from birth to old age.
but !! Sexuality is not just sex!! It’s much more than that.

Sexuality accompanies our lives in 3 forms ^1,2 :

1. Touch – soothing and encouraging, or stimulating and stimulating,

2. Emotion – affection and love or attraction and erotic excitement,

3. Special closeness to another person – physical and mental closeness or erotic intimacy

The expressions of sexuality can be erotic (eg, physical contact that provokes stimulation, sexual excitement and satisfaction). However, most expressions of sexuality during our lives are rather non-erotic. For example, hugging children, kissing family members or spouses, hugging while dancing, holding hands, having an intimate conversation in which difficulties or doubts are shared. All of these belong to our sexuality, and they contribute to calmness, to a sense of security, to reducing anxiety, to preventing a feeling of loneliness, to increasing self-confidence and allowing us to feel protected and desired. All these contribute to the quality of life and WELLNESS ^1,2 .

In conversations with patients, they share a frustrating experience. Sometimes, they feel lonely. Need a hug or an intimate conversation, to sit close together, and not beyond that. But for a hug, they are forced to have sex. As if there is a social message that if you hug and kiss you must progress to sexual relations. That is, even if they only need a non-erotic experience, a relaxing and pleasant human connection, they will have to participate in an erotic experience. Perhaps this is one of the reasons for the high rate of people’s dissatisfaction with their sexuality.

Sexuality contributes to health and WELLNESS

Sexuality makes a significant contribution to our physical and mental health ¹ . Many studies show that sex, as well as non-erotic touch, improves health in both the short and long term.

Below are 10 important health benefits of sexual activity ¹ :

1. The immune system is stronger, since sexual activity increases the level of immunoglobulins, which are an important component of the immune system.

2. A decrease in blood pressure and a reduction in the chance of developing heart disease has been found among people who have sex.

3. Estrogen and testosterone levels are kept high in the blood, so the risk of osteoporosis and its complications (fractures and damage to health) decreases.

4. Sexual activity protects people from cognitive decline and dementia during aging.

5. Sexual activity reduces pain and stress (for example, menstrual pain, chronic back pain, and even migraines). The reason for this lies in the hormonal changes that occur during sexual activity: a decrease in cortisol (stress hormone), an increase in dopamine (provider of pleasure), an increase in endorphins (blocks pain and reduces stress), and oxytocin (increases intimate connection and reduces pain).

6. Strengthening the pelvic floor muscles and vaginal flexibility, increasing vaginal moisture, due to blood flow to the pelvis and muscle work during orgasm.

7. The improvement of sleep due to the calm created by the physical and mental closeness between the couple. In addition, after the orgasm, prolactin is secreted – a hormone responsible for feelings of relaxation and sleepiness.

8. Sexual activity is physical, a kind of exercise class where the heart rate increases, muscles are activated and burn 85 calories in 30 minutes of sex.

9. Improvement in mood, decrease in level of anxiety and depression associated with sexual activity (erotic and non-erotic).

10. An increase in self-image, in the feeling of happiness and satisfaction, good mental health, partners feel more affection, touch more and support more.

Good sexual health is a right for every person

From this it is clear to us why the World Health Organization ³ has been declaring, for many years, that sexual health is considered a basic right of every person and an inseparable part of their general health. The World Health Organization speaks of the right of everyone to enjoy their sexual health and fertility, to control them according to their beliefs and social worldview, to receive up-to-date and comprehensive information about sexuality and safe sex, and to receive professional treatment for problems in this area. The World Health Organization further states that every person has the right to participate in safe and enjoyable sexual activity, without coercion, without discrimination, without deprivation and without violence.

When people around the world are asked about the role of sexuality in their lives, they find that it is important to young and old, to the healthy and to those living with illnesses and physical and mental disabilities. Despite the importance of the topic and its contribution to health, patients and their partners, as well as the medical and paramedical staff, have difficulty discussing it. The result is that the majority of those suffering from damage to their health, as well as people living with multiple sclerosis, do not get to receive an appropriate response to their sexual problem or the possibility to discuss their personal and marital intimate needs. One of the common reasons is the lack of knowledge and embarrassment of the professional staff and of people living with multiple sclerosis. Getting to know the changes in sexual function that accompany the disease, and understanding coping methods and solutions will allow MS patients and their partners to maintain their quality of life and WELLNESS ³ .

