Abstract
Background
Multiple sclerosis (MS) is a chronic neuroinflammatory disease with highest incidence during the period of optimal reproductive health. This scoping review aimed to identify and summarize available data on sexual/reproductive health in males with MS (MwMS).
Methods
This review was based on PRISMA extension for Scoping Review. PubMed database was searched for keyword “multiple sclerosis” alongside keywords “sexual health”, “reproductive health”, “family planning”, “male fertility”, “male infertility”, “sexual dysfunction”, and “erectile dysfunction”, iteratively using the “AND” logical operator. Descriptive analysis was performed on the included articles.
Results
Thirty-four studies were included, and four topics emerged: sexual dysfunction, erectile dysfunction, fertility, and family planning. Sexual dysfunction is common in MwMS (35–72%), yet only a minority of MwMS discuss their sexual health with their treatment teams. Both MS disability and depression were associated with sexual dysfunction in MwMS, with erectile dysfunction and decreased libido as the most prevalent aspects of sexual dysfunction. Positively, phosphodiesterase-5 inhibitors appear effective for treating erectile dysfunction and improving sexual quality of life in MwMS. There may also be a relationship between MS and male infertility, though changes in sexual behavior may underlie this association. Finally, a prominent knowledge gap was observed for disease-modifying therapy use and family planning in MwMS.
Conclusion
Sexual dysfunction is common, impacted by MS severity, and associates with decreased quality of life in MwMS. Communication barriers regarding sexual and reproductive health appear to exist between MwMS and providers, as do literature gaps related to MS therapeutics and sexual/reproductive health.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
Multiple sclerosis (MS) is a chronic neuroinflammatory disease that adversely affects physical and mental health and can lead to social dissatisfaction [1, 2]. There are 2.8 million people living with MS worldwide [3]. Newer high-efficacy disease-modifying therapies (DMTs) are shifting approaches in care, as risks for relapses substantially decrease with their use [4, 5]. Despite advances in managing disease activity, disease progression persists and many symptoms are difficult to control and worsen over time [6]. In addition to motor impairment in MS, other frequent symptoms include cognitive dysfunction, fatigue, bladder dysfunction, and sleep disturbance, while depression, anxiety, hypertension, and dyslipidemia are common comorbidities [7, 8]. Comprehensive MS care entails management of active symptoms and comorbidities, but there are recognizable challenges due to knowledge gaps for understudied symptoms and lesser recognized comorbidities [9].
Background
Sexual and reproductive health is severely affected by MS [10,11,12]. Causes of sexual dysfunction are multifactorial and may be a consequence of neurologic dysfunction, inflammation, hormonal imbalances, and/or due to cognitive dysfunction and mood disorders, which are prevalent in MS [10]. Clinical approaches in MS define primary sexual dysfunction as related to reproductive system dysfunction, secondary as related to disability due to motor impairment, fatigue, or associated bladder and bowel dysfunction, and tertiary as related to psychological and social factors [13]. Sexual dysfunction and impaired reproductive health lead to increased burden of disease, with direct impact on physical health, mental health, and quality of life in MS [12, 14, 15]. Despite the recognized value of sexual and reproductive health in MS, data on these domains are sparse, mostly based on cross-sectional or retrospective studies, and from periods before the availability of newer high-efficacy DMTs [14,15,16,17,18,19,20,21,22]. Newer DMTs such as B-cell-depleting drugs have different safety profiles than predecessors, and their teratogenic potential is mostly unknown or investigated with ongoing monitoring [21]. In addition, the longitudinal effects of common MS comorbidities on sexual and reproductive health in MS populations remain severely understudied.
The incidence of MS is greatest between the ages of 20 and 40 years [23], which coincides with the age period of optimal fertility, and, thus, family planning should be a part of standard MS care [24]. Studies suggest female infertility may be more common in MS, but causes are not well understood, and recent findings are conflicting [17,18,19]. Robust data on infertility in males with MS (MwMS) are lacking, but fewer pregnancies in women with MwMS partners compared to the general population have been reported [18, 25]. Similar to females with MS (FwMS), sexual dysfunction is very common in MwMS, with 50% experiencing ejaculatory or orgasmic dysfunction and 40–75% experiencing erectile dysfunction [26,27,28,29,30]. Timely use of effective DMTs is increasingly encouraged to maintain remission, despite known and unknown teratogenic potential [19,20,21,22]. Most FwMS discontinue DMT as part of pregnancy planning, though trends over the last decade show an increase in continued use [19]. There are knowledge gaps in MS care regarding the effects of DMT use on sexual and reproductive health in MwMS.
