The aim of this article is to summarize the current data in the literature concerning sexual difficulties linked to multiple sclerosis (MS), to question some of the assumptions that are currently held and to provide a basis for recommendations for management of sexual problems in patients with MS, and more generally in patients with disabilities.

MS is used as a model for analyzing sexual problems in patients with disabilities and this article is the result of a literature review as well as our own clinical experience.

The frequency of genital and sexual problems in the studies on MS is between 75 and 84% for men and 45 and 85% for women. Because sexual disorders (SD) often appear at an early stage, and because it is often difficult to diagnose SD in patients with disabilities, systematic questioning about sexuality should be the rule. According to Alarcia (1997), 63% of these patients had never talked to their doctor about sexual problems, and neurologists only asked questions about sexuality in 30% of cases. All phases of sexuality may be affected. Sexual problems have a significant impact on quality of life and relationships (there is a high rate of separation and divorce) but there does not seem to be a connection with the duration of the illness. Many factors which may or may not have an effect on sexual function in MS, have been analyzed in the literature (urinary problems, depression, age, sex, employment status), and results are often contradictory. Such studies need to be refined and extended to other types of disability.

Sex therapy treatment networks are almost non-existent for people with disabilities. There is a sorry lack of effective help with sexuality for patients with disabilities, that might help them overcome isolation. Such programmes can only be effective, however, if they are accompanied by attention to the social, relationship, psychological and affective aspects that are particular to people with disabilities and which vary greatly from individual to individual.