Gender-Specific Associations between Primary, Secondary, and Tertiary Sexual Dysfunction in MS

Background: Sexual dysfunction (SD) impacts up to 73% of individuals with MS. SD in MS is complex and is divided into primary, secondary, and tertiary dysfunctions (PSD, SSD, TSD) characterized by neurologic changes with direct implications on sexuality, physical changes with indirect effects on sexual response, and psychosocial issues associated with disability that affect sexual satisfaction. Since there are established gender differences in the reporting of SDs among individuals with MS, investigating potential gender differences in the types of SDs reported may prove to be an advantageous endeavor in enhancing the current understanding of SDs in the MS population as well as providing potential targets for novel treatment interventions.

Objectives: Examine how correlations between PSD, SSD, and TSD in MS differ between males and females.

Methods: The sample for this study consists of respondents to the North American Research Committee on Multiple Sclerosis Registry’s (NARCOMS) survey via Internet and mail. Only respondents who provided complete responses to the survey were included in the analysis (1,405 of 2,237 male respondents [62.8%]; 4,262 of 7,010 female respondents [60.8%]). A total of 5,667 participants were included in the final sample. Data in the analysis included gender and self-reported responses to the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15). A Fisher-z-transformation comparing bivariate Spearman-rho correlations was conducted to examine the difference in gender on the correlations of the SD subscales.

Results: The bivariate correlations were significant at all levels of SD. There was a significant difference between genders in the bivariate correlation between PSD and TSD (p=.0129), such that men (rs=.663) had a higher correlation than women (rs=.623).  Further, the genders differed significantly in the correlation between SSD and TSD, p=.0192. Women (rs=.655) had a higher bivariate correlation than men (rs=.618). There was no significant difference between men and women in the correlation between PSD and SSD.

Conclusions: Men and women differ in the correlations between PSD and TSD and SSD and TSD. Specifically, emotional/psychosocial factors impacting SD (i.e, TSD) are more highly correlated with neurological changes associated with SD (i.e, PSD) in men than women and more highly correlated with physical implications of SD (i.e., SSD) in women than in men.