MS – Sexual Dysfunction — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS – Sexual DysfunctionSCE Neurology

A 50-year-old man with MS develops sexual dysfunction including reduced libido, erectile dysfunction, and difficulty achieving orgasm. His testosterone level is normal. He is not on SSRIs. He has no depression. His DMT does not cause sexual side effects. What is the most likely cause?

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Correct answer: B — MS-related sexual dysfunction due to spinal cord demyelination affecting autonomic and somatic pathways

Sexual dysfunction is extremely common in MS (affecting 40–80% of patients) and is caused by demyelination affecting the spinal cord autonomic pathways, somatic nerve pathways, and supraspinal centres. It is classified as: primary (directly from demyelination — erectile dysfunction, reduced sensation, difficulty achieving orgasm), secondary (from other MS symptoms — fatigue, spasticity, bladder dysfunction), and tertiary (psychosocial — altered body image, relationship changes). Management is multidimensional — PDE-5 inhibitors for ED, lubricants, vibrostimulation, and psychosexual counselling. A: Testosterone is normal. C: DMT not causative. D: No depression. E: The severity and pattern suggest MS-related cause.

Reference: NICE NG100 MS (2022)