Clinical relevance and objectives
Following recent reviews focused on female reproductive and sexual health in MS [20, 24, 31], we conducted a scoping review to evaluate the available literature on male reproductive and sexual health in MS. Such a comprehensive summary will facilitate current knowledge synthesis and identify existing gaps in the literature, which will guide next steps in enhancing MS clinical care and research related to male sexual and reproductive health in MS.
Methods
Study design and sources
To address the stated objective, we conducted a focused scoping review using the PRISMA-ScR Checklist as a methodological guideline [32, 33]. Candidate publications were identified in PubMed database with the use of keyword “multiple sclerosis” and selected keywords (“sexual health”, “reproductive health”, “family planning”, “male fertility”, “male infertility”, “sexual dysfunction”, “erectile dysfunction”), as respective combinations with the logical operator “AND”. Following the initial title and abstract identification, full papers were read for those passing the screening. Secondary sources, which were otherwise not detected with the earlier search, were sporadically identified in retrieved papers and additionally considered for inclusion in the final review based on their relevance. Final included sources had to meet eligibility criteria and were classified by topic, study design, year of publishing, number of male participants, and study population country and continent of recruitment. Specific data on DMTs were not part of this review. Search was performed between July 15th, 2023 and July 24th, 2023. The methodological flowchart with results is presented as Fig. 1.
Eligibility criteria
Studies available via PubMed database published in English between January 1st, 2002, and July 1st, 2023 were included in the initial screening. The initial date was chosen as a time point after the International Panel on MS Diagnosis presented the recognized diagnostic standard in 2001, which notably integrated magnetic resonance imaging and enabled greater diagnostic accuracy for MS [34]. The final date was chosen as the beginning of the month closest to the time when the literature search was performed. The defined period, spanning more than 2 decades, was also deemed appropriate to assess the overall trends in publishing regarding topics investigated. To broaden the assessed literature, the initial screening included studies regardless of methodology. The final bibliography for the scoping review was manually compiled of original investigations with a focus on MwMS. Duplicates were excluded, as well as reviews, case reports or case series, in vitro or animal studies, and studies that did not report male-stratified findings. The senior author reviewed and approved the final bibliography.
Synthesis of results
Descriptive analysis was performed for the articles included in the scoping review. Main results are presented in table form and discussed.
Results
Initial search based on keyword combinations identified 1119 articles, of which 1024 were excluded based on title and abstract review (Fig. 1). Of the 95 articles remaining for screening, 27 duplicates were excluded, and 68 and were assessed for full reading. Further, 37 articles were excluded based on eligibility criteria. From the eligible articles, seven additional sources were identified, and three of those were excluded due to not fully meeting eligibility criteria. The final scoping review included 34 articles.
Summary of study characteristics
Information on study types, topics of studies, and geographical locations where studies were conducted is displayed in the Supplemental Table 1. Four main study topics emerged following final review: sexual dysfunction covering multiple domains of sexual health, erectile dysfunction as a specific topic of interest, fertility, and family planning. Most studies were cross-sectional (21/34, 62%) and from Europe (22/34, 65%). Sexual dysfunction in a broader sense was the most frequently addressed topic (20/34, 58%), followed by studies focused on erectile dysfunction (7/34, 21%), fertility (5/34, 15%), and family planning (2/34, 6%). Cohort studies (N = 9) were more common than clinical trials (N = 2) or case–control studies (N = 2). Of the two clinical trials, both investigated treatment for erectile dysfunction. Three studies were international: a clinical trial, a prospective cohort, and a cross-sectional study. Temporal trend showed that half of the included studies (17/34, 50%) were published after 2017 (Fig. 2), with at least one publication every year since 2017. Conversely, there were years between 2002 and 2017 which did not yield any studies for the final scoping review literature (Fig. 2).
