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MS and Intimacy
by Tanya Radford

INTRODUCTION

What is intimacy? Is it sex, love, touching, honesty, commitment, acceptance? Or is it vulnerability, fear of rejection, sexual difficulties, shame? For many people with MS, intimacy is all of these things—the good and the bad.

Confronting the challenges of MS draws many couples closer together. Talking about problems and developing solutions can deepen both partners’ sense of intimacy. But MS can also create barriers. People often report that their relationships suffer as a consequence of MS. Many people with or without MS don’t talk easily about their sexuality—either the positive aspects or the anxieties associated with it.

Although study results vary somewhat, it seems clear that people with MS do experience more sexual problems than the general population. MS can affect sexuality both directly and indirectly. This booklet looks at the effects of the problems and outlines how they can be managed, solved, or minimized.

Many of the suggestions are useful even if MS is not the source of sexual problems. Difficulty with sex is quite common among humans in general. Happily, there are many sources of help and support. The primary care physician can usually start the process of identifying the source of problems and offer both medical and non-medical treatment options and/or referrals. But often, the person with MS has to bring up the subject.

An easy way to begin is by requesting regular checkups related to sexual health: For women, annual breast and pelvic exams, a pap smear, and, after age 40, mammograms; for men, testicular cancer screening, prostate exams, and, after 40, PSA tests. For both sexes, birth control and HIV prevention advice. These requests not only protect health, they’ll remind your health-care provider that you are a sexual being, despite the MS diagnosis. You may then find it easier to report personal symptoms and ask questions.

The essential point
Intimacy and sexuality are important components of a healthy and contented life. Sexuality does not have to disappear from the lives of couples when one partner has MS. Instead, partners can find satisfying approaches to sexual intimacy that overcome the barriers.

 

TALKING ABOUT “IT”

Often the biggest problem is the inability to discuss sex and intimacy with one’s partner. In many ways, a discussion of personal sexual problems is still taboo in our society, despite a popular culture that seems to be steeped in sex. Not only is the subject embarrassing, but in many cases we just don’t have the language to describe our feelings and experiences.

Writing it down
It can help to start by putting pen to paper. What physical symptoms interfere with your intimate relations? Which of these symptoms is the greatest barrier? What feelings and as-sociations do you have when you think about MS and your love life? Writing ideas down may help put the problems into language and start the difficult process of communicating. It may also help to clarify where the challenges lie, which is the first step toward a solution.

Communicating with your partner
Talk is the main way that we come to feel close to another person, perhaps because of how very difficult it is to talk to someone about personal things. We share our life stories, goals, fears, and dreams only with special people.

When MS problems are in the picture, avoiding talk can easily lead to avoiding sex. Sen-sory changes may make things that used to bring pleasure feel painful or uncomfortable. Telling your partner what feels good and what doesn’t, becomes crucial to intimate relations when MS changes the body and the mind. It’s important to find out what your partner wants, and let him or her know what you want.

Confiding in your partner actually deepens intimacy and may go a long way toward resolving fears. For example, one common anxiety among people with MS is fear or shame about bladder or bowel accidents. Giving up sexual activity is not a solution to this. Discussing the problem will reduce anxiety between loving partners. Open communication with health-care professionals will produce some solutions. Bladder and bowel problems can usually be managed through manipulation of medication and establishing regular eating and toileting schedules. With good communication, a little urine won’t destroy a rewarding sex life. Con-cealing the problem and the anxieties associ-ated with it might.

The person with MS is not the only one who needs to talk about sexual feelings and anxieties. The well partner’s experience is also affected by the MS. Communicating these feelings can help well partners avoid guilt, grief, and resentment.

Cognitive problems can undermine sexuality in subtle ways. People with MS who have developed difficulties with short-term memory or concentration, may drift off during sexual activities in ways that can be disheartening to their partner. Indeed, the partner may be more aware of this MS symptom than the person with MS.

It requires love and patience to bring this out in the open and to seek the needed psychological and medical treatment.

Talking to your doctor
Physicians may or may not include sexuality in patient evaluation and treatment, and they may or may not be aware of all the resources available for help. For this reason, it’s a good idea to learn as much as you can about sexual issues and to be proactive with your health-care team.

If you have symptoms that hamper sexual activity, tell your health-care team. Or write out a list that you can hand over to your doctor or nurse. Many sexual problems associated with MS can be medically managed. You can encourage your doctor to focus on ways to minimize the effects of MS and MS treatments on your sex life if you ask.

