Multiple sclerosis (MS) affects approximately 400,000 patients in the U.S. – and more than 2,5 million people in the world with a probable annual incidence of 4 to 6 per 100 000 inhabitants. It is the most frequent neurological condition in the young subject, affecting young adults aged between 20 and 40. More than two million people worldwide have MS.
Multiple Sclerosis (MS) Outlined By My Canadian Pharmacy
Multiple sclerosis, referred to as MS, is the most commonly observed neurological neurological disease of the central nervous system in young adults. It is characterized by an inflammatory reaction developed against the myelin of the central nervous system and thus deteriorates the quality of nerve impulses.
The disease affects mostly young adults and women more often than men. MS is the leading cause of non-traumatic disability in young adults. MS is an autoimmune disease, that is, a disease resulting from a disorder of the immune system, which is manifested by the action of cells and antibodies on certain organs, which are then assimilated to foreign bodies. The patient manufactures antibodies against his own tissues called autoantibodies. In the case of MS, the immune system of the sick person reacts against myelin and neutralizes it as if it were a foreign body.
Acute form corresponds to one or more neurological disorders, isolated or associated, which settle within a few hours, extend over a period of at least 24 hours, several days or weeks and then disappear completely or partially. During the acute stage, new symptoms may appear, but also reappear from old manifestations. Present symptoms may also worsen.
The recurrent form is the most frequent: more than 80% of the patients present this phase at the beginning of the disease. The recurrent form is characterized by the appearance of acute stages alternating with phases of remission. During the early phase, the symptoms may be totally absent, and sometimes even for several years.
Secondarily, progressive MS is considered to be the second phase of the disease in nearly one in two patients, 10 years after the first symptoms: it is characterized in particular by a regular worsening of irreversible neurological abnormalities. Regression at periods of remission is increasingly incomplete, the number of relapses and remissions decreases in parallel with the disability that persists more and more intensely.
Progressive MS primary affects about 10% of patients and occurs in the elderly. The symptoms worsen very rapidly progressively, and the handicap increases rapidly and becomes permanent because there is neither thrust nor remission. The progression is then irreversible.
Progressive recurrent MS is the rarest form of MS corresponding to approximately 5% of patients. It progresses as soon as it appears, but periods of remission occur but are not necessarily accompanied by improvement or recovery.
Erectile Dysfunction As A Common Multiple Sclerosis Symptom
In the state of flaccidity (non-erection), the muscle fibers of the penis are contracted, due to the activity of a so-called ‘sympathetic’ center which is located in the lower middle (thoraco-lumbar) spinal cord.
The erection, on the other hand, corresponds to a relaxation of the muscle fibers of the penis. This state is under the control of the ‘parasympathetic’ center located at the very low part of the spinal cord.
The innervation which allows to perceive the sensibility originating from the genital region and which controls the muscles of the base of the penis (bulbo-cavernous, ischio-cavernous) is attached to the same area: these are used to transmit voluntary and involuntary reflexes for the maintenance of erection and ejaculation.
The sensory stimulation of the genital area favors the emergence of a ‘reflex’ erection which passes through the parasympathetic center which is stimulated and which then triggers relaxation of the muscular fibers of the penis: the arterial blood will fill the open spaces with this relaxation and leads to a gradual increase in pressure, and thus to the stiffness that will be optimized by the muscle contractions of the base of the penis.
In contrast, or rather in addition to the reflex erection, the ‘psychogenic’ erection is under the control of the thoraco-lumbar center. It is triggered by sensory stimulations (vision, smell, etc.) or mental (imagination, dreams, etc.) with an inhibition of sympathetic activity.
In the brain, complex circuits intervene by bringing into play various zones:
- Sensors that distinguish pleasant perceptions and discriminate them from any other sensation
- Transmitters that provide a suitable affective and behavioural response, involving innate phenomena and elements that result from culture and education.
- Sensory nerves
- The sum of the above processes will result in an active response or inhibition to sexual stimulation.
The emission of seminal fluid is under the control of the thoraco-lumbar center, as is the contraction of the prostate and seminal vesicles with the closure of the bladder neck during ejaculation. The clonic and jerky ejection of sperm, involving in particular rhythmic contractions of the muscles of the perineum, is under the control of the sacral spinal cord.
Reflexively, flaccidity may occur (or an erection difficult to obtain) due to the presence of an ‘irritative spine’, perceived or not, in the region concerned by the same lumbosacral innervation: incarnated nail, eschar, hemorrhoid or anal fissure, poor emptying of the rectum, urine retention, urinary tract infection, etc. This physiology therefore concerns regions which correspond to those, from the marrow to the brain, which are affected by multiple sclerosis. The neurological control of sexual functions therefore concerns areas affected by multiple sclerosis, from the marrow to the brain.