Sexual dysfunction
A summary of studies focused on sexual dysfunction is provided in Table 1. Cross-sectional studies were the most used methodology (16/20, 80%), and three studies were based on cohorts (3 prospective and 1 retrospective). More than half of the studies were European (12/20, 60%) and a fifth were North American (4/20, 20%). The largest study was based on North American Research Committee on Multiple (NARCOMS) Registry and included 1568 male participants [29], while the smallest included 12 male participants [35]. Most studies used standardized questionnaires such as MS Quality of Life [26, 30, 36,37,38], MS Intimacy and Sexuality Questionnaire [29, 35, 39,40,41,42,43,44,45,46], Sexual Quality of Life Questionnaire for men [35, 44, 47, 48], and International Index of Erectile Function [44, 47, 48], but other methods also included original surveys created by the investigators [46, 49], or other validated forms [38, 39, 46, 49,50,51]. Serum laboratory tests [42] and magnetic resonance imaging (MRI) [35] were uncommon across studies. Based on instruments applied, sexual dysfunction was predominantly determined as a composite qualitative outcome comprising a sexual quality of life metric in combination with measurements of erectile dysfunction and issues with libido, orgasm, or ejaculation. Across studies, the reported prevalence of sexual dysfunction was 35–72% (Table 1). Common associated factors were depression [36, 38], older age [36, 38, 44, 47], and disability due to MS [36, 38, 43, 44, 50]. Additional factors which were reported as associated with sexual dysfunction in individual studies were fatigue [30, 36] and smoking [44]. A cohort study including 27 MwMS determined a continued decrease in sexual activity and worsening sexual function over a 6-year period [49]. The study also reported that those affected were more willing to discuss sexual dysfunction with their partners than with their treatment team (33% vs 7%) [49], but a later cross-sectional study noted that the presence of family or friends during a clinical encounter can be a barrier to help seeking for sexual dysfunction [46]. In the same study, 6/20 MwMS reported that other MS symptoms overshadow their sexual problems, and 5/20 felt there was insufficient time to discuss sexual function during the encounter [46]. In a cross-sectional study of 50 MwMS investigating serum sex hormone profiles including 17-beta estradiol, progesterone, androstenedione, dehydroepiandrosterone-sulfate, total testosterone, estrone, prolactin, sex hormone-binding globulin, inhibin B, and anti-Mullerian hormone, there were no substantial differences in those with or without sexual dysfunction, except for lower levels of inhibin B in those with sexual dysfunction [42]. No specific brain or spinal cord MRI findings were found to be associated with the severity of sexual dysfunction [35].
Erectile dysfunction
A summary of studies focused on erectile dysfunction is provided in Table 2. More than half of the included studies were cross-sectional (4/7, 57%), two were clinical trials, and one was a case–control study. Besides the case–control study based on a national database (38,139 cases with erectile dysfunction and 262,848 controls) [52], the second largest study was a randomized double-blind placebo-controlled clinical trial including 217 participants [53]. All studies included the International Index of Erectile Function questionnaire as the main assessment method, with the addition of quality of life [27, 53,54,55] or urinary tract function [27, 54, 56] metrics in some. In cross-sectional studies assessing the prevalence of erectile dysfunction in MwMS, the values were 45% [28] and 74% [27]. Depression, urinary tract symptoms, and greater disability due to MS were factors associated with erectile dysfunction in MS [27, 54, 56]. Diagnosis of MS was shown to be associated with erectile dysfunction in the large Taiwanese case–control study based on their national insurance database [52]. Phosphodiesterase-5 inhibitors (sildenafil, tadalafil), were shown to be effective for erectile dysfunction in MS leading to improvement in sexual quality of life in two clinical trials [53, 55]. In an international multi-center randomized controlled trial assessing sildenafil (104 subjects) against placebo (113 subjects), after 3 months, 90% of those using sildenafil (25–100 mg dose) reported improvement in erectile function and quality of life in comparison to 24% in the placebo group, a result which was sustained in the 48-week open label extension [53]. In an Italian single-arm prospective study assessing tadalafil, 70 of 92 participants noted improvement in erectile function and quality of life as measured at 3 months [55]. Both trials supported phosphodiesterase-5 inhibitors as safe pharmacological interventions with caveats regarding exclusion criteria, notably uncontrolled cardiovascular comorbidities and major psychiatric disorders [53, 55].