Problems with sexual function in people living with multiple sclerosis

A significant percentage of women and men with multiple sclerosis (40-80%) complain of problems with sexual function already at an early stage of the disease. These include loss of libido, erectile difficulties, decreased vaginal wetness and genital sensation, pain during intercourse, difficulty reaching orgasm, a change in its intensity or frequency, and a significant decrease in satisfaction. Almost any symptom of multiple sclerosis can affect sexual function: fatigue, depression, muscle weakness, spasticity, limited movement, pain, tingling, numbness, decreased sensation, visual disturbances, difficulty concentrating, or anxiety around incontinence ². All of these cause tension and vigilance that impair desire, the ability to concentrate and respond to sexual stimulation and a decrease in motivation to be a partner in a sexual experience. Some of the drugs given for the disease also disrupt sexual function. This is accompanied by psychological changes related to the loss of roles at home, in the family and at work, a decrease in self-confidence and body image, and the difficulty in accepting physical disabilities. All of these may have a negative effect on intimate relationships, sexual relations and cause an increase in personal and marital stress ² .

How to maintain healthy sexuality, marital intimacy and sexual function

Below is a list of tips, and all of them are relevant to people living with multiple sclerosis and also to their partners ^1,2 :

1. Don’t keep silent – talk about the problem: try to share with your partner and/or find professionals you feel comfortable with.

2. Treatment of anxiety, depression and difficulty accepting the disease and disability in order to restore desire and the ability to respond to sexual stimulation.

3. Choosing a new time to have sex, during hours when there is almost no fatigue, stiffness or pain in the body and the ability to concentrate is higher.

4. Treat erectile problems with a doctor specializing in urology or family medicine. Today there are effective treatments for erectile problems, for example, erectile dysfunction drugs, penile injections, shock waves, vacuum devices, and even surgery to implant a prosthesis.

5. Treat the problem of wetness in the vagina using lubricants to facilitate the visit to the vagina and to prevent pain during intercourse.

6. Contact a doctor specializing in gynecology or endocrinology to find out if there is a need for an appropriate hormonal balance, to improve blood flow to the female vagina and to increase sensation in the area.

7. to change the positions in order to allow non-erotic contact (curling, hugging, pampering) and intercourse.

8. Use aids for support and stability, such as support pillows, straps to prevent excessive mobility and a more stable physical feeling.

9. Pain during sexual intercourse in the woman and erectile difficulties in the man suppress sexual desire and prevent any sexual experience, therefore it is recommended to temporarily stop internal intercourse and instead have external intercourse (without visiting the penis inside the vagina) or have non-erotic sexual activity (hugging, pampering touch) ) and thus maintain intimacy and a close relationship.

10. Contact the professionals in order to receive appropriate advice to prevent “accidents” due to urinary or fecal incontinence during intercourse or contact.

11. Contact a sexual therapy clinic in order to improve communication and sexual openness and find together suitable solutions for having a pleasurable sexual activity for each of the partners. With the help of the sexual therapy, the couple will be able to more easily change their sexual habits (timing, location, positions, use of sexual aids for massage and effective stimulation in light of the decrease in sensation.

On the website of the Israeli Association of Sexologists you can find the list of public clinics and also the list of certified sex therapists at itam.org.il.

The author: Gila Bruner, MSW, MPH
Senior Sexologist, Chief Consultant and Mentor, Sexual Therapy Clinic, Tel Aviv Medical Center.
Founder and former manager of the sexology service, Sheba Medical Center.

Sources:

1. Basson R, Bronner G. Management and rehabilitation of neurological patients with sexual dysfunction. Handb Clin Neurol. 2015;130:415-434
2. Bronner G, Elran E, Golomb J, Korczyn AD. Female sexuality in multiple sclerosis: the multidimensional nature of the problem and the intervention. Acta Neurol Scand. 2010;121(5):289-301
3. World Health Organization. Sexual Health. https://www.who.int/health-topics/sexual-health#tab=tab_3 Accessed: May 14, 2023

Video: “Rehabilitation of the patients with Multiple Sclerosis”

Multiple Sclerosis. Exercises for stretching and improving body flexibility and joint mobility, reducing tone.

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Our website presents the following sets of exercises for the rehabilitation of the patients with Multiple Sclerosis:

1. MULTIPLE SCLEROSIS. EXERCISES FOR STRETCHING AND IMPROVING BODY FLEXIBILITY AND JOINT MOBILITY, REDUCING TONE

2. MULTIPLE SCLEROSIS. EXERCISES TO STRENGTHEN THE MUSCULOSKELETAL AND MUSCULAR SYSTEM, ENDURANCE

3. MULTIPLE SCLEROSIS. EXERCISES TO IMPROVE COORDINATION, BALANCE AND GAIT

4. MULTIPLE SCLEROSIS. STRETCHING AND WORKING WITH A MASSAGE ROLLER. ADVANCED STAGE OF REHABILITATION