How To Diagnose Sexual Dysfunction

We need to have some urology, some Ob-GYN interaction; we need to do some labs. And these are just baseline: free and total testosterone and this is either females or males; we need to check prolactin levels; we need to check LH/FSH; sex hormone binding group. Also is important to do a fasting cholesterol panel and a fasting glucose because no everything is demyelinating lesions.

We also have to ensure that the patient stops smoking. We know smoking is not good for MS but also smoking it going to make sexual functioning problems. We also need to be confident that the stress, depression, and all this other stuff is addressed.

What are the most common complaints in females?

  • Decreased libido/desire;
  • Decreased arousal;
  • Decreased vaginal lubrication;
  • Decreased vaginal muscle tone;
  • Sensory changes in vaginal area;
  • Pain during penetration;
  • Reduced intensity or frequency of orgasms;
  • Decreased clitoris engorgement.

Usually, it is reduced desire. And then some of the female patients come to the office, and they tell you “Well, but that is not bad. You know, I have a lot of friends that are my age, and they have two or three kids, and they work, and they say they don’t think about sex”. And then I say “Well the question is, were they like that before? And were you like that or it is something that just happened?”

Decreased vaginal lubrication is a big problem. So patients need to use a lot of lubricants. And then also there could be a pain on penetration, and they can be anorgasmia as well.

In the males, one of the most common complaints is an erectile dysfunction.

  • Inability to achieve and maintain an erection (ED);
  • Decreased libido/desire;
  • Decreased or altered sensation;
  • Reduced intensity or frequency of orgasms;
  • Premature ejaculation.

There’s also decreased libido. There can be anorgasmia. And just to let you know problems with anorgasmia are not that common, but when it happens, it is challenging to treat. There is no FDA-approved medication for that. I’ve been trying to get Naso oxytocin because there are some studies about it. But this drug was discontinued by FDA a few years ago, and we’ve been unable to find it. You can get it from Europe or Canada, but at least the patients that are having issues are trying to get it from there. But for an anorgasmia that’s the only thing that I have read that may be helpful.