Fertility
Four cohort studies (3 retrospective and 1 prospective) and a case–control study were focused on fertility as the main topic (Table 3). The prospective cohort study was the smallest (32 participants), but included longitudinal serum sex hormone profiles and sperm analysis [57]. It demonstrated no changes in measured hormonal or sperm parameters over a 12-month follow-up period in those treated with natalizumab or ocrelizumab. The larger retrospective study [58], based on the pooled data from Danish national registries for infertility and multiple sclerosis (24,011 with male-factor infertility, 49 MwMS), showed that male infertility was associated with a presence of diagnosis of MS (odds ratio 1.6), but not with subsequent new diagnosis of MS. In a similar manner, a Swedish case–control study (497 MwMS and 1081 controls) showed there was an association between MS diagnosis in men and being childless for the 5 years preceding index MS clinical symptom with an odds ratio 0.6 for a diagnosis of MS for those with children when compared to being childless [18]. A prior Danish national retrospective cohort based on a sample of 2,240,000 men (3426 MwMS) showed a reduced risk of MS diagnosis in men who had a child, with more children further decreasing the risk of MS diagnosis [25]. However, these case–control studies might reflect changes in sexual behaviors that might lead to conception in the prodromal period for MS. Finally, in a cohort treated with mitoxantrone (238 participants, 80 MwMS), there were no differences in number of pregnancies or rates of abortion or miscarriages between FwMS and partners of MwMS [59].
Family planning
Two cross-sectional studies focused on family planning [60, 61] and both were based on original surveys. The first, based on 102 MwMS in Denmark, reported information about fetal risk with use of DMT was commonly obtained from MS treatment team (40% of respondents), but a majority of participants did not know if their current DMT had direct teratogenic effects (74%), or if DMT of male partners with MS may be associated with teratogenicity in case of conception with a female partner without MS [61]. In the second study, in an international sample of 61 MwMS, 49% reported their MS diagnosis did not have an impact on their desire to have children, 8% decided not to have children due to their diagnosis, and 25% reported changing their plans significantly [62].
Discussion
Our scoping review based on male sexual and reproductive health in MS included 34 original studies published over the last 2 decades (2002–2023). Most studies broadly focused on sexual dysfunction [26, 29, 30, 35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51], followed by specific focus on erectile dysfunction [27, 28, 52,53,54,55,56], fertility [18, 25, 57,58,59], and family planning [61, 62], respectively. Despite the growing availability of DMT options in recent years, including newer high-efficacy treatments, comorbidity management which includes sexual and reproductive health, remains one of the cornerstones to improve quality of life and minimize direct or indirect disability due to MS [63].
Multiple sclerosis and male sexual health
Prevalence of sexual dysfunction in global male populations increases with age, especially after the age of 40 years and even more after age of 70 years, but a majority (> 50%) still retain sexual desire [64]. Erectile dysfunction affects 20% of otherwise healthy 50-year-old men, but the prevalence doubles in those with hypertension, obesity, and diabetes [65]. In contrast to a general male population, a much greater proportion of MwMS are affected with erectile dysfunction or loss of libido (40–75%) [26,27,28,29,30]. In the Taiwanese case–control study, the association between erectile dysfunction and a diagnosis of MS remained evident even when controlling for age, socio-economic status, and comorbidities [52]. Although erectile function and libido are the most commonly considered factors associated with male sexual health, etiology of sexual dysfunction in MS is complex, and postulated factors have been clinically organized into a tripartite hierarchical model [13]. For MwMS, our summary identified erectile dysfunction as the most common factor categorized as a component of primary sexual dysfunction, disability due to MS categorized as secondary, and depression categorized as tertiary. Specific hormonal or neuroimaging findings pointing to sexual dysfunction in MwMS have not been identified, aside from a potential role of lower levels of inhibin B [42]. A prior electrophysiologic study based on volunteer sample of 29 MwMS reported neurogenic causes as more frequent than isolated psychological (26 vs. 3 participants), though the latter was also recognized as a potential co-factor when the former is present [66]. Besides optimizing prevention and management of comorbidities found to impact sexual health in the general male population, our review highlights reduction of the burden of motor disability due to MS and improving mental health as additional intervention targets to ameliorate sexual dysfunction in MwMS. In review of the epidemiologic evidence, there were only two clinical trials focused on erectile dysfunction in MwMS. Most of the observational studies on sexual dysfunction were cross-sectional (14/20), which precluded inferences about longitudinal relationships between associated factors. Despite general study design limitations, including modest sample sizes, similar manifestations and related symptoms or comorbidities were reported across studied populations.
Multiple sclerosis and male reproductive health
There is a major knowledge gap regarding DMT use in the context of reproductive health in MwMS population [61], which possibly has a direct impact for about a third of MwMS who change their plans regarding having children following an established diagnosis of MS [62]. Sexual health is an integral part of reproductive health, but fertility and fecundity also depend on male factors such as sperm quality. Exact pathophysiologic mechanisms of male-factor infertility in MS remain to be determined, though up to 40% of causes of male-factor infertility are elusive even in general population-based studies [67]. Scandinavian population-based studies showed an association between male diagnosis of MS and fewer offspring, and may be indicative of increased infertility but it may also reflect altered sexual behaviors [18, 25, 58]. Most of the observational studies on these topics were retrospective (4/7) and based on specific European populations (4/7 Scandinavian countries, 2/7 Italy), which limits generalizability.
