Sexual problems in patients suffering from multiple sclerosis.

A questionnaire which allowed anonymous answering and which also included many other questions besides those dealing with sexual life was sent to 302 patients suffering from multiple sclerosis (MS). Sexual life had changed for 91% of males and 72% of females. About half of the patients replied that their sexual life was unsatisfactory or had ceased altogether. These patients were as a rule in a relative poor physical condition. In males, disturbances in erection (62%) were the most common problem, erection was normal in only 20%. In females the essential figures were: loss of orgasm in 33%, loss of libido in 27% and spasticity in 12%. There was no correlation between the incidence of sexual disturbances and the duration of the MS. It seems that the neurological disturbances in sexual life depend simply on the location of the plaques in the central nervous system.     

Sexual and micturition problems in multiple sclerosis patients: Psychological issues

Sexual dysfunction and micturition problems are widespread in MS patients. Especially in the case of sexual dysfunction, there is a complex interplay of factors. It is important that counsellors are well aware of this. The most common links between symptoms and iatrogenic effects too are discussed. Since sexuality not only consists of performance but also of desire, the major influences of MS on the patients' and their partners' fantasies are discussed. It is shown how patients and partners often increase their handicap due to inhibition to trying out new experiences and roles. In addition, the place of sexuality in the couple and sociocultural influences are discussed.     

Sexual dysfunction in patients with multiple sclerosis

In patients with multiple sclerosis many different types of sexual problems may exist. Paraesthesiae and decreased sensibility in the genital region may interfere with the perception of pleasurable sensations and diminish the sexual response. Lesions especially of the spinal cord may also result in impotence or loss of ejaculation. Brain lesion may cause a decrease in libido and alter the sensation of orgasm. Symptoms of sexual dysfunction are fairly common even among early and mild cases of multiple sclerosis. In advanced cases sexual problems are very common. In such cases different psychological mechanisms may play an important role. The importance of sexual counselling and sexual rehabilitation in patients with multiple sclerosis is discussed.     

Exploring the problems of multiple sclerosis and the requirements for assistance

Zusammenfassung Die Schweizerische Multiple Sklerose Gesellschaft (SMSG) hat in den siebziger Jahren bei 2250 Personen, die von der Multiple Sklerose befallen und die Abonnenten des vierteljährlich erscheinenden Mitteilungsblattes sind, eine Erhebung durchgeführt. Daraus ist eine vertiefte Studie hervorgegangen, die sich auf 1523 zurückgesandte Fragebogen stützt. Diese hat die Komplexität der Situation der MS-Kranken und ihrer Angehörigen anschaulich gemacht. Von ihren Bedürfnissen ausgehend ausreichend bemessen hat die SMSG ihr Aktionsprogramm anfangs des Jahrzehnts 80 neu überdacht und beschlossen, ihren Personalbestand zu erweitern.

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An investigation on the problems of multiple sclerosis and resulting need for assistance

Summary In a study conducted by the Swiss Multiple Sclerosis Association (SMSG) 1523 of 2250 patients receiving the Quarterly Informations answered in a survey by mail questionnaires. Results provide an illustrative account of the difficult and complex situation of the patient and their relatives. They are the basis for the action programme for the eighties of the SMSG and the reason for an increase in the staff of the association.

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Investigation des problèmes posés par la sclérose en plaques (SP) et des besoins d'aide qui en découlent

Résumé La Société suisse de la sclérose en plaques (SSSP) a procédé à la fin des années 1970 à une enquête auprès de 2250 personnes atteintes de sclérose en plaques abonnées à son bulletin trimestriel d'information. Il en est ressorti une étude approfondie se fondant sur 1523 questionnaires qui lui ont été retournés. Celle-ci a mis en évidence la complexité de la situation des malades SP et de leurs proches. C'est en partant de leurs besoins, largement quantifiés que la SSSP a repensé son programme d'action au début de la décennie 1980 et a décidé d'augmenter ses effectifs en personnel.

     

Survival in multiple sclerosis

Survival from onset of symptoms was calculated for two series of MS patients, a population-based epidemiologic series from southern Lower Saxony of 224 cases, and a revised hospital series of 1429 cases from 11 neurologic centers throughout the Federal Republic of Germany. Median survival for the epidemiologic series was 35-42 years, with no finer estimate possible. Observed survival was 3/5 expected survival after 35 years of illness. Survival in this series was similar to that from two other population-based reports. No significant difference was found between the sexes, though patients with onset at age 35 + had a significantly shorter survival than those with onset at age under 35 years. The much larger hospital series, where median survival was 30 years, demonstrated significant differences separately favoring females and young onsets. However, the ratios of observed to expected survival from population life tables were strikingly similar among all four subgroups defined by sex and age at onset. While overall there is a substantial reduction in the expectation of life in MS, the differential survival by sex and age appears to be a reflection of the expected survival by sex and age per se, and not that of the disease.     

Bowel dysfunction in multiple sclerosis

Bowel symptoms are seen in two thirds of multiple sclerosis (MS) patients, constipation and fecal incontinence, frequently coexisting, being the major symptoms. Since bowel symptoms are common in community, the need for precise definitions of pathology are stressed. Pathophysiological studies of bowel function are reviewed and the following hypothesis is suggested: Constipation is caused by a delay in colonic transit time, by a delay in the defecation reflex and by early external sphincter exitation. Fecal urgency/incontinence may be explained by impaired rectal sensation, not warning the patient to seek the toilet in time. Decrease in rectal compliance and in some patients abnormal rectal contractions may facilitate fecal expulsion and weak external sphincters allow leakage. Treatment options are commented and the need for treatment studies stressed.     

Sexual problems in a Malian village

This research note summarizes findings from a pilot needs assessment conducted during 1993-94 in two development projects in Mali. The case studies included women in villages in Sienso and Niamana-Bancouman. The ethnic group was primarily Bwa and Marka as agriculturalists and Peulh as cattle breeders and agriculturalists. Qualitative information was collected by means of participatory observation, semi-structured interviews, single and mixed sex group discussions, and informal chats. Women initially were reluctant to talk even in private about sexual health problems, which were known to be quite common in the area. A short drama was developed for and by the community around the topic of childbirth practices. 150 adults and children attended the final one hour play. The enactment was introduced by the village leader, who was a supporter of women's rights. Subsequent discussions opened up conversation among adults. Girls' discussions at school focused on circumcision, family planning, and the workload of women. Night time discussions with team members focused on reproduction, sexuality, AIDS, and how to control infidelity. Afternoon school free-time became devoted to the equivalent of sex education classes with the use of an illustrated birth manual for birth attendants. Even a few boys were asked to join the group. The performance was repeated in neighboring villages and video taped. The crowd was large because of the entertainment rather than educational medium. The play served to build trust between the community and the team. Other key ingredients included a harmonious and dedicated team, flexibility, patience, humor, and growing friendships. Taboo areas for the first time were opened to discussion.