Various elements therefore logically interfere with these sexual dysfunctions, either because they induce situational difficulties (more difficult sexual positions to be taken and maintained) or difficulties experienced in a modified sexual life.
These elements, whose therapeutic management will be indispensable in the treatment of sexual dysfunction, are:
- Fatigue, physical and / or psychic, which is a disabling parameter common in multiple sclerosis; one of the factors aggravating this fatigue is the situation of maladjustment to the effort of the patients who tend to avoid the physical activity so as not to be fatigued but, as a result, progressively reduce their capacity to adapt cardio-respiratory and muscular to realize physical activity is sustained. This fatigue constitutes an argument for reducing sexual activity, the improvement of which could, on the contrary, reduce the feeling of fatigue, physical and also moral;
- Motor problems: motor weakness and / or spasticity can interfere with sexual acts: they can make certain postures difficult, make them unstable, reduce the flexibility and spontaneity of the act, and may also alter their image Themselves and their partner make of them;
- Sensory disturbances that can modify sexual sensations and promote erectile dysfunction also affect the body more generally and then increase motor difficulties, for example due to poor perception of the lower limbs;
- Cognitive alterations (memory, concentration …) are also a factor of degradation of the sex life; They must be analyzed, they must be dissociated from psychological and particularly depressive phenomena (which may also be present and are also deleterious to the quality of sexual life) and must be re-educated;
- The pain of various types (neurological, articular, related to spasticity …) create discomfort that adds to the other elements in order not to motivate the man to undertake a sexual activity; They should never be considered intractable;
- The frequently associated perineo-sphincteric problems, bladder and / or anal, aggravate the discomfort especially in case of risk of urinary or fecal leak
All these elements seem all the more invalidating as man is installed in a stable or even old relation, because of the modifications that induce in relation to habits in the sexual practice. The management of the sexual disorders of the patient has then interest, to be effective, to actively concern the two partners.
In general, the interference of these various elements is shown by the link between the general disability scales (Measure of Functional Independence, EDSS score, self-assessment of disability by the patient, etc.) and the quality of the sex life. Conversely, there is no direct link between the quality of sexual life on the one hand, the duration of the disease’s progression and the severity of the neurological impairment on the other. This shows that coping mechanisms exist spontaneously and after treatment by medication and re-education, and that any eventual deficits do not prevent sexual development.
Why Erectile Dysfunction Occurs In Multiple Sclerosis Patients
The localization of neurological lesions in the brain and spinal cord explains the frequency of sexual difficulties in multiple sclerosis.
During the course of the disease, only slightly more than 4 out of 10 men are satisfied with their sex life. Part of the central nervous system housed in the cranial cavity that includes the brain, cerebellum and brain stem. About 1/3 of the men encounter marital difficulties but close to 6 out of 10 nevertheless feel able to satisfy their partner.
More precisely, according to a scale that makes it possible to differentiate various situations of quality of the sexual life, the frequency in man afflicts of multiple sclerosis is approximately:
- Absence of sexual disorder: 5%
- Less active sexually but with better quality of life: 47%
- Less active sexually and with poor quality of life: 29%
- Sexually inactive: 5%
- Sexually inactive and with poor quality of life: 13%
Sexual disorders are reported to be present in about two-thirds of the sclerosis in sclerosis that develop in relapses, in nearly 90% of the forms that progress secondarily without thrust, and nearly 100% of the forms that progress from the outset without the acute phase.
Sexual disorders are rarely the first isolated signs of the disease (about 5%). In 10% of the cases, there are difficulties already before the diagnosis. By comparison, less than a quarter of men with rheumatism and 15% without chronic disease report sexual dysfunction. In practice, sexual difficulties are rarely mentioned from the outset by patients to their doctors.
On the one hand. because the onset of the disease entails other problems that are considered more disabling (walking, manipulations, sight, urinary disorders, etc.). On the other hand because they concern the privacy of patients who often have difficulty to be open about this kind of trouble.
In the minds of patients, the ‘gaze of others’, which is a factor of discomfort in the lived experience of the disease, does not concern so much the sexual life, which can be masked, as more visible elements: modified ambulation, lack of urinary leakage, and so forth.
However, precisely because of the frequency of these sexual disorders, doctors who intervene at different levels in the management of multiple sclerosis (re-educator specialists, general neurologists, and others) are accustomed to discuss and manage them at the same time that other problems and their improvement is experienced by the patient as a factor of revalorization and improvement of his quality of life.
The problem most commonly encountered is a decrease in libido, that is, sexual desire. This may be related to certain inflammatory lesions of the brain but much more to the stress induced by the disease, as if the sex life was pushed to a second level in relation to other questions: various limitations of activity and socio-professional consequences, uncertainties about the course of the disease, treatments for multiple sclerosis, and so on.