Sometimes the well partners pull away from sexual activity because they worry about hurting the person with MS. In this situation, well partners should have an open discussion with the health-care team and get information about the safety of various sexual activities.

People with a gay sexual orientation sometimes have problems communicating with health-care professionals. You need to take action if you find that your health-care provider is uncomfortable, disrespectful, or dismissive of your sexuality. This attitude affects your total health care. You can and should seek more supportive professionals. Ask your Society chapter for referrals. Community gay rights organizations may also be able to offer some assistance.

Educating yourself
Knowing more about how MS can affect sexuality may help with communication. Know-ledge often makes it easier to name and discuss particular problems that you or your partner are experiencing. The Review section of this booklet (page 24) is a good starting place. Your Society chapter may be able to recommend additional reading that will help you learn more about MS and sexuality. The chapter staff can certainly help keep you informed about new treatments and medications.

 

GETTING HELP

Medical assessment
There is no single site for sexual response in the human nervous system. The nerves that orchestrate it are spread throughout the brain and spinal cord. This wide dissemination means that there are many pathways where MS lesions (scarring, inflammation, or other damage) might disrupt nerve messages for sexual activities or feelings. But it also means that the central nervous system can compensate by using other pathways if the usual pathway is blocked.

Assessment of sexual function in MS
Assembling a comprehensive picture may require medical and neurological records. Your primary-care provider may consult with or refer you to other specialists, possibly a psychologist and/or a urologist.

Psychologists and other mental-health professionals help people clarify and discuss intimate issues. Counseling often helps couples gain perspective on their attitudes and behaviors. Training in communication may be offered, to teach couples ways to talk more easily with each other and with the medical team. National MS Society chapters can provide referrals to mental-health professionals who have experience with MS.

Urologists evaluate and treat both bladder and erectile problems. Bladder problems can interfere with sexual activity for both men and women. These are manageable problems that shouldn’t be neglected. Urologists may also perform the medical tests to evaluate sexual function in men. These might include penile doppler sonography, which looks at blood flow in the penis, and nocturnal penile tumescence, which determines if the usual nocturnal erections are taking place.

 

MANAGING SEXUAL PROBLEMS—WOMEN

The most common problems experienced by women are loss of sex drive, uncomfortable sensory changes in the genitals, vaginal dryness, and loss of or difficulty reaching orgasm.

Loss of sex drive
Currently, there is no proven medical treatment for loss of sex drive (or libido) in women. Sometimes the sex drive simply returns. Other times the loss or lessening of intensity may be permanent. The sex drive in women is vulnerable on many fronts. Demyelination (or damage to the myelin that protects nerve fibers), fatigue, anxiety, or depression can all cause loss of desire.

However, loss of sexual desire does not make a satisfying sex life impossible for women. Desire is not a necessary precondition. Women can experience sexual pleasure even in the absence of a powerful drive.

In the movies, desire is always sparked in both partners at once. In real life, one partner produces sexual interest in the other through play—teasing, flirting, and foreplay. Many couples discover that the loss of intense sex drive simply means more flirting and foreplay.

Sensory changes
Changes, like numbness, that sometimes occur in the vaginal area can make intercourse uncomfortable or interfere with orgasm. Medications such as phenytoin and carbamazepine may dampen sensory discomfort. Gently rubbing the genital area with a bag of frozen peas can also reduce discomfort.

Increasing stimulation to the genital area can help overcome numbness. In some cases, oral or manual stimulation of the clitoris will be enough to enable a woman to achieve orgasm.

If this is not sufficient, vibrators and other sex toys may provide even greater stimulation. There are many kinds of vibrators available at adult novelty stores and through mail-order catalogs. Some couples may enjoy the small egg-shaped vibrators made to be worn during intercourse. There is also a device called EROS-CTD—consisting of a soft cup to be placed over the clitoris and a palm-sized vacuum pump that draws blood into this tissue, increasing arousal.

Decreased vaginal lubrication
Decreased lubrication makes intercourse un-comfortable, even chafing. Water-soluble lubricants are an easy solution. Over-the-counter brands such as KY Liquid and Astroglide are widely available. Many people find liquids last longer and work more effectively than jellies. They can fail when they are used too sparingly. (Don’t skimp—use lots!) Avoid oil-based lubricants like petroleum jelly because they can trap bacteria and cause infections.