Limitations
Limitations of this study are primarily related to the nature of the scoping review methodology and chosen strategy, i.e., we restricted our selection of eligible publications to PubMed database for initial article retrieval and defined a specific period. In case an additional source was sporadically identified in one of the read articles, it was considered for inclusion based on same eligibility criteria. Although this enabled an additional number of sources to be included, grey literature on potentially relevant topics and publications in language other than English were not reviewed. With the goal of summarizing the available literature in a broader, yet focused manner, only descriptive reporting or analysis was used. Evaluation of the quality of the included studies was not performed. Aside from research based on national registries, most studies were modestly sized (< 100 participants) and therefore potential subject to sampling variability and from which limited inference is possible.
Conclusions and future directions
Literature on sexual and reproductive health in MS is predominantly based on female populations, but there may be a trend of a growing scientific interest for male populations for similar aspects of health. Sexual dysfunction in a broader sense has emerged as the topic with most included studies, and our literature review showed a greater geographical diversity for those studies starting in 2020, with otherwise prior dominance of European data. Sexual dysfunction is more prevalent in MwMS than in the general male population, and it is associated with worse quality of life, depression, and disability due to MS. This is potentiated by communication barriers for disclosing sexual dysfunction. Phosphodiesterase-5 inhibitors may improve erectile dysfunction, a very common manifestation of sexual dysfunction. There is scarce data on family planning in MS from male perspective. Additional epidemiological and clinical efforts are needed to further investigate the apparent association of male infertility and MS diagnosis. For better understanding of reproductive health in MS, larger and geographically more diverse studies are needed in male populations, ideally based on prospective registries.
References
Shirani A, Zhao Y, Kingwell E et al (2012) Temporal trends of disability progression in multiple sclerosis: findings from British Columbia, Canada (1975–2009). Mult Scler 18:442–450. https://doi.org/10.1177/1352458511422097
Ståhl D, Bjereld Y, Dunér A (2022) Disabled in Society—a scoping review on persons living with multiple sclerosis and disability. JMDH 15:375–390. https://doi.org/10.2147/JMDH.S353347
Walton C, King R, Rechtman L et al (2020) Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Mult Scler 26:1816–1821. https://doi.org/10.1177/1352458520970841
Bossart J, Kamm CP, Kaufmann M et al (2022) Real-world disease-modifying therapy usage in persons with relapsing-remitting multiple sclerosis: cross-sectional data from the Swiss Multiple Sclerosis Registry. Mult Scler Relat Disord 60:103706. https://doi.org/10.1016/j.msard.2022.103706
Chen C, Zhang E, Zhu C et al (2023) Comparative efficacy and safety of disease-modifying therapies in patients with relapsing multiple sclerosis: a systematic review and network meta-analysis. J Am Pharm Assoc 63:8-22.e23. https://doi.org/10.1016/j.japh.2022.07.009
Lublin FD, Häring DA, Ganjgahi H et al (2022) How patients with multiple sclerosis acquire disability. Brain 145:3147–3161. https://doi.org/10.1093/brain/awac016
Gustavsen S, Olsson A, Søndergaard HB et al (2021) The association of selected multiple sclerosis symptoms with disability and quality of life: a large Danish self-report survey. BMC Neurol 21:317. https://doi.org/10.1186/s12883-021-02344-z
Marrie RA (2017) Comorbidity in multiple sclerosis: implications for patient care. Nat Rev Neurol 13:375–382. https://doi.org/10.1038/nrneurol.2017.33
