SEXUAL DYSFUNCTIONS IN PATIENTS AFFECTED BY MULTIPLE SCLEROSIS: EVALUATION IN A CONTEMPORARY COHORT FROM A REFERRAL CENTER

Introduction & Objectives: We aimed to determinate the prevalence of sexual dysfunction (SD) in a cohort of patients with Multiple Sclerosis (MS) and investigate the correlations with course of disease, disability status, lower urinary tract symptoms (LUTS) and lesion sites. Materials & Methods: One hundred and twenty-one patients, 56 males and 65 females, 22 to 79 years old (mean age 46.2; SD:12.8), with clinical syndrome of MS were consecutively and prospectively studied. Patients were divided into three clinical groups based on course of disease: primary progressive (PP), relapsing– remitting (RR) and secondary progressive (SP). We investigated SD by using IIEF for male patients and PISQ-12 for female patients. Patients were evaluated for overall disability using the Expanded Disability Status Scale (EDSS). LUTS were investigated by using international established questionnaires: ICIQ-MLUTS for male patients and ICIQ-FLUTS for female patients. Lesion sites were determined by magnetic resonance imaging (MRI). We used SPSS 13.0 for Windows for statistical analysis. Chi-square tests were used to evaluate the measure of association. Spearman’s rank correlation was used to describe the dependence between two variables. A P-value <0,05 was considered statistically significant. Results: At least one SD was reported by 42% (51 out of 121) of patients. In 40% of patients SD occurred in the early stage of disease. SDs occurred in male patients with a higher frequency compared to female patients (52% vs. 34%; p<0,05). Among male patients the most common symptom was erectile dysfunction (47%), followed by hypoactive sexual desire (26%), delayed or absent ejaculation (26%) and reduced or absent orgasms (25%). Among female patients the most common symptom was reduced or absent orgasms (37%), followed by hypoactive sexual desire (33%) and dyspareunia (31%). 52% of male patients and 44% of female patients referred an ‘unsatisfied’ sexual life. Only 48% of patients reporting SD had previously spoken to a doctor about this problem. 75 patients had RR-MS; 33 patients had SP-MS and 13 had PP-MS. We found a significant correlation between disease course and SD, that was more frequent in SP (67%) and PP (60%) patients than in RR (27%) patients (p < 0,05). A direct correlation was observed between EDSS score and SD (p < 0,05). The average EDSS score was 4,03 (SD=2,2) in patients referring SD and 2,39 (SD=1,9) in patients without SD. We observed a direct correlation also between complaint of LUTS and SD (p<0,05). No significant correlation was found between SD and lesion sites at MRI (p>0,05). Conclusions: Our data confirmed the high prevalence of SD in MS patients, even if they are often underestimated. The prevalence is higher in males than in females. We found a correlation between SD and course of disease, EDSS score and LUTS.