Kegel exercises
Kegel exercises can strengthen the muscles in the vagina, which may enhance sensation and sexual response. To locate these muscles, try to stop the flow of urine as you urinate. Once the muscle is located, contract it a couple of dozen times a day, independent of urination. Except for the test, don’t contract during urination as this may cause a pattern of incomplete emptying, leading to infection.

 

MANAGING SEXUAL PROBLEMS—MEN

The most common problems experienced by men are difficulty or inability to get or hold an erection, decreased genital sensation, rapid ejaculation, and difficulty or inability to ejaculate.

In some cases it may be hard to tell what is causing the problem. Demyelination (or loss of the protective myelin layer on nerve fibers) may directly affect erectile function. Medica-tions may also be factors. Stress and anxiety produced by living with MS may contribute to or even be the primary cause of erectile dysfunction. Your physician will try to clarify the source of the problem in order to choose the most appropriate solution. Understanding the mechanics may help you and your partner.

How do erections happen?
In the presence of sexual stimulation, nerves in the spongy tissue of the penis release the chemical nitric oxide, which stimulates production of something called cyclic GMP. The release of cyclic GMP relaxes the smooth muscle in the penis, compressing the veins. When this happens, blood flows in but cannot get back out, and an erection occurs.

The fear of having difficulty getting or keeping an erection can be so overwhelming that it causes some men to lose interest in sex entirely. This anxiety may even be the sole source of the problem.

Medications help
Viagra, Cialis, Levitra, Alprostadil, and topical medications are currently used to treat erectile problems. Talk to your doctor about them, and ask for regular updates on new medications and other approaches.

Viagra, Levitra, and Cialis produce a higher cyclic GMP concentration in the penis and enhance erections by creating more compression of the veins by smooth muscle tissue. Recent research indicates that Viagra is effective in about 50% of men with MS.

Levitra, approved by the FDA in 2003, and Cialis, also approved by the FDA in 2003, both work by targeting an enzyme important for keeping blood in the penis during erections. Viagra, Cialis, and Levitra are all taken in pill form. Many physicians see them as interchangeable but may recommend trying another if one of them fails to work well. Individual responses vary.

All three drugs help maintain an erection but do not produce one. Sexual stimulation is needed for that. No men with MS were in the trials that led to the approvals, although Viagra has been studied in an MS population.

Before taking any one of these drugs, it’s important to take precautions against possible drug interactions and to discuss side effects with a knowledgeable physician. Men who have heart or blood pressure conditions or who take nitrate-based medications may be especially at risk for problems.

Other options include self-injection of Alpro-stadil into the spongy tissue of the penis. This relatively painless injection produces an erection. The needle is very small, and the satisfaction with it is generally excellent.

Devices can also work
The vacuum tube and band device can be an effective alternative to medications. It consists of a plastic tube with a pump and band for the base of the penis. The tube fits over the penis. The hand pump produces vacuum pressure, and the band constricts the veins. This makes the penis fill up with blood, producing an erection. The tube is then removed. Because of its effectiveness and availability, the vacuum tube and band is widely used by men with MS.

These devices can be purchased in specialty shops and through mail-order and Internet catalogs, some of which are listed in the Resource section of this booklet. Catalogs and specialty stores also sell rubber rings meant to be worn at the base of the penis. These rings reduce blood flow out of the penis and can help to maintain erections.

It is important to get instruction on using such devices from a urologist or other medical professional to prevent damage to the penis. The vacuum tube and band may also be prescribed by physicians or urologists.

Decreased genital sensation
Sensory changes in the genital area may impair pleasure or interfere with ejaculation. Manual and/or oral stimulation may provide enough extra sensory input for erection and orgasm.

Ejaculation problems
Absent or too rapid ejaculation may occur because MS-related nerve damage interferes or reduces control. Additionally, anxiety about rapid ejaculation can actually trigger it. Some men are able to gain greater control by learning (through practice) when they are approaching the point of inevitability and then stopping intercourse long enough to regain control. This process is described in some of the resources listed at the back of the booklet.

 

ACHIEVING ORGASM

People tend to think of orgasm as the ultimate goal of sex. But is this true? There may be times when orgasm is impossible. Does this make sexual behavior pointless? The temporary or even permanent loss of orgasm in women or in men does not invalidate their need for intimacy and sexuality. Physical intimacy produces emotional intimacy that deeply affects people’s physical and emotional well-being.

