Erectile Dysfunction and Multiple Sclerosis.

If you have Multiple Sclerosis (MS), there are serious problems to address. Your immune system is mistakenly attacking your myelin sheath - the coating that surrounds the nerves and nerve fibres in your brain. The standard treatment uses interferon beta (Avonex and Rebif, and Betaseron), glatiramer acetate (Copaxone), and mitoxantrone (Novantrone) to modify the immune system and so reduce the number and severity of attacks. But there is no long-term cure.

MS affects both the central and the peripheral nervous system. It therefore can produce a wide range of different symptoms. Treating them can make you feel more comfortable even though it will not stop the disease from developing. Some symptoms can be managed by changing your diet, and introducing more physical exercise and other changes of habit. Medications are available for each kind of symptom. Managing your condition involves deciding whether to treat any given symptom as needed or regularly, depending on how inconvenient or painful it is. The symptoms include:

• insomnia and fatigue;
• muscle spasms, stiffness and tremors;
• constipation and frequent urination;
• pain and abnormal sensations;
• depression; and
• erectile dysfunction.

There is an emerging consensus on how to treat MS. There is evidence that long-term treatment with interferon beta and glatiramer acetate can reduce or delay disability if started early enough. It seems that permanent damage to the nervous system is caused during the first phase of the disease. Early treatment can therefore improve the quality of life for those with relapsing-remitting MS. But some people whose initial symptoms are mild prefer not to begin interferon therapy, which causes flu-like side effects, until their condition worsens.

The treatment for the associated ED covers the full spectrum of remedies. The PDE-5 inhibitors, Viagra, Cialis and Levitra have good general effectiveness but, to date, only Viagra has been through clinical tests with MS sufferers. Nevertheless, since they all work in the same way, there is every reason to suppose that all three would help those with MS. But since none of these medications affects libido and depression with MS is quite common, counselling is almost certainly necessary to help couples resume intimacy. Since testosterone deficiency is not associated with MS, it is not helpful to prescribe a testosterone supplement. You should also note that the FDA has specifically warned against the use of Yohimbe for ED without prescription. Apomorphine hydrochloride sold under the brand name Uprima is used in the USA but, after a large scale study in the UK, its use there was discontinued in 2006.

Penile injections or suppositories that are inserted into the urethra are available. You can administer them yourself or your partner can do it for you. For those with MS, there can sometimes be a slight but transient ache from the injections. The resulting erection lasts for about one hour. There are three medications used for this purpose:

• prostaglandin E1 is sold under the names Alprostadil, Muse, Caverject and Edex - this has the best outcomes with the fewest side effects and is the only medication approved by the FDA for this purpose;
• Papaverine is an opium alkaloid used as a smooth muscle relaxant but it has a greater risk of causing priapism and so has not been approved by the FDA for this purpose;
• Phentolamine sold under the brand name Regitine is a vasodilator sometimes used in conjunction with either of the two other medications to improve blood flow.

As an alternative to drug therapy, you can also try the vacuum device which is placed over the penis. When air is pumped out, blood enters the penis and causes an erection. A small band is placed to prevent the blood from draining out and the erection is safe for about 20 minutes. If you have not responded to oral or injected medication, and have found counselling of little use, you may consider a surgically-implanted prosthesis whether semi-rigid or inflatable.

There can be associated problems with stiffness in the legs which make it difficult to maintain the necessary motion or to stay comfortable. Drugs, physiotherapy and experiment with different sexual positions may help. Similar management problems can occur if bladder control is not properly maintained. Again medications are available to keep the problem under control. Other problems of maintaining concentration and inhibition control can be addressed through counselling and behavioural therapy. Otherwise, different symptoms associated with depression and physical causes can be controlled but your physician must be involved at all times to ensure a proper and safe balance between the medications and your sexual needs.