Relationships and Intimacy

Older couple walking outside with their arms around one another.

3 Aug 2020 | ~3:06 Engagement Time


Meghan Beier , Neuropsychologist & Kathleen Healey , Nurse Practitioner


Up to 80% of people living with MS will experience a sexual challenge throughout their lifetime. However, sexual challenges are not just experienced by people living with MS. Approximately 35-40% of people in the general population also experience sexual difficulties. 

So, What Gets in the Way?

It can be a lot of different factors, and not all of them are directly related to MS. Sexual dysfunction is a complex issue. Therefore, it’s important to fully explore all the possibilities. It’s also possible for the underlying cause of sexual difficulties to change throughout your life. Importantly, sometimes sexual difficulties may not be related to MS, rather, other unrelated medical problems may be causing or contributing to issues.  

With aging, both men and women can develop cardiovascular disorders, hormonal changes, and structural changes within the pelvis and the sexual organs that can cause or affect sexual functioning. Certain medications and excessive use of other substances including alcohol may play a role.  

There are many strategies to improve sexual functioning, and you may try several solutions before finally landing on the right one for you, your partner(s), and your situation. 

The foundation of a good sex life is communication.  Only 9% of heterosexual couples report feeling comfortable talking about sex, which is less than homosexual couples. In a 12-year study conducted by Dr. Gottman and Dr. Levenson, they found that same-sex couples were more direct in conflict management, less physiologically flooded during conflict, used humor to reduce conflict tension, talked more directly about sex, and overall reported a more contented sexual relationship.  Often a foundation of strong relational intimacy can lead to an overall better sex life.  

How Do You Build A Foundation of Intimacy?

A few suggestions for building intimacy include: 

  1. Make time for each other and stay good friends.  What were the things you enjoyed about your partner when you first met? What did you talk about? Long-time partners often drift away from prioritizing their partner, and prioritize everything else instead.  They start to drift apart.  Set a date night.  Have deep and meaningful conversations.  If you need some communication starters try this app. 
  2. Say “I love you”, cuddle, and be physically affectionate.  New couples often hold hands, and touch frequently. This builds intimacy.  Try connecting with your partner with small physical touches. 
  3. Talk about sex, and physical intimacy. Know what turns your partner on and off.  This can happen in or outside the bedroom.  In the bedroom reward your partner when they are turning you on – “I like that!” or “I love it when you do that.”  Outside the bedroom, practice short, targeted conversations about sex or physical intimacy.  Discuss any worries, concerns, or unhelpful self-talk you are having with your partner. You may realize it isn’t a concern for them, or you both can come up with a creative solution. 

What Other Factors Can Affect Intimacy?

Outside of physical and emotional intimacy, there are a variety of medical reasons that can interfere with sex. They can be directly related to lesions on the brain or spinal cord (e.g., numbness, loss of desire, vaginal dryness, erectile dysfunction).  They can be due to MS symptoms (e.g., pain, spasticity, fatigue, bladder/bowel incontinence, mobility issues), medications (e.g., anti-depressants), or medical treatments and interventions (e.g., catheters). 

Sex can also be impacted by anxiety, depression, relationship role changes, or low self-esteem.  It is important to explore all of these potential causes. This can be done by speaking to your health care team, or working with a sexual specialist like a pelvic floor physical therapist or a sex therapist.   

Overlooked may also be the fact that many adults have never had formal sex education. In a large survey, 92 percent of respondents have never formally learned basic anatomy and physiology and/or “how to have sex”.  Over 70 percent of adults surveyed believe they would benefit from taking a sex ed class now. 

A few things to keep in mind: 

  1. Intimacy and sex are an important part of health. 
  2. You are not alone. Many people have challenges with intimacy and sex, they just don’t talk about it 
  3. Learn about sex 
  4. Communicate with your partner 
  5. Identify someone on your health care team to assist you in analyzing/investigating causes and make recommendations. Bring it up if they don’t and be proud of yourself if you do! 
  6. Use appropriate resources (we have listed some below) 
  7. Remember: knowledge is power!