Background

Sexual dysfunction is a common, but underestimated symptom of multiple sclerosis (MS). Although sexual dysfunction may occur even as early symptom of disease or in people with mild neurological disability, only few patients report this symptom to their physician. Only few studies investigated association between sexual dysfunction and MS-related cerebral changes. But no studies specifically investigating sexual dysfunction and spinal cord pathology in MS.

Objectives

Objectives: 1) to identify the sexual dysfunction (SD) in females with MS using the Female Sexual Function Index (FSFI = 19-item questionnaire of the FSFI that concerns sexual function and satisfaction in sex life).

2) to explore the association between SD, physical disability and MR measures, especially lesion topology and spinal cord pathology.

Methods

In 251 women with MS (mean age: 43.3 ± 8.9 years; mean disease duration 14.7 ± 6.2), sexual functions were evaluated by using the Female Sexual Function Index (FSFI).

We determined potential confounding factors of sexual dysfunction: age; disease duration; physical disability; depression.

Global and regional brain volumes were measured by Morphobox Prototype; Lesion load and topography was assessed by LeMan-PV Prototype. Spinal cord (SC) volume was measured semi-automatically by ScanView.cz; SC lesions and diffuse abnormalities were assessed manually between C1 and Th4. We correlated disability measures and FSFI domains with one another and with MRI measures.

Results

Of the 251 female patients, 147 replied completely, with a response rate of 58.5%. Using a cut-off value of 28 for FSFI scoring, 60 out of 141 (42.5%) had sexual dysfunction (SD). FSFI total score and subscores correlated moderately with BDI (0.331, p=0.011), FSS (0.45, p=0.05) and weak to moderate negative correlations with EDSS (0.481, p=0.002), sensory (0.441, p=0.005), bowel and bladder (0.346, p=0.031), pyramidal (0.481, p=0.002), cerebellar (0.434, p=0.006) and cerebral FS (0.39, p=0.014)scores. Women with- and without SD did not differ in cerebral lesion load and/or lesion topography.

Conclusions

We found no association between measures of SD, total and regional brain volumes, spinal cord volume, cerebral lesion load and topology. SD in women with MS is associated with higher disability, disease duration, and degree of concomitant fatigue and depression rather than specific lesion topology. The major limitation of this interpretation is the absence of a SC imaging distal from Th4.

Supported by grant of Czech Ministry of Education Progres Q27/LF1.