Treatment of sexual dysfunction in MS remains an unmet need for patients, in part because clinicians do not inquire about it.
Previous research indicates that, in addition to typical MS symptoms, patients with the disease may also experience sexual dysfunction, which can greatly affect mental, emotional, and physical well-being and decrease QOL. The prevalence of sexual dysfunction in people with MS ranges from 40% to 80% for women and 50% to 90% for men. However, patients with MS are rarely screened for sexual dysfunction, which can lead to underdiagnosis and delayed treatment.
As many as two-thirds of patients with MS have reported their physicians do not frequently ask about sexual problems. A variety of potential barriers have been identified, including apprehension from physicians about inquiring about sexual function or sex in general as well as a lack of time during patient consultations. The presence of a family member or friend during a consult or a lack of knowledge of sexual dysfunction as a comorbidity associated with MS are other possible barriers to screening.
Exploring Barriers to Sexual Function Evaluations
Considering the substantial impact of sexual dysfunction on QOL, self-image, self-esteem, and interpersonal relationships, it is important to understand how neurologists assess and treat sexual dysfunction and the barriers physicians face during evaluations of patients with MS. “These efforts are paramount to enhancing and optimizing care and can inform efforts to educate clinicians on sexual function in MS,” says Silvia Juliana Bueno Florez, MD.
For a study published in BMC Neurology, Dr. Bueno Florez and colleagues aimed to describe how neurologists assessed and treated sexual dysfunction and explore possible barriers during evaluations of sexual function. Investigators developed a questionnaire for neurologists with sections asking participants about demographic data, evaluation and treatment of sexual dysfunction, and possible reasons for not discussing it with patients. Answers were grouped according to the type of consultation. The questionnaire was sent to 326 neurologists; 50 completed the survey.
Sexual Dysfunction Remains a Significant Unmet Need
Among respondents, 64% of neurologists stated they typically studied sexual dysfunction in neurological disorders, with 86% saying they received information via private reading and 14% receiving such information by attending medical conferences. Among the 29% of clinicians who worked within an MS program, all asked their patients about sexual function. Conversely, approximately 19% of physicians working outside an MS program never asked about sexual function.
The study identified several key reasons for not discussing sexual dysfunction when managing patients with MS, the most common of which were lack of knowledge, the presence of a companion, and not having time (Table). Most neurologists (91%) reported their patients usually and frequently inquired about sexual function. Approximately 80% of neurologists employed informal questions to evaluate sexual function, but only about two-thirds reported being aware of validated sexual dysfunction questionnaires. When sexual dysfunction was detected, most neurologists referred patients to another specialist and did not start any treatment.
Efforts Needed to Strengthen Knowledge of Sexual Dysfunction
According to Dr. Bueno Florez, it is critical that efforts be made to improve knowledge among neurologists and patients with MS about the diagnosis and treatment of sexual dysfunction. “It’s also crucial to remove barriers surrounding this topic,” she says. Evaluation and treatment of sexual function should be included as a key part of routine care for patients with MS.
Based on the findings, the study authors offered recommendations to potentially eliminate gaps and barriers. For example, to maximize the time available during patient consultations, questionnaires about sexual dysfunction can be filled out in the waiting room or sent before appointments via email. “It’s important for clinicians to explore with their patients how they want their sexual function to be assessed,” says Dr. Bueno Florez. Furthermore, including sexual dysfunction topics in conferences, symposia, and local education sessions could be useful for strengthening knowledge of sexual dysfunction in MS.