Prevalence of sexual dysfunction in relapsing-remitting multiple sclerosis and its association with brain and cervical cord MRI findings

Abstract

Sexual dysfunction (SD), a prevalent yet underreported complication in multiple sclerosis (MS), significantly impacts quality of life. This cross-sectional study at Imam Reza Clinic, Shiraz University of Medical Sciences, evaluated SD prevalence in 80 relapsing-remitting MS (RRMS) patients (65 females and 15 males; mean age 38.7 years) compared to 80 demographically matched controls (61 females and 19 males; mean age 39.1 years). SD was assessed using the Female Sexual Function Index (FSFI) for females and the International Index of Erectile Function (IIEF) for males, alongside brain-focused MRI to examine morphological changes. Female RRMS patients had significantly lower FSFI scores (mean 21.80, SD 7.13) than controls (mean 27.86, SD 4.83; p < .001). FSFI scores negatively correlated with cerebrospinal fluid volume (r = −0.297, p = .016), disease duration (r = −0.319, p = .010), fatigue (r = −0.412, p = .001), and depression (r = −0.387, p = .002). Male RRMS patients showed lower IIEF scores (mean 64.40, SD 8.77) compared to controls (mean 73.21, SD 2.84; p = .0012), with positive correlations between IIEF scores and insular cortex volume (r = 0.576, p = .025), cerebellar grey matter volume (r = 0.727, p = .002), and total grey matter volume (r = 0.846, p < .001). Multivariate regression identified MRI measurements, disease duration, and fatigue as independent SD predictors (p < .05). The high SD prevalence in RRMS, with distinct sex-specific neuroimaging correlates, highlights the need for routine SD screening and tailored interventions in MS care to improve patient outcomes.