Women with Multiple Sclerosis (MS) are usually found to have a lack of libido and sometimes even an absolute abhorrence for sex. It is, also, common that their lower urinary tract symptoms (LUTS) may be correlated with this situation. The aim of our study is to determine if treatment with clean intermittent self-catheterizations (CIC) could improve their sexual functionality.

In our observational study, sexually active women with MS have been observed. Their medical history included severe LUTS with the filling of incomplete voiding, urgency, frequency and incontinence. Patients without post-void residual (PVR) and no sexual function have been excluded. Also, women with PVR> 150ml have been advised and decided to start CIC, 4-6 per day, with or without anticholinergics. In the first visit, all patients underwent a kidney-bladder ultrasound, an uroflow and a baseline urodynamic test. Additionally, they were all asked to complete the Female Sexual Function Index (FSFI) and Hamilton Depression and Anxiety questionnaires. In the second visit, three months later and under CIC, women were re-evaluated with ultrasound, FSFI and Hamilton’s tests. The following statistical analysis has been based on SPSS v21.

An amount of 51 sexually active women with MS have been observed and 34 of them, aged 24-45 (mean= 31.5), have been finally enrolled. The rest 17 were excluded as they had PVR< 150ml (70.6%), they referred no sexual dysfunction (23.5%) or they rejected CIC treatment (5.9%). In the first visit, FSFI domains have been calculated separately. The mean desire score was 2 (range 1-3), while mean arousal scored at 2.65 (range 0-4). Lubrication domain have been found at a mean of 2.97 (range 1-4) and mean pain was 3.23 (range (1-4). The mean orgasm score was 1.5 (range 0-4) and the mean satisfaction score was 2 (range (0-4). Mean total FSFI was 15.5 (range 0-23). The Hamilton Depression test scored at a mean of 19.5 (range 14-22) and Hamilton Anxiety test calculated with a mean of 34.5 (range 21-56). Especially on question 12 of Anxiety test, referring to the urogenital disorders, the mean score was 3 (range 2-4). In the second visit the same scores have been performed. Hence, mean desire score was 3.5 (range 2-5), mean arousal score 4 (range 2-5), mean lubrication score was 3 (range 1-4), mean pain score was 3 (range 1-4), mean orgasm score was 2.5 (range 2-5) and mean satisfaction score was 3.5 (range 2-5). The statistical difference was found significant in desire, arousal, orgasm and satisfaction domains (p= 0.02, p= 0.01, p= 0.03, p= 0.01 respectively). Lubrication and pain domains were not significantly affected (p> 0.05). The mean of total FSFI in the second visit was 19.5 (range 10-28) with a statistically significant improvement compared to the first visit (p= 0.03). The Hamilton Depression test scored at a mean of 18.5 (range 14-20) and Hamilton Anxiety test at a mean of 31 (range 19-48). No statistical difference has been found compared to the first visit scores (p> 0.05). Nevertheless, question 12 of Hamilton Anxiety test scored at a mean of 1 (range 0-2), statistically improved after the first visit (p= 0.02).

There is a statistically significant improvement of sexual life in women with MS, treated with CIC, according to FSFI scores.

Treatment with CIC in sexually active women with MS could improve their sexual activity, maybe relieving them from severe LUTS. Their psychological status seems to be mainly unaffected. Observation of more cases could give more evidence in these preliminary results.