Letter to the editor: Classification and management of sexual dysfunctions in multiple sclerosis patients: A review of current literature,Campetella et al

Dear Prof. Pier Francesco Bassi,

We read with interest the recent article by Campetella et al in which the authors review the current literature pertaining to sexual dysfunction in the Multiple Sclerosis (MS) patient. ¹ They highlight the importance of treating sexual dysfunction to improve quality of life. The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-19) is discussed with examples of primary, secondary and tertiary dysfunction provided.

Although a thorough literature review is discussed in the article the authors omit to mention the Tonic Study. ² This national study of 722 MS patients examined the relationship between depression, fatigue, physical impairments, demographic factors and sexual dysfunction. ² Over 80% answered questions related to sexual function with only 18.5% reporting no impact on intimacy. Sexual Dysfunction was found to be linked to MS subtype and expanded disability status scale. Additionally, depression was not directly associated with sexual functioning, but following analysis appeared as a consequence of the psychological issues regarding sexual dysfunction. ²

Another paper not covered in the review is the recent study employing the Index of Sexual Satisfaction (ISS), the Sexual Intimacy Questionnaire (SIQ), and the Folkman and Lazarus Coping Strategies Questionnaire to assess coping mechanisms in 122 female MS patients. ³ Analysis showed that problem-focused coping strategy improved sexual satisfaction whereas emotion focused coping strategies had negative impacts on improved sexual intimacy.

Treatment of sexual dysfunction in the MS patient requires a multidisciplinary approach involving Neurology, Urology and Rehabilitation teams, with all team members remaining aware of the patient’s age, relationship status, manual dexterity, disease course and disability.

The authors are to be commended for this review and in particular emphasizing the tertiary elements of sexual dysfunction, which are often overlooked by the neurourologist.