Péloquin S, Schmierer K, Leist TP et al (2021) Challenges in multiple sclerosis care: results from an international mixed-methods study. Mult Scler Relat Disord 50:102854. https://doi.org/10.1016/j.msard.2021.102854
Guo Z-N, He S-Y, Zhang H-L et al (2012) Multiple sclerosis and sexual dysfunction. Asian J Androl 14:530–535. https://doi.org/10.1038/aja.2011.110
Nazari F, Shaygannejad V, Mohammadi Sichani M et al (2020) Sexual dysfunction in women with multiple sclerosis: prevalence and impact on quality of life. BMC Urol 20:15. https://doi.org/10.1186/s12894-020-0581-2
Drulovic J, Kisic-Tepavcevic D, Pekmezovic T (2020) Epidemiology, diagnosis and management of sexual dysfunction in multiple sclerosis. Acta Neurol Belg 120:791–797. https://doi.org/10.1007/s13760-020-01323-4
Foley FW (2006) Sexuality. In: Kalb R (ed) Multiple sclerosis: a guide for families, 3rd edn. Demos Medical Publishing, New York
Zorzon M, Zivadinov R, Bosco A et al (1999) Sexual dysfunction in multiple sderosis: a case-control study. 1. Frequency and comparison of groups. Mult Scler 5:418–427. https://doi.org/10.1177/135245859900500i609
Zorzon M, Zivadinov R, Monti Bragadin L et al (2001) Sexual dysfunction in multiple sclerosis: a 2-year follow-up study. J Neurol Sci 187:1–5. https://doi.org/10.1016/S0022-510X(01)00493-2
Lamaita R, Melo C, Laranjeira C et al (2021) Multiple sclerosis in pregnancy and its role in female fertility: a systematic review. JBRA. https://doi.org/10.5935/1518-0557.20210022
Houtchens MK, Edwards NC, Hayward B et al (2020) Live birth rates, infertility diagnosis, and infertility treatment in women with and without multiple sclerosis: data from an administrative claims database. Mult Scler Relat Disord 46:102541. https://doi.org/10.1016/j.msard.2020.102541
Hedström A, Hillert J, Olsson T, Alfredsson L (2014) Reverse causality behind the association between reproductive history and MS. Mult Scler 20:406–411. https://doi.org/10.1177/1352458513498126
Toscano S, Chisari CG, Meli A et al (2023) Pregnancy planning and management for women with multiple sclerosis: what has changed over the last 15 years? An Italian single-center experience. Mult Scler Relat Disord 70:104526. https://doi.org/10.1016/j.msard.2023.104526
Krysko KM, Bove R, Dobson R et al (2021) Treatment of women with multiple sclerosis planning pregnancy. Curr Treat Options Neurol 23:11. https://doi.org/10.1007/s11940-021-00666-4
Massarotti C, Sbragia E, Gazzo I et al (2021) Effect of multiple sclerosis and its treatments on male fertility: cues for future research. JCM 10:5401. https://doi.org/10.3390/jcm10225401
Dobson R, Hellwig K (2021) Use of disease-modifying drugs during pregnancy and breastfeeding. Curr Opin Neurol 34:303–311. https://doi.org/10.1097/WCO.0000000000000922
Gbaguidi B, Guillemin F, Soudant M et al (2022) Age-period-cohort analysis of the incidence of multiple sclerosis over twenty years in Lorraine. France Sci Rep 12:1001. https://doi.org/10.1038/s41598-022-04836-5
Krysko KM, Dobson R, Alroughani R et al (2023) Family planning considerations in people with multiple sclerosis. Lancet Neurol 22:350–366. https://doi.org/10.1016/S1474-4422(22)00426-4
Nielsen NM, Jørgensen KT, Stenager E et al (2011) Reproductive history and risk of multiple sclerosis. Epidemiology 22:546–552. https://doi.org/10.1097/EDE.0b013e31821c7adc
Altmann P, Leutmezer F, Leithner K et al (2021) Predisposing factors for sexual dysfunction in multiple sclerosis. Front Neurol 12:618370. https://doi.org/10.3389/fneur.2021.618370
Balsamo R, Arcaniolo D, Stizzo M et al (2017) Increased risk of erectile dysfunction in men with multiple sclerosis: an Italian cross-sectional study. Cent Eur J Urol 70:289–295. https://doi.org/10.5173/ceju.2017.1380
Dachille G, Ludovico GM, Pagliarulo G, Vestita G (2008) Sexual dysfunctions in multiple sclerosis. Minerva Urol Nefrol 60:77–79
Orasanu B, Frasure H, Wyman A, Mahajan ST (2013) Sexual dysfunction in patients with multiple sclerosis. Mult Scler Relat Disord 2:117–123. https://doi.org/10.1016/j.msard.2012.10.005
