Ask the Doctor

Q: I am experiencing weight and muscle loss even though I am eating well and lifting weights. Can you give me any suggestions to avoid and even reverse “wasting?”

A: I am very pleased to hear that you are exercising and eating properly. Sometimes, loss of fat appears to be a loss of muscle, but muscle strength testing should help alleviate this fear. Although not frequent, some individuals with MS do lose muscle mass, even with proper diet and exercise. We believe this is due to loss of signals from the brain via the spinal cord to the muscles from MS lesions. Usually, other muscles can be strengthened by exercise to overcome such wasting. If not, this symptom may be an early sign of progressive MS with continued damage to myelin and axons (wires in the brain). In this situation, an evaluation of the effectiveness of your immunomodulating therapy must be considered.

Usually, the best professional to evaluate this situation is a rehabilitation medicine physician and/or physical therapist who have expertise in multiple sclerosis. Apparent muscle loss with increasing muscle strength is unlikely to be a long-term problem. However, if muscle strength is decreasing in spite of an exercise program, a thorough evaluation by an MS expert is warranted.

Q: What can be done about the loss of sexual desire, particularly among young women with MS?

A: Before I attribute loss of sexual desire or libido to MS, I look at a number of other issues. First, is there an underlying medical problem which may be contributing to loss of libido? Thyroid problems, anemia, asymptomatic bladder infections, and other medical causes can decrease libido. I also look for depression and/or anxiety, which may contribute to the problem. Fatigue, muscle spasms, and hygiene issues are all important in evaluating loss of libido. Another common problem associated with loss of libido is decreased vaginal lubrication which can produce pain during sexual intercourse. A number of lubricants are available which markedly reduce the dryness, friction and irritability. The newer ones, such as Astroglide®, are easier to use than Vaseline®.

Some women have a notable increase in muscle spasms during sexual intercourse. Anti-spasticity medications are often helpful. Anti-seizure medications such as Neurontin® or Tegretol®, can sometimes reduce the frequency of episodic painful symptoms. Bladder infections may also precipitate pain and spasms. Therefore, a thorough bladder evaluation is important. Some women have such increased muscle stiffness in their thighs that sexual intercourse is physically difficult. Again, anti-spasticity medications or sometimes Botox® injections can help.

Once these medical, psychological, and physical impediments are explored, the issue of medications to treat loss of libido arises. While Viagra has been highly touted in males with impotency, its results in women are less consistent. In addition, it does not have a direct effect on libido. Also, sexual dysfunction clinics have been using low doses of testosterone in women with mixed results.

In summary, many issues must be considered with loss of libido in women with MS. One of the most frequently overlooked issues is the intimacy of the relationship with their partner. One of the best ways to stimulate libido is feeling intimate and having successful communication with their partner. Foreplay, or even hugging or touching, can be powerful aphrodisiacs.

One parting comment: many women with MS are uncomfortable discussing the topic of sexual dysfunction with their physician. Too often, we have an attitude of, “Doctors don’t ask and patients don’t tell.” Breaking down this communication barrier between patients and their doctors will help initiate an evaluation of medical, physical, and psychological issues related to sexual dysfunction which can lead to a much more satisfying sexual relationship for the patients and their partners. If the doctor does not appear to be knowledgeable (or interested), comprehensive MS centers have liaisons with specialty programs, sexual dysfunction clinics, women’s clinics, and gynecologists who specialize in the treatment of sexual dysfunction.

Jack Burks, MD, is the chief medical officer for MSAA and is the president of the Multiple Sclerosis Alliance. Dr. Burks is a neurologist, and holds the positions of medical director of the Washoe Institute for Neurosciences, and clinical professor of medicine (neurology) at the University of Nevada School of Medicine in Reno, Nevada. In the 1970s while in Colorado, he established one of the nation’s first comprehensive MS centers. Dr. Burks is one of the founders of the Consortium of MS Centers, the MS Council, and the American Society of Neurorehabilitation. He has served on the Board of Directors of the American Academy of Neurology and is on the Medical Advisory Board of the National MS Society. Along with Ken Johnson, MD, Dr. Burks is editor of an MS textbook, “Multiple Sclerosis: Diagnosis, Medical Management, and Rehabilitation.” He is also co-editor of the textbook, “Interdisciplinary Rehabilitation of Multiple Sclerosis and Neuromuscular Disorders.”