Estimates of the prevalence of sexual dysfunction with multiple sclerosis (MS), as well of its risk factors, differ depending on the specific cutoffs used to assess sexual health on a standardized test, a study highlights.
Regardless of the cutoff given, however, findings suggest that patients with poorer cognition tend to report more problems with sexual performance and satisfaction, implying that interventions to improve cognition also may improve sexual health.
Sexual issues with MS often assessed using the MSISQ-19 questionnaire
Sexual dysfunction can be a common MS symptom. It may be caused directly by MS-related damage to the nervous system that results in problems with arousal, or indirectly by symptoms like fatigue, spasticity, or depression that make it more difficult to pleasurably engage in sexual activities.
Sexual issues in MS often are assessed using a standardized questionnaire called the MS Intimacy and Sexuality Questionnaire-19 (MSISQ-19), in which patients rate how often they experience 19 different sexual problems on a scale from 1 (never) to 5 (always).
Higher scores on the MSISQ-19 are broadly indicative of issues with sexual performance and satisfaction. However, there is no set definition for when MSISQ-19 scores are high enough to constitute “sexual dysfunction.” This means that it’s hard to compare the results of different studies that may use different cutoffs, and also difficult to estimate exactly how common sexual dysfunction is with multiple sclerosis.
Scientists in Italy set out to test how different MSISQ-19 cutoffs might change the frequency of sexual dysfunction. The team conducted an online survey that included the MSISQ-19, as well as various other questionnaires assessing factors like depression and cognitive ability.
Their survey was answered by 1,155 people with MS, of whom 949 reported being sexually active recently. Patients’ average age was around 40, about two-thirds identified as female, and 79% identified as heterosexual. More than half (67%) were either married or living with a partner, and the group’s average disease duration was 11.62 years.
After gathering MSISQ-19 scores from these patients, the researchers compared two score cutoffs as defining of a problem. Under one definition, a total score higher than 30 was considered to indicate sexual dysfunction. According to this definition, 54% of patients had sexual dysfunction.
Under the other definition, a score of 3 or higher on any one item of the MSISQ-19 was considered as sexual dysfunction. By this definition, 45% of patients had sexual dysfunction.
“Applying two different MSISQ-19 cut-offs to the same population we obtained a 10% difference in [sexual dysfunction] prevalence,” the researchers wrote. They also noted that, for both definitions, the rate of sexual dysfunction was comparable among male and female patients, and also among patients who were or were not sexually active.
With individual items on the MSISQ-19, female patients more frequently reported difficulty reaching orgasm or feeling less attractive due to MS, while male patients most commonly reported difficulty getting or maintaining an erection and feeling less masculine due to MS. Across sexes, mobility issues commonly were noted as causing difficulty with sexual activity.
The scientists then conducted statistical analyses into factors that significantly associated with a higher risk of sexual dysfunction, as defined by either cutoff.
Based on the total score higher than 30 cutoff, sexual dysfunction was significantly more common among patients who were older, had anxiety, or had cognitive impairment. Based on the MSISQ-19 item higher than 3 cutoff, risk factors for sexual dysfunction were greater motor disability or cognitive impairment.
Better cognitive abilities ‘consistently’ tied to fewer sexual dysfunction reports
“Interestingly, higher score in self-reported cognitive performance was the only factor consistently associated with a decreased [sexual dysfunction] risk” across both cutoffs, the researchers wrote. This suggests that interventions aiming to improve or preserve cognition may also help improve patients’ sexual health, they added.
Apart from cognition, the fact that the two cutoffs associated with different risk factors “is of great relevance, as it underlines how the role of [possible] risk factors might substantially change redefining the outcome of interest in the context of the same instrument,” the researchers wrote.
The team emphasized that, in studies of sexual health in MS, scientists need to take care to ensure that the specific cutoffs used are appropriate for the type of research being done. Findings also highlight that it may not be reasonable to directly compare the results of different studies that used different cutoffs, the researchers noted.
“We demonstrated that applying different MSISQ-19 cut-offs influences both the estimated prevalence and the identification of risk factors for [sexual dysfunction], underlining the need for careful study planning in future works, and reinforcing the concept that direct comparison of seemingly similar studies should be avoided,” the scientists wrote.