Wu J, Jelinek GA, Weiland T et al (2020) Perceived cognitive impairment is associated with sexual dysfunction in people with multiple sclerosis: a 2.5-year follow-up study of a large international cohort. Mult Scler Relat Disord 45:102410. https://doi.org/10.1016/j.msard.2020.102410
Carlson AK, Ontaneda D, Rensel MR et al (2023) Reproductive issues and multiple sclerosis: 20 questions. CCJM 90:235–243. https://doi.org/10.3949/ccjm.90a.22066
Arksey H, O’Malley L (2005) Scoping studies: towards a methodological framework. Int J Soc Res Methodol 8:19–32. https://doi.org/10.1080/1364557032000119616
Tricco AC, Lillie E, Zarin W et al (2018) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169:467–473. https://doi.org/10.7326/M18-0850
McDonald WI, Compston A, Edan G et al (2001) Recommended diagnostic criteria for multiple sclerosis: guidelines from the international panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127. https://doi.org/10.1002/ana.1032
Seyman E, Kim D, Bharatha A et al (2022) Quantitative spinal cord MRI and sexual dysfunction in multiple sclerosis. Mult Scler J Exp Transl Clin 8:205521732211321. https://doi.org/10.1177/20552173221132170
Kaplan TB, Feldman T, Healey B et al (2023) Sexual problems in MS: sex differences and their impact on quality of life. Mult Scler Relat Disord 74:104672. https://doi.org/10.1016/j.msard.2023.104672
Sabanagic-Hajric S, Memic-Serdarevic A, Sulejmanpasic G, Mehmedika-Suljic E (2022) Influence of sociodemographic and clinical characteristics on sexual function domains of health related quality of life in multiple sclerosis patients. Mater Sociomed 34:188–192. https://doi.org/10.5455/msm.2022.34.188-192
Tepavcevic D, Kostic J, Basuroski I et al (2008) The impact of sexual dysfunction on the quality of life measured by MSQoL-54 in patients with multiple sclerosis. Mult Scler 14:1131–1136. https://doi.org/10.1177/1352458508093619
Celik DB, Poyraz EÇ, Bingöl A et al (2013) Sexual dysfunction ın multiple sclerosis: gender differences. J Neurol Sci 324:17–20. https://doi.org/10.1016/j.jns.2012.08.019
de Melo EMVD, Schoeps VA, Oliveira FFLD et al (2023) Sexual dysfunction in Brazilian patients with multiple sclerosis. Arq Neuropsiquiatr 81:350–356. https://doi.org/10.1055/s-0043-1767824
Demirkiran M, Sarica Y, Uguz S et al (2006) Multiple sclerosis patients with and without sexual dysfunction: are there any differences? Mult Scler 12:209–211. https://doi.org/10.1191/135248506ms1253oa
Di Pauli F, Zinganell A, Böttcher B et al (2023) Sexual dysfunction in female and male people with multiple sclerosis: disability, depression and hormonal status matter. Eur J Neurol 30:991–1000. https://doi.org/10.1111/ene.15696
Fragalà E, Privitera S, Giardina R et al (2014) Determinants of sexual impairment in multiple sclerosis in male and female patients with lower urinary tract dysfunction: results from an Italian cross-sectional study. J Sex Med 11:2406–2413. https://doi.org/10.1111/jsm.12635
Nabavi SM, Dastoorpoor M, Majdinasab N et al (2021) Prevalence of sexual dysfunction and related risk factors in men with multiple sclerosis in Iran: a multicenter study. Neurol Ther 10:711–726. https://doi.org/10.1007/s40120-021-00257-0
Pašić H, Vujević L, Bošnjak Pašić M et al (2019) Sexual dysfunction and depression in patients with multiple sclerosis in Croatia. Psychiatr Danub 31:831–838
Tudor KI, Eames S, Haslam C et al (2018) Identifying barriers to help-seeking for sexual dysfunction in multiple sclerosis. J Neurol 265:2789–2802. https://doi.org/10.1007/s00415-018-9064-8
Lew-Starowicz M, Rola R (2014) Correlates of sexual function in male and female patients with multiple sclerosis. J Sex Med 11:2172–2180. https://doi.org/10.1111/jsm.12622
Lew-Starowicz M, Rola R (2014) Sexual dysfunctions and sexual quality of life in men with multiple sclerosis. J Sex Med 11:1294–1301. https://doi.org/10.1111/jsm.12474
Kisic-Tepavcevic D, Pekmezovic T, Trajkovic G et al (2015) Sexual dysfunction in multiple sclerosis: a 6-year follow-up study. J Neurol Sci 358:317–323. https://doi.org/10.1016/j.jns.2015.09.023