The worst discomfort experienced by men is the decline in the quality of erection that would occur in at least half of men with multiple sclerosis is the absence of morning erection. It must be distinguished from the reduction of the libido without which the erection can not be optimal. Stiffness can be normal if one compares the quality of the erection of men who have multiple sclerosis with that of men free from any pathology or suffering from chronic diseases including rheumatism, but it is the frequency of this optimal stiffness which is more fluctuating in the case of multiple sclerosis.
Nevertheless, the fact that at some point erection can be normal, and even if it is not the majority of the time, means that the neurological pathways that lead to a normal erection work and that a psychological factor is added.
Often, it is the appearance of erectile dysfunction throws a man off the rails; in the course of his sexual relationships, he focuses totally on this problem and wonders if the erection is going to be possible, normal or if it will let go: it is the stress (or anxiety) of performance which stimulates the nervous system’s anti-management and whose management can be at the center of a sexotherapeutic focus.
As with erection, the quality of ejaculation can be normal but is more fluctuating or difficult to obtain, it will be all the easier as the rigidity will be optimal. Conversely, the occurrence of premature ejaculation is more rare, in less than a quarter of cases.
Multiple sclerosis can also lead to a decrease in sensitivity (up to 75% of cases according to the clinical form of multiple sclerosis) or subjective phenomena (tingling or pain) of the penis; these sensory elements will hinder man in the perception of his pleasure, in the voluntary control of his erection (and all the more so as he refers to his anterior sensations) and in the reflex mechanisms of maintaining the rigidity of the penis. The situation can go as far as an absence of orgasm (up to 2/3 of the cases).
There is no direct link between the observed sexual problems and the quality of sexual life, which can accommodate changes, or between the occurrence of an outbreak and the satisfaction of sexual relations. An improvement in the quality of intercourse may even be noted after the onset of multiple sclerosis.
Erectile Dysfunction Drugs To Benefit Multiple Sclerosis Condition?
Sildenafil improves erection in at least 89% of cases, compared to 24% if a placebo is used. Approximately 20% of patients should increase the dose of sildenafil to achieve the same effect within two years of starting treatment; Conversely, the use of this treatment may be only temporary, making it possible to reassure the man and helping him in particular to reduce the stress of performance by obtaining an adapted erection.
A limiting factor may be the price of each tablet; This price is reduced artificially by the purchase of the highest dosage that the patient can divide. Another fear of use of these products by patients is related to the cardiac events that accompanied the first uses of sildenafil, probably related to the associated use of a nitrate derivative (in the context of angina pectoris or a history of myocardial infarction), the association of which is contraindicated. Treatment must be clearly explained to be properly integrated into the sex life. It involves a bit of programming, and takes about 30 to 60 minutes before the sexual act.
During the research of 2013 carried out in mice and targeting the immunosuppressive effects of sildenafil (Viagra), PDE5 inhibitors (the aforementioned sildenafil, vardenafil and tadalafil) have a potential to decrease the number of MRI lesions in patients with MS. Although there has been no study in humans until the present day, it is possible to successfully employ 60 mg of a given PDE5 inhibitor agent to benefit individuals affected by MS in order to improve formation of myelinating oligodendrocytes, increasing the number of remyelinating axon and thus protecting the neural cells of the spinal cord from damage caused by the disease.
Levitra (Vardenafil) In Multiple Sclerosis: A PDE5 Inhibitor With The Lowest Side Event Profile
More recent molecules (vardenafil, tadalafil) have a longer presence in the blood and are likely to bring more comfort in their use. As with sildenafil, a limiting factor may be the price of each tablet; this price is reduced artificially by the purchase of the highest dosage that the patient can divide.
Vardenafil effects are very similar to those of sildenafil described above, with the advantage of having a significantly lower adversity profile, which is especially beneficial in patients with MS. Levitra tablets for the combined purpose of slowing the progression of the disease and regulating the sexual function can thus be regarded as the best option of ED treatment in MS patients.
Levitra, available both as brand and cheaper generic mediation, is regularly reported to be the mildest-acting of PDE5 agents taken orally, and is therefore the first-line defence against ED chosen for the treatment of both conditions in MS individuals. There are still, however, certain risks to consider, such as individual intolerance and other comorbidities that might be present in such patients.
Another fear of use of these products experienced by patients is related to the cardiac events that accompanied the first uses of sildenafil, probably related to the associated use of a nitrate derivative (in the context of angina pectoris or a history of myocardial infarction), the association of which is contraindicated.
My Canadian Pharmacy www.mycanadianpharmacyrx.com insistently recommends choosing ED medications together with your medical supervisor for your MS condition, since the primary concern is directed to the developments of the more serious disease that underlies male impotence. At no events should you self-administer any drugs for either of these conditions. Seek professional advice from Online Canadian Pharmacy or your healthcare provider of choice in order to better understand your options on improving general quality of living and sexual health in the course of MS management.