Prevalence and Psychopathological Determinants of Sexual Dysfunction and Related Distress in Women With and Without Multiple Sclerosis

Introduction:Sexual dysfunction (SD) is common but still underdiagnosed in women with multiple sclerosis(MS); in fact, the lack of a consistent use of validated diagnostic tools makes the prevalence of SD and relateddistress difficult to define precisely.Aim:To assess the prevalence of SD in Italian women with MS compared with age-matched healthy controlsubjects (HC) and the association with demographic, psychological, and MS-related characteristics.Methods:The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale were administered to153 women with MS and 153 HC. Demographic, gynecologic, and neurologic data were obtained. Disabilitywas assessed using the Expanded Disability Status Scale. Psychological symptoms were evaluated in MS patientswith Profile of Mood State and the Beck Depression Inventory II.Main Outcomes Measures:Prevalence of SD and sexual distress in women with MS compared with HC.Results:Among women sexually active in the last month, we found an increased prevalence of SD in MS patientscompared with HC subjects (42.0% vs 16.0%,P¼.0001). The prevalence of dysfunctional FSFI global scores(<26.55) was higher in women with MS compared with HC (49.6% vs 33.6%,P¼.014). In the MS group, theprevalence of SD was similar between pre- and post-menopausal women. Both premenopausal and postmenopausalMS women presented a greater prevalence of SD if compared with the premenopausal and postmenopausal HCgroups (30/79 [37.9%] vs. 5/74 [6.8%],P¼.0001 and 20/40 [50.0%] vs 16/57 [28.1%],P¼.03, respectively). Anegative correlation was observed between the FSFI global score and age and Expanded Disability Status Scale.Depressive symptoms were more common in women with MS and SD than in those without.Clinical Implications:This study suggests that sexual function investigation should always be a standard part ofthe consultation with healthcare professionals for MS.Strength & Limitations:The strength of this study was the comparison with an age-matched healthy controlgroup and the use of validated questionnaires to assess both sexual function and sexual distress. Larger andmulticenter studies may further support ourfindings.Conclusion:In our cohort, the prevalence of SD and sexual distress was higher in women with MS compared tothe HC group. Age, disability, and depressive symptoms were associated with increased SD.