Sexual Dysfunction and Its Correlation to Depression and Bladder Dysfunction in Hispanics with Multiple Sclerosis

Background: Sexual dysfunction (SD) is an under diagnosed and under treated complication for patients with multiple sclerosis (MS). Zorzon et al, estimated 73.1% of patients with MS experience SD compared to 15.4% and 11.2% of healthy males and females, respectively. Comorbidities such as Bladder dysfunction (BD) and Depression can aggravate SD in MS patients.

Objectives: To determine the percentage of Hispanic MS patients that experience SD. Secondary outcome is to determine the SD categories distribution in this clinical sample and determine any association between Disease-modifying therapies (DMTs), BD and/or depression with experiencing sexual dysfunction.

Methods: A retrospective review of 477 questionnaires submitted by patients to the Puerto Rico Multiple Sclerosis Foundation from 2002 to 2008. Each questionnaire had information on SD, BD, and Depression and information regarding use of DMT. The reported symptoms and their relationship, as well, as their age and gender were analyzed. Tukey-style box and whisker plots exploratory data were analyzed to shed light on marginal distributions of the response variables and covariates of interest. Bivariate analyses were conducted between the study outcome and covariates of interest. Chi-square or Fischer´s exact test were done for categorical covariates. All analyses used the usual two-sided Type I error level of 0.05 as the threshold for statistical significance.

Results: 477 questionnaires were completed 80% (382) were women 20% (95) were men. 23% (111) reported sexual dysfunction. Of those 111, 71% (79) were women 29% (32) were men. 53.4% (255) of total reported Depression while 67% (75) of patients with SD also reported Depression. 45% (215) of total reported BD while 56.8% (63) of patients with SD also reported BD. 42.3% (47) patients reported SD, BD, and Depression. 19.8% (22) of patients that reported SD did not report any other co-morbidity. MS duration for patients without SD and with SD was 5.8 and 7.8 years, respectively. There was a statistically significant association (p< 0.05) between sexual dysfunction, BD, and depression. If we adjust for sex only, patients that reported BD and Depression were 3.4 times more likely to experience SD. Adjusting for age and MS duration, the results are unchanged.

Conclusions: SD is a significant complication that affects MS patients´ quality of life. SD should be evaluated when a patient reports Depression or BD and vice versa.