In other words, sex makes people feel good, even when it doesn’t lead to orgasm. Making love does not necessarily mean having intercourse. And having intercourse is not the only way to experience sexual pleasure.

Despite the tremendous emphasis on orgasm and ejaculation as the “goals” of sexual activity, most people experience great physical and mental arousal from the activities we call foreplay. This is an unfortunate name, because it assumes that these activities are a prelude to “real sex” and not a satisfying form of sexual gratification in themselves.

People who hold themselves to a standard of performance that must culminate in orgasm are going to find less satisfaction than people who are willing to explore and experiment with different sexual activities. This is true for everyone, not just people who live with MS.

Rediscovering sexuality
Men and women with MS may want to redefine sexuality for themselves. This may mean putting more emphasis on forms of touching that provide warmth: cuddling, caressing, and massage, for example. Some may need to ex-plore sexual activities that require less mobility. Oral and manual stimulation of the clito-ris, penis, and many other parts of the female and male body can be highly satisfying alternatives to “traditional” intercourse. And couples may want to revive those old “juvenile” activities, like “making out.” Kissing is one of those sexual activities that adults tend to rush through in pursuit of an orgasm.

Self-stimulation is an area heavily colored by cultural values and expectations. Some religious groups consider it unacceptable. If that is true for you, please skip the next paragraph.

Commonly, people think of masturbation as “juvenile,” or as a substitute for sex. The fact is, most sex experts today say that solo sexual activities help people to redefine and renegotiate their sexuality. If sex is not just orgasm, then sex is not just something that only happens between two people. Self-stimulation reminds us that we need not be dependent on another person for pleasure and release. In cases where the effects of MS make solo sexuality difficult, the strain and discomfort may be reduced by experimenting with vibrators and other sexual aids.

 

TREATING THE MEDICAL PROBLEMS—A CHECKLIST

Many sexual problems produced by MS symptoms or MS treatments can be managed with the help of your medical team.

  • Pain can be controlled with medications.
  • Spasticity can be reduced with medication, cold packs, and stretching or massage.
  • Side effects may be minimized by taking medications at a different time of day or by changing the timing of sexual activity. You might also consult your doctor about switching to medications with fewer sexual side effects.
  • Fatigue can be alleviated through energy conservation and, in some cases, with medication. Making love at times when the partner with MS is most energetic (usually the morning) will also help.
  • Alternative sexual positioning can help with both spasticity and weakness. Using pillows for support or trying the side positions can relieve discomfort.
  • Catheters can be secured during sex. Your doctor or nurse can show you the best way.

 

CAREGIVING AND SEXUALITY

How does one shift from being a caregiver to a lover? In relationships where a partner provides a lot of caregiving this can be difficult. It is important for the well partner to maintain some regular personal time away from caregiving duties because that helps prevent feelings of resentment. It may also be important for the couple to create new rituals and new sexual signals that separate caregiving activities from sex and romance. Talking together about the old signals and rituals may help a couple begin creating a new path.

 

REDISCOVERING ONE’S BODY

Living with a chronic illness makes people very aware of their bodies—the ways it works and the ways it doesn’t. Often this intense awareness makes the body seem strange and unfamiliar. And certain MS symptoms make the body respond very differently than it once did. Making peace with this new condition means taking the time to investigate and explore it.

Body mapping
Body mapping is a simple exercise in self-exploration. The idea is to map out personal sensations by touching yourself from head to toe. What makes your body feel pleasure? Discomfort? Relaxation? Mapping will help identify areas of change, numbness, and discomfort. It will also help locate areas and ways of touching them that produce pleasure.

For this exercise to be successful, it is important to adopt an attitude of open exploration. In a comfortable, secure setting, spend 15 minutes gently touching all the parts of your body that you can reach. Repeat the exercise regularly—several times a week. Linger on the pleasure areas, but don’t try to achieve an orgasm. The purpose of body mapping is to get to know your body. Pursuit of an orgasm may interfere with this exploration.

More advanced body mapping exercises include both partners. Exploring each other through touch can help deepen intimacy and enhance sexuality. In some cases, this explorative touching may make verbal com-munication between partners easier.

Feel sexy
Being sexy has a lot to do with feeling sexy. A person can decide to feel good. To start, take care of your body through good healthy food, relaxation, and enjoyable exercise. Make time to do things that are special. Spend some time on your clothing and hair. Dress has a huge impact on self image. Select clothing that makes you feel comfortable and attractive.

