Erectile Dysfunction in Multiple Sclerosis

What is Multiple Sclerosis(MS)?

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system.It is a potentially disabling disease of the brain and spinal cord (central nervous system).In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause permanent damage or deterioration of the nerves.

In which age people Multiple Sclerosis mostly observed?

Multiple sclerosis (MS), usually diagnosed between the age of 20 and 40 years , is one of the most frequent diseases of the central nervous system resulting in both somatic motor and autonomic disturbances.

What are the Signs and Symptoms of Multiple Sclerosis?

Signs and symptoms can widely differ from patient to patient, depending on where the lesions are located. The main autonomic nervous system disorders include 

  1. sweating abnormalities
  2.  lower urinary tract dysfunctions (LUTDs)
  3.  gastrointestinal symptoms and 
  4. sexual dysfunctions (SDs).

Among these, sexual dysfunctions (SDs) are common, but often underestimated symptoms, even if their impact on the quality of life is remarkably high. The reported rate of sexual dysfunction (SD) in multiple sclerosis (MS) patients ranges from 50% to 90%, depending on the clinical characteristics of the studied population and the duration of follow-up. The most common sexual complaint in a multiple sclerosis (MS) male is erectile dysfunction (ED), that can be found in 23% to 91% of patients. Sexual dysfunctions (SDs) in multiple sclerosis (MS) are a complex set of conditions, associated with anatomic, physiologic, biologic, medical and psychological factors.

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How Multiple Sclerosis can cause Erectile Dysfunction?

Sexual dysfunctions (SDs) are common and are very distressing symptoms of multiple sclerosis (MS).Studies have shown that the proportion of sexual dysfunctions (SDs) in multiple sclerosis (MS) is greater than in other neurological diseases, and almost five times higher than in the general population. A study by Central Europe journal of Urology contributed to this under-investigated topic, analyzing the prevalence of sexual dysfunctions (SDs) in multiple sclerosis (MS) male patients and their influence on the sexual quality of life. According to a review article by Schmidt et al, sexual dysfunctions (SDs) are estimated to occur in between 64% and 91% of men with multiple sclerosis (MS), erectile dysfunction (ED) being the most commonly reported (19–62%). In the present study the high prevalence of erectile dysfunction (ED) (74.2%) is consistent.

1. Erectile Dysfunction caused by Damaging Myelin

It is generally known that multiple sclerosis substantially determines a generalized demyelination process that interrupts the continuity of the neural pathways and alters the neural function that is essential for normal erection function (EF).

2. Depression

Multiple sclerosis can be responsible for depression which affects erections.

Depression is the most common psychiatric disorder in multiple sclerosis (MS) patients and is more prevalent than other chronic diseases. In multiple sclerosis (MS) patients, many factors can trigger depression such as localization of brain lesions, psychosocial factors, drugs used for treatment, and disabilities of patients. The prevalence of depressive symptoms was high in men with multiple sclerosis and consistent.

Patients with multiple sclerosis (MS) who are depressed might not search for sexual intimacy, and, conversely, patients with multiple sclerosis related sexual dysfunctions might experience reactive depression.

And even the medications used for treating depression can cause erectile dysfunction, as dopamine is known to enhance libido and sexual arousal while serotonin has a clear inhibitory effect on sexuality.

3. Lower urinary tract symptoms (LUTS)

High percentage (75%) of multiple sclerosis (MS) patients experience lower urinary tract symptoms (LUTS).Lower Urinary Tract might not directly impact erections but there has been a large body of evidence linking lower urinary tract symptoms (LUTS) with depression.

Depression and Depression medications are directly linked to Erectile Dysfunction and other Sexual Dysfunctions.

4. Lowering testosterone levels

Multiple Sclerosis causes the lowering of testosterone levels in the blood which causes erectile dysfunction.


Multifactorial etiology of erectile dysfunction (ED)is observed in multiple sclerosis (MS). Therefore, in clinical practice, each patient needs an individualized evaluation of factors that could contribute to his sexual problems, but unfortunately, the majority of physicians may lack adequate training to discuss it with their patients. Particularly diagnosing sexual dysfunctions (SDs) in multiple sclerosis (MS) men seem to be increasingly important, as effective methods to treat these conditions are available. In fact, Chao et al. found that intracavernosal therapy with trimix could be effective for neurogenic erectile dysfunction (ED), including in multiple sclerosis (MS) patients. 

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