Chat transcripts

Welcome, everyone, and thank you once again for joining us tonight. Tonight's chat will be a moderated question and answer session. You may send your questions now and at any time throughout the chat tonight. Your question will appear to the audience when our guest responds to it.

Our guest this evening is Frederick W. Foley, PhD. Dr. Foley is Associate Professor of Psychology, Albert Einstein College of Medicine and Director of Neuropsychology & Psychosocial Research, Bernard Gimbel Multiple Sclerosis Center, Holy Name Hospital. He is also the author of the MSF publication Intimacy and Sexuality with Multiple Sclerosis. We are very honored to have him here tonight. Welcome, Dr. Foley!

Is there a medication to improve a female's arousal and subsequent chance for orgasm?

Arousal and orgasm can sometimes be improved with pde-5 inhibitors, such as Viagra, Levitra, or Cialis, although there is very little evidence to date in women with MS. There are several topical preparations, including Aestra and Argin MAx, which increase blood flow (and arousal). There are few studies, but these may be worth trying.

I want to remind everyone that tonight's chat is a Q&A format, so there will be a brief pause between questions as Dr. Foley prepares his answer.

Can ms spasms cause the vagina to be so tight that intercourse is difficult and very painful, even with outside lubrication?

The vaginal tissues can tighten for many reasons in MS: lack of lubrication, decreased blood flow to vaginal tissues, or spasticity in the adductor muscles of the hips that indirectly prevents intercourse. The solutions to these problems stem from diagnosing the exact cause, eg. spasticity meds, alternate sex positions, lubricants, etc.

Does MS cause a woman to lose sensation in her nipples and their ability to harden if she is sexually aroused?

MS can cause decreased sensation anywhere in the body, including the nipples or vagina. Decreased sensation can sometimes be helped by increased stimulation (eg oral sex, vibrators, more vigourous touching)

how does one manage problems of the leaking of urine during intercourse?

What if your husband is unwilling to go to a therapist but afraid to be intimate with you since you have had physical symptoms such as incontinence and leg spasms? He clams up when I try to talk about it also but yet says he is willing to try. It has been 10 years now.

leakage can be controlled through restricting liquid intake for a couple of hours prior to intercourse, judicious use of anticholinergic bladder meds prior to intercourse, or self-catheterization prior to intercourse. more importantly, talk w /your partner about it and see if you can jointly come up w/ solutions

I have heard of decreased libido and other such difficulties in women with MS, but can MS be the reason for an increase in libido? If so, how does this happen?

Most of the time, MS causes decreased libido. some ppl experience increased libido. this occurs more often in men w/ MS than women.

While Dr. Foley prepares his next answer, let me remind you that there is one more national event on the schedule for National MS Education and Awareness Month. Next Wednesday there will be a teleconference for caregivers, and we hope that you will invite the spouses and family members who support you to listen in. For more information, call MSF toll-free at 888-673-6287.

I have vaginal dryness. My doctor recommended K-Y Jelly but it doesn't seem to help. Do you have any other suggestions?

Talk w/ your doc about vaginal creams that have hormones (estrogen) in them, or lubricating suppositories (non-hormonal). Try longer lasting lubricants like Astroglide. One woman found KY irritating, and liked corn oil. Do not use petroleum jelly or similar products as it can lead to infection. Use lots and lots of lubricant (dont be afraid to soak the sheets!!!!)

For those of you just joining us, tonight's chat is in a Q&A format. You can send your questions now or at any time throughout the chat this evening. To see a transcript of the chat so far, click the icon in the upper right corner of your screen that looks like a quill in an ink bottle.

I have little to no sex drive. My husband has been a saint - but he can't be this understanding forever. I'm taking Prozac and Copaxone. Do these lower my sex drive and is there anything I can do?

