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Erectile Dysfunction as a Symptom of Multiple Sclerosis

Difficulty Acheiving and Maintaining an Erection Very Common in Men with MS

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Updated June 15, 2014

The mechanics of achieving an erection are probably not thought about very much until a problem occurs and something makes achieving or maintaining an erection more difficult than it used to be. Erections rely on nerves functioning properly and multiple sclerosis (MS) impairs nerve functioning, making erectile dysfunction one of the most common symptoms of MS reported by men.

I know I always say this, but in this case, I really mean it: Talk to your doctor. I can imagine that erectile dysfunction is not any man’s idea of a fun conversation, and that it probably often gets overlooked in neurological exams, where the focus tends to be on neurological signs and walking ability. However, this is one of those symptoms that actually can be treated successfully. Please. You owe it to yourself (and your partner) to ask your doctor for help. You’ll be glad you did.

What Does Erectile Dysfunction Feel Like?

While erectile dysfunction is defined broadly as the inability to attain or maintain an erection which is adequate for sexual intercourse, it also can have the following characteristics:
  • Inconsistent ability to achieve an erection
  • Dissatisfaction with size or rigidity of erection
  • Having erections of short duration
  • Requiring excessive time and/or stimulation to achieve erection

How Common Is Erectile Dysfunction in Multiple Sclerosis?

Erectile dysfunction is extremely common, with as many as 70 to 85 percent of men with MS experiencing problems with their erections. These typically are not the first MS symptoms that a man experiences, but happen some years after the onset of symptoms or diagnosis.

What Causes MS-Related Erectile Dysfunction?

Erections occur when signals from the brain and local nerves cause the muscles of the penis to relax, allowing blood to flow into two chambers on the underside of the penis. This makes the penis expand and become rigid. Erections happen in response to physical stimulation of the penis or in response to erotic situations (like kissing or foreplay) or thoughts.

Erections that happen as a result of genital stimulation are using nerves in the lower part of the spinal cord, and basically “bypass” the brain – the brain does not need to send messages in order for an erection to occur.

However, erections that are in response to other kinds of physical contact or erotic thoughts or visual cues do require processing by the brain. In this case, signals must pass from the brain along the whole spinal cord to reach the penis.

This is important, because depending on where in the brain or spinal cord the man has inflammation or demyelination, he may find that he is able to achieve erections in response to physical stimulation, but not foreplay or erotic situations (or vice versa).

How Severe Can Erectile Dysfunction Get?

Well, pretty severe – as in the complete inability to achieve any kind of erection. However, many treatments exist, and almost any case of erectile dysfunction can be treated to some degree.

Additional Points/Information

Ejaculation Is A Different Matter: Male orgasm (ejaculation) is a more complicated process than achieving an erection that requires fairly intact nerve pathways between the brain and lower spinal cord. For this reason, it is possible that a man can achieve an erection, but find ejaculation much more difficult or impossible.

Don’t Assume It’s MS: While it is pretty likely that erectile problems have something to do with MS, there can be other causes of erectile dysfunction. Diabetes, high blood pressure and high cholesterol are big culprits in causing problems with erections, and need to be managed.

Check Your Meds: Certain prescription medications that you might be taking for MS symptoms could be causing (or contributing to) your erectile dysfunction. These include:

  • Anticholinergics, prescribed for bladder dysfunction or diarrhea, including: propantheline, (Norpanth, Pro-Banthine) and dicyclomine (Bentyl)
  • Antidepressants, including:
    • Tricyclic antidepressants, such as amitriptyline (Elavil, Endep), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil-PM), nortriptyline (Pamelor).
    • Selective Serotonin Reuptake Inhibitors (SSRIs), including fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and paroxetine (Paxil).
    • Norepinephrine Reuptake Inhibitors, a newer class of antidepressants, which includes venlafaxine (Effexor) and duloxetine hydrochloride (Cymbalta).
  • Marijuana: If you are using marijuana, or any of its derivatives, for MS-related spasticity, tremor or pain (or for any other reason), be aware that marijuana use can lead to erectile dysfunction.

Sources:

Turkington, C. and Hooper, K. The A to Z of Multiple Sclerosis. New York: Checkmark Books, 2005.

C. D. Beits, S. J. Jones, C. G. Fowler and Clare J. Fowler. Erectile dysfunction in multiple sclerosis Associated neurological and neurophysiological deficits, and treatment of the condition. Brain Vol. 117, No. 6, 1303-1310, 1994.

Hennessey A, Robertson NP, Swingler R, Compston DA. Urinary, faecal and sexual dysfunction in patients with multiple sclerosis. J Neurol. 1999 Nov;246(11):1027-32.

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