Sexual Dysfunction, Depression, MS Severity All Linked

Pauline Anderson

June 29, 2017

AMSTERDAM — Researchers are unraveling the connections between sexual dysfunction, depression, and disease severity in women with multiple sclerosis (MS).

Knowing whether sexual dysfunction is caused by depression or by the severity of MS could be important for treatment strategy, said Ruihao Wang, MD, Department of Neurology, University Erlangen-Nuremberg, Germany.

"If sexual dysfunction is because of depression, you need to treat the depression in these patients, but for those whose sexual dysfunction is due to the severity of the disease, you have to treat the MS in order to treat the sexual dysfunction."

Dr Wang presented the new research here at the Congress of the European Academy of Neurology (EAN) 2017.

Sexual Dysfunction Classifications

More than 50% of women with MS have depression, and many also experience sexual dysfunction. Such dysfunction can be classified as primary (due to cerebral or spinal cord lesions), secondary (due to MS-related physical disability, such as bowel or bladder issues), or tertiary (MS-induced psychological issues, such as body image or lack of self-esteem).

MS severity, as well as depression, affects sexual dysfunction, and an association has also been shown between depression and sexual dysfunction; either could lead to the other, said Dr Wang.

"But what is not known is the interrelation between MS severity, depression, and sexual dysfunction," she said.

The study included 83 female patients with MS (median age, 36.2 years; age range, 29 to 42.5 years). Of these, 76 had relapsing-remitting MS, 6 had secondary progressive MS, and 1 had primary progressive MS.

In these patients, researchers assessed depression using an applied version of the Beck Depression Inventory (BDI-V) that was developed for use in epidemiologic studies. Higher total scores indicate more severe depressive symptoms.

They assessed MS severity using the Expanded Disability Status Scale (EDSS), which ranges from 0 to 10, with lower scores indicating less disease severity.

To assess sexual dysfunction, researchers used the Female Sexual Function Index (FSFI), which includes domains such as desire, satisfaction, orgasm, and pain. On this scale, scores below 26.55 indicate sexual dysfunction.

And to classify sexual dysfunction related to MS as primary, secondary, or tertiary, investigators used the 19-item MS Intimacy and Sexuality Questionnaire (MSISQ-19).

The researchers calculated correlations between scores on the BDI-V, EDSS, FSFI, and MSISQ-19 using the Spearman rank correlation test (Spearman-rho).

Responses to the FSFI showed that 37 patients (44.6%) had sexual dysfunction, and BDI-V scores indicated that 28 patients (33.7%) had depression. Nineteen of the 83 patients had both depression and sexual dysfunction.

FSFI scores were inversely correlated with BDI-V scores (Spearman-rho = –0.489; P < .001). FSFI scores were inversely correlated with BDI-V scores (Spearman-rho = –0.489; P < .001).

Responses to the MSISQ-19 revealed that 73.7% of patients had primary sexual dysfunction, 84.2% had secondary sexual dysfunction, and 57.9% had tertiary sexual dysfunction.

Significant Associations

The analysis showed that MSISQ-19 scores indicating tertiary sexual dysfunction correlated with BDI-V scores (Spearman-rho = 0.505; P = .028).

"We can say here that the association between depression and sexual dysfunction was only significant in tertiary sexual dysfunction," said Dr Wang.

"Depression actually causes sexual dysfunction in MS patients, maybe because of impaired self-esteem."

MSISQ-19 scores indicating secondary sexual dysfunction correlated with EDSS scores (Spearman-rho = 0.551; P = .014).

"So increasing MS severity, with increasing physical impairment, can compromise sexual function," said Dr Wang.

After Dr Wong's presentation, session co-chair Max J. Hilz, MD, professor, Department of Neurology, University Erlangen-Nuremberg, stressed the importance of knowing whether sexual dysfunction is primarily triggered by "some organic problem" or has a "depressive origin" because "completely different approaches" would be required.

If you treat sexual dysfunction not related to depression with antidepressants, "you worsen the situation," said Dr Hilz.

He noted that the questionnaire that distinguishes between primary, secondary, and tertiary sexual dysfunction "gives us a big hint as to whether we should treat the depression or the sexual dysfunction."

The questionnaire is easy for patients to fill out and takes only a few minutes, he said.

Dr Wang has disclosed no relevant financial relationships.

Congress of the European Academy of Neurology (EAN) 2017. Abstract O2105. Presented June 25, 2017.

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