Copaxone does not affect sex drive, but Prozac has a big impact on drive (libido). Talk w/ your doc about taking an alternate SSRI w/ a lower sexual dysfunction profile, such as Lexipro, or talk w/ him/her about switching to Welbutrin, which does not decrease libido, or talk w/ him/her about staying on Prozac but adding a low dose of Welbutrin to your regimen. Sometimes adding amantadine may help, because like Welbutrin, it stimulates the dopamine system w/ helps w/ sex drive.

What are some of the problems that women experience sexually?

The most common symptoms reported by women are lower sex drive, vaginal dryness, and difficulty having orgasm. Loss of sex drive is the most common complaint of women in the general population, it just occurs much more frequently in MS. We have learned in our studies of women w/ MS that treatment of sexual difficulties has to be approached in several ways: identifying the interfering problem (which may be a result of MS directly, a side effect of some medications, depression, or psychological changes/stresses that occur). we make sure to address all of these areas to maximize success.

Keep your questions coming ladies! And don't forget, if you have questions about topics that are outside the scope of tonight's chat, you can visit the MSF's Ask the Doctor forum on our website for assistance.

How can a woman feel sexy with so many MS symptoms?

This is a common problem. We are brainwashed by society to think that we can only feel sexy if we are young and healthy. Regardless of MS symptoms, you are still a woman who is capable of love, of giving and receiving pleasure. Sometimes it is exhausting to deal w/ so many symptoms, but it is important to remember that you are so much more as a human being, as a woman, than your MS. That you can feel sexy and be sexy, no matter what the symptoms. Counseling frequently helps with this

I notice we've had a few more people just join us - welcome! Tonights chat is a moderated question and answer session. You may send your questions now and at any time throughout the chat tonight. Your question will appear to the audience when Dr. Foley responds to it. There will be brief pauses between questions.

I have tried Viagra with some success but is it safe for me? I have no cardiac condition but I do have RRMS.

your doctor who treats you will help you determine the risks of taking any medications. Viagra, Levitra and Cialis are OK for most, except for certain pts w/ blood pressure problems, & patients taking nitrate based cardiac meds. But always check w/ your doc.

Has there been any studies with women using Viagra, Levitra, or Cialis?

There has been one study published to date, but our research (unpublished at this moment) suggests that counseling should be combined w/ medicines for women. Womens sexuality is more complicated than mens. Women want the relationship to be working well in general (more so than men), in order to feel comfortable sexually

The pause between answers is a great time to get your questions in, folks!

i sometimes feel the start of arousal but canot reach orgasm any sugestions?

It depends what is interfering w/ orgasm....medicines, anxiety, body image concerns, or just a lesion somewhere in the spinal cord. Talk w. your doc about it.....ask him/her to review your meds to see if this could be causing it (by the way, no disease modifying med interferes w/ sexual function). Sometimes increasing stimulation or getting sex counseling to re-learn how the body has changed in MS, which can lead to maximizing arousal can help.

Do medicines that increase blood flow to help achieve orgasm lessen or interfere with the effectiveness of Avonex and Keppra (for seizures)?

There is no evidence for that, that i am aware of.

Gyneologically I check out completely normal. Could MS be the cause of pain w/ cervical contact during intercourse?

yes. ms can cause pain or sensory discomfort in the genitals. sometimes applying a cold pack to the genitals prior to intercourse dampens the sensory pain, or taking neurontin or phenytoin can help decrease the pain.

We have conquered the leakage of urine problem with catheterization & I have other symptoms controllec but my husband still seems to have no interest in regaining intimacy in our relationship or pursuing therapy with a physical therapist. Are there sessions available on videotape, maybe?

There is the "better sex" video tape series, which depicts real-life couples/marital partners learning how to communicate better from a sexual standpoint. some of my pts have found them helpful. watch them together w/ your husband and discuss them

Does Amitriptyline (Elavil) affect libido?