Think sexy
What things are sexually exciting to you? What things are turn-offs? What thoughts interfere with or suppress your sexuality?

Self-scrutiny is an important part of main-taining sexuality in your life, especially if MS has dampened desire. Thinking more positively will help to restore enthusiasm.

Include romance
When everyday activities take on an aura of the erotic, that’s romance. Find ways to transform the everyday into the romantic, for there, intimacy thrives. Dine by firelight, take a bath by candlelight, watch the sun set or the moon rise, hold hands, flirt.

Most important of all, don’t give up the pleasures of physical and emotional intimacy. Do give up the niggling worry that sex is not a fit subject for conversation. Talk about it with your lover and talk about it with your doctors and nurses. It’s worth it.

 

A REVIEW OF THE SEXUAL EFFECTS OF MS

Primary sexual effects
Sexual arousal begins in the central nervous system, as the brain sends messages to the sexual organs along nerves running through the spinal cord. MS-related damage to these nerve fibers can directly impair sexual feelings or sexual response. And, just as with other aspects of MS, sexual problems can arise at any time, without any clear cause.

The primary sexual effects of MS include:

  • Decreased or absent sex drive.
  • Altered genital sensations such as numbness, pain, or hypersensitivity.
  • Decreased vaginal muscle tone.
  • Difficulty or inability to get an erection.
  • Decreased vaginal lubrication and clitoral engorgement.
  • Difficulty or inability to ejaculate.
  • Decreased frequency and/or intensity of orgasms.

All of these are changes that can occur as a direct result of demyelination in the spinal cord or brain.

Secondary sexual effects
Secondary effects arise as a consequence of MS-related physical changes or MS treatments. Secondary problems include fatigue, spasticity, bladder or bowel problems, sensory changes, decreased non-genital muscle tone, cognitive impairments, tremor, and pain.

  • Fatigue, a very common MS symptom, can suppress desire.
  • Spasticity can interfere with sexual positioning or cause pain.
  • Bladder and bowel problems are closely related with sexual difficulties because the nerve pathways are shared or nearby. Bladder and bowel disturbance also create fears that other symptoms do not. The thought of having a bladder or bowel accident during sex can stifle interest.
  • Uncomfortable sensory changes can make physical contact, such as caressing, uncomfortable. Because physical contact is such an important part of intimate communication and simple pleasure, the loss can be devastating.
  • Decreased non-genital muscle tone. Muscle tension in the body helps build sexual excitement and contributes to orgasm in both men and women. The decrease in muscle tone caused by MS can interfere with both.
  • Cognitive impairments, such as changes in attention and concentration, can also interfere with the buildup and progression of sexual excitement and feeling. Changes in attention or concentration can disrupt the emotional and behavioral interactions of sexual activity, producing a sudden loss of interest.
  • Tremor, such as intention tremor, can in-terfere with touch and communication. Tremors in the hands or body can interfere with physical and emotional communication between people.
  • Pain commonly occurs with MS and can interfere with both intimacy and sexuality.
  • Side effects of various medications can interfere with sex drive or function. Managing indwelling catheters can pose additional difficulties.

Tertiary sexual effects
Tertiary effects result from psychological, social, and cultural issues. In many ways, they raise the most difficult barriers to contentment in intimate and sexual relationships. And they can affect both the person with MS and his or her partner. Tertiary effects include depression, demoralization, and guilt; family and social role changes or role conflict; performance anxiety; and changes in self-image.

  • Grief, demoralization, anxiety, and depression frequently accompany MS. These emotions affect both partners. They may cause feelings of isolation, interfere with desire, and lead both partners to stop thinking sexually.
  • MS may change a person’s roles in work, in running a household, in parenting, in the activities of daily living. Sometimes these changes make the person with MS feel childlike and dependent, unable to be a loving partner. These changes can be difficult for well partners, too. Caregiving activities can leave the well partner feeling more like a caretaker than a sexual partner.
  • Changes in body image can affect both the person with MS and the well partner. Changes in physical appearance may damage people’s image of themselves or their partner as a sexual being. Our society doesn’t offer up many images of sexiness that include a cane or wheelchair.
  • Fatigue, stress, and lack of personal time also affect self image. It is hard to feel sexy when you are tired and anxious. And it can be difficult to make time to take care of yourself and your body.
  • Cultural values and expectations get in the way of intimacy and sexuality. Many ideas about “proper” or “adult” sexuality prevent people from exploring new ways of giving and receiving pleasure. Our society puts great emphasis on ejaculation and orgasm as the sources of sexual satisfaction. This goal-oriented approach to sex may make the pursuit of satisfaction a frustrating experience.
  • Clearly living well with MS—and establishing or maintaining healthy intimate relations—requires a great deal from everyone involved. The Society wants to be an ally, helping people to learn for themselves and to find trustworthy help—from urologists, psychologists, and other health-care specialists to self-help groups and educational programs. You can connect to the chapter nearest you by dialing 1-800-FIGHT-MS. The Resources following may also be of help.