Fraser C, Mahoney J, McGurl J (2008) Correlates of sexual dysfunction in men and women with multiple sclerosis. J Neurosci Nurs 40:312–317. https://doi.org/10.1097/01376517-200810000-00010
McCabe MP, McKern S, McDonald E, Vowels LM (2003) Changes over time in sexual and relationship functioning of people with multiple sclerosis. J Sex Marital Ther 29:305–321. https://doi.org/10.1080/00926230390195506-2372
Keller JJ, Liang Y-C, Lin H-C (2012) Association between multiple sclerosis and erectile dysfunction: a nationwide case-control study. J Sex Med 9:1753–1759. https://doi.org/10.1111/j.1743-6109.2012.02746.x
Fowler CJ, Miller JR, Sharief MK et al (2005) A double blind, randomised study of sildenafil citrate for erectile dysfunction in men with multiple sclerosis. J Neurol Neurosurg Psychiatry 76:700–705. https://doi.org/10.1136/jnnp.2004.038695
Bientinesi R, Coluzzi S, Gavi F et al (2022) The impact of neurogenic lower urinary tract symptoms and erectile dysfunctions on marital relationship in men with multiple sclerosis: a single cohort study. JCM 11:5639. https://doi.org/10.3390/jcm11195639
Lombardi G, Macchiarella A, Del Popolo G (2010) Efficacy and safety of tadalafil for erectile dysfunction in patients with multiple sclerosis. J Sex Med 7:2192–2200. https://doi.org/10.1111/j.1743-6109.2010.01797.x
Tomé ALF, Miranda EP, de Bessa JJ et al (2019) Lower urinary tract symptoms and sexual dysfunction in men with multiple sclerosis. Clinics (Sao Paulo) 74:e713. https://doi.org/10.6061/clinics/2019/e713
D’Amico E, Zanghì A, Calogero AE, Patti F (2021) Male fertility in relapsing-remitting multiple sclerosis patients treated with natalizumab and ocrelizumab: a prospective case-control study. Mult Scler 27:2284–2287. https://doi.org/10.1177/13524585211009208
Glazer CH, Tøttenborg SS, Giwercman A et al (2018) Male factor infertility and risk of multiple sclerosis: a register-based cohort study. Mult Scler 24:1835–1842. https://doi.org/10.1177/1352458517734069
Frau J, Coghe G, Casanova P et al (2018) Pregnancy planning and outcomes in patients with multiple sclerosis after mitoxantrone therapy: a monocentre assessment. Eur J Neurol 25:1063–1068. https://doi.org/10.1111/ene.13650
Bonavita S, Lavorgna L, Worton H, Jack D (2022) Family planning in people with multiple sclerosis: a plain language summary. Neurodegener Dis Manag 12:9–14. https://doi.org/10.2217/nmt-2021-0045
Rasmussen PV, Magyari M, Moberg JY et al (2018) Patient awareness about family planning represents a major knowledge gap in multiple sclerosis. Mult Scler Relat Disord 24:129–134. https://doi.org/10.1016/j.msard.2018.06.006
Bonavita S, Lavorgna L, Worton H et al (2021) Family planning decision making in people with multiple sclerosis. Front Neurol 12:620772. https://doi.org/10.3389/fneur.2021.620772
Langston C, Fabian M, Krieger S (2021) Symptom management in multiple sclerosis. In: Neuroimmunology. Springer
Beutel ME, Weidner W, Brähler E (2006) Epidemiology of sexual dysfunction in the male population. Andrologia 38:115–121. https://doi.org/10.1111/j.1439-0272.2006.00730.x
Pellegrino F, Sjoberg DD, Tin AL et al (2023) Relationship between age, comorbidity, and the prevalence of erectile dysfunction. Eur Urol Focus 9:162–167. https://doi.org/10.1016/j.euf.2022.08.006
Kirkeby HJ, Poulsen EU, Petersen T, Dørup J (1988) Erectile dysfunction in multiple sclerosis. Neurology 38:1366–1366. https://doi.org/10.1212/WNL.38.9.1366
Babakhanzadeh E, Nazari M, Ghasemifar S, Khodadadian A (2020) Some of the factors involved in male infertility: a prospective review. Int J Gen Med 13:29–41. https://doi.org/10.2147/IJGM.S241099
Funding
Karlo Toljan has received a training grant from the National MS Society (FP-2207–39855).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflict of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Toljan, K., Briggs, F.B.S. Male sexual and reproductive health in multiple sclerosis: a scoping review. J Neurol 271, 2169–2181 (2024). https://doi.org/10.1007/s00415-024-12250-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-024-12250-2