Sometimes it does. although not as often as the SSRI meds (like Prozac)

I'd like to make sure that everyone is aware that the booklet "Intimacy and Sexuality with Multiple Sclerosis" by Dr. Foley is available from our Program Services Department and does contain some of the information and resources we are discussing tonight. To receive a copy, call 888-673-6287 or email support@msfocus.org

achieving orgasms..we've tried somay things...oral sex. vobrators and different positions but i still have none

Sometimes, regardless of what people try, they will not regain orgasm. So we encourage them to mourn the loss (because many experience it as a significant loss), and to move towards focusing on sexual sharing as an intimate communication between oneself and ones partner, and to explore/focus on what pleasure is experienced in the physical act of touching...in the emotional play that takes place between 2 lovers...

For those of you who haven't submitted your questions yet, we only have a few more minutes. Don't miss out on this great opportunity!

Is there any way to tell if symptoms such as urinary urgency -loss of libido are coming from menopause rather than ms? And does Paxil also affect libido?

menopause is associated w/ dramatic drops in female sex hormone production (as well as drops in testosterone production...yes, women produce testosterone as well, but in much lower amounts than men) Decreases in sex drive are common after menopause because of the drop in hormones. And yes, Paxil does decrease libido in many. it is a common side effect. Sorting out what is caused by MS vs menopause is a good questions for your doc, because the solutions may a little different.

Does orgasm help any MS symptoms?

Good question....I wonder....there is a nice relaxation that follows orgasm, and sex helps with overall muscle tone. This would make for a fun and interesting clinical trial !

I'm assuming the Aestra and ArginMax you mentioned earlier is Rx is there anything over the counter?

I am sorry.. That was Zestra (not Aestra). I believe they are just herbal preparations. I don't think they are prescription products.

Does the doctor recommend a certain type of vibrator or other device, or is it simply trial and error?

Vibrators are great for decreased sensation, or decreased arousal. They sometimes provide the stimulation needed for orgasm. Generally, I recommend battery operated vibrators (not electric plug in models), because they are more gentle on vaginal tissue. Some women like a vibrator that attaches to the base of their partners penis, so when the penis is inserted into the vaginal it rests on the clitoris...and transforms the entire penis into a vibrator! Basically, it is trial and error. Such experimenting is best approached together in relaxed and playful manner, with no pressure to have sex. Make it playful!

Have you ever spoken at the VAMC in Washington DC?

no, i don't think so.

My husband worries about my aches and pains and is afraid he will hurt me although I do try to reassure him he is not. What to do about this? Are most men fearful of this with MS wives?

Some men treat their partners w/ MS like they were fragile or delicate. They think of them as ill or vulnerable, rather than sexy. This is a mistake!!!! We frequently have to redirect the men back to thinking about their partners as the wonderful sexy women they are

Is Vulvar Pain related to having MS?

vulvar pain could be due to MS...see your ob/gyn, then see your neurologist w/ the gyn's findings.

Let me remind you once again that there is one more national event on the schedule for National MS Education and Awareness Month. Next Wednesday there will be a teleconference for caregivers, and we hope that you will invite the spouses and family members who support you to listen in. For more information, call MSF toll-free at 888-673-6287.

How does a neurogenic bladder play into effect with a persons sex drive

Neurogenic bladder is sometimes treated w/ anticholinergic meds, which can cause severe vaginal dryness, which makes sex uncomfortable and painful...which in turn can decrease drive (many times drive drops from a psychological standpoint when sex becomes uncomfortable). talk w/ your urologist and health care team

Well, everyone, our time is up this evening! I'd like to thank you all for joining us, and a special thanks to Dr. Foley for giving of his time to be here!

I would like to end by saying that the single most important solution to sexual problems in MS is improved communication w/ your health care team and parnter. get educational materials, share them, and talk about it

My best wishes to you all, and thank you. Its an honor to be chattin w/ you all in cyberspace!

And to that end, don't forget that you can call for a copy of the booklet Intimacy and Sexuality With MS. That number again is 888-673-6287. Thanks, Dr. Foley and goodnight everyone!

Dr Foley Thank You so much for time patience, it has been interesting .

Thank You!

Thank you, Dr. Foley. You're the best.

You're welcome