 

RESOURCES

Books

Multiple Sclerosis Fact Book by Richard Lechtenberg, M.D., Second Edition, 1995. $27.95. Write: F.A. Davis Company, 1915 Arch Street, Philadelphia, PA 19103. Tel: 800-323-3555 for credit card orders. Web site: www.fadavis.com.

Multiple Sclerosis: A Self-Care Guide to Wellness edited by Nancy Holland, M.S.C.N., Ed.D., and June Halper, M.S.N., R.N. Paralyzed Veterans of America, Inc., 2004. $19.95. Tel: 888-860-7244.

Managing the Symptoms of Multiple Sclerosis, 4th Edition, by Randall T. Schapiro, M.D., Demos Publications, 2003. $19.95. Write: Demos Publications, 386 Park Avenue South, Suite 201, New York, NY 10016. Tel: 800-532-8663. Web site: www.demosmedpub.com.

Multiple Sclerosis: The Questions You Have—The Answers You Need by Rosalind C. Kalb, Ph.D., Third Edition, 2004. $39.95. Write: Demos Publications, 386 Park Avenue South, Suite 201, New York, NY 10016. Tel: 800-532-8663. Web site: www.demosmedpub.com.

Enabling Romance: A Guide to Love, Sex, and Relationships for People with Disabilities by Ken Kroll and Erica Levy Klein, No Limits Communications, 2001. $15.95. Can be ordered from Amazon.com.

The Joy of Solo Sex by Dr. Harold Litten, Factor Press, Paperback, 1996. $12.95. Focuses mainly on men. Can be ordered online or at your local bookstore.

Sex for One: The Joy of Self Loving by Betty Dodson, Random House, 1995. $14.00. Focuses mainly on women. Can be ordered online or at your local bookstore.

Research help

Sexuality Information and Education Council of the United States (SIECUS) provides a bibliography of print and audiovisual materials related to sexuality and disability for $3.00 Write: SIECUS, 130 West 42nd Street, Suite 350, New York, NY 10036-7802. Tel: 212-819-9770. The bibliography is also available free on the Web at www.siecus.org.

Counseling

American Association of Sex Education Counselors and Therapists (AASECT) provides a list of certified sex therapists and counselors in your area. Send a self-addressed stamped envelope to: AASECT, PO Box 1960, Ashland, VA 23005-1960. Tel: 804-752-0026. Web site: www.aasect.org.

Catalogs

Lawrence Research Group. A catalog of sexual aids, books, resources, and information. $4.00 each. Write: 5375 Procyon Street, Suite 102, Las Vegas, NV 89118. Tel: 800-242-2823.

Good Vibrations provides a mail-order and Internet catalog of sexual aids, books and videos. To get a catalog, write 938 Howard Street, Suite 101, San Francisco, CA 94103. Tel: 800-289-8423.

Web sites

www.sexualhealth.com
The Sexual Health Network’s Web page has information on sexuality for those with disabilities and illnesses. It also provides links to other resources and offers live broadcasts. There is an archive of mainly educational books and videos.

www.intimacyinstitute.com
The Sinclair Intimacy Institute has a catalog of adult sex education videos.

 
     
 
For additional information
Bowel Problems: The Basic Facts (Society brochure)
Controlling Bladder Problems in Multiple Sclerosis (Society brochure)
MS and Your Emotions (Society brochure)
Controlling Spasticity in MS (Society brochure)
Taming Stress in Multiple Sclerosis (Society brochure)
 
     
 

Tanya Radford is a freelance health writer.

A special thank you to Dr. Fred Foley for his work in this field on which much of this booklet is based.

This publication is supported by contributions to the National Multiple Sclerosis Society from its members and friends.

Reviewed by members of the Client Education Committee of the National Multiple Sclerosis Society’s Medical Advisory Board.

 
     
  Copyright © National Multiple Sclerosis Society, 2005  
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