Sexual Therapy for Women with Multiple Sclerosis and Its Impact on Quality of Life

  • Maryam Zamani Counseling Center, Tehran University, Tehran, Iran.
  • Azadeh Tavoli Department of Psychology, Faculty of Educational Sciences and Psychology, Alzahra University, Tehran, Iran.
  • Behjat Yazd Khasti Department of Sociology, Faculty of Humanity Studies, Esfahan University, Esfahan, Iran.
  • Neda Sedighi mornani Department of Psychology, Faculty of Humanities and Social Sciences, University of Bath, Bath, UK.
  • Masood Zafar Counseling Center, Shahed University, Tehran, Iran.
Keywords: Multiple Sclerosis, Quality of Life, Sexual Therapy


Objective: Multiple Sclerosis (MS) is a disease with a detrimental effect on functional status. The present study investigated the effect of a sexual therapy program on the quality of life (QOL) of women with multiple sclerosis.

Method: Women with multiple sclerosis and sexual dysfunction (n = 30) were selected, and were randomly assigned into the treatment (n = 15), or the control groups (n = 15). Participants of the treatment group (n = 15) received 12 weekly sessions of sexual therapy. Participants in both groups completed the Female Sexual Function Inventory (FSFI) and the MS Quality of Life- 54 (MSQOL-54) in the onset of the program and at the end of the program.

Results: ANCOVA(s) using pre-test scores as covariate(s) revealed that in comparison to the control condition, MS patients within the treatment group showed a significant improvement in their sexual desire (0.0001), arousal (0.022), lubrication (0.001), orgasm (0.001), satisfaction (0.0001), overall quality of life (0.001), energy (0.023), cognitive function (0.005), and social function (0.001) at the end of the program. In addition, they were less limited in their roles due to the emotional and health problems.

Conclusion: The present study revealed that addressing sexual dysfunction in MS patients could improve their quality of life. In the future, this research can extend its results, and apply the same method to men with MS to find whether sexual therapy enhances their quality of life.


Compston A, Coles A. Multiple sclerosis. Lancet 2002; 359: 1221–1231.

Bjartmar C, Wujek JR, Trapp BD. Axonal loss in the pathology of MS: consequences for understanding the progressive phase of the disease. J Neurol Sci. 2003; 206: 165-171.

Dombovy ML. Multiple sclerosis and Parkinson’s disease rehabilitation. In: Lazar R, editor. Principles of Neurological Rehabilitation. New York: NY, McGraw Hill, 1998. p. 173-197.

Khan F, McPhail T, Brand C, Turner-Stokes L, Kilpatrick T. Multiple sclerosis: disability profile and quality of life in an Australian community cohort. Int J Rehabil Res. 2006; 29: 87-96.

Gulick EE. Symptom and activities of daily living trajectory in multiple sclerosis: a 10-year study. Nurs Res. 1998; 47: 137-146.

Smeltzer S, Bare B. Brunner & Suddarth's Textbook of Medical Surgical Nursing. 10th ed. Philadelphia: Lippincott com; 2004.

Izadi S, Nikseresht A, Sharifian M, Sahraian MA, Hamidian Jahromi A, Aghighi M, et al. Significant increase in the prevalence of multiple sclerosis in iran in 2011. Iran J Med Sci. 2014; 39: 152-153.

Kesselring J. Rehabilitation in Multiple Scloresis. ACNR 2002; 2: 6-8.

Isaksson A-K, Ahlström G, Gunnarsson L-G. Quality of life and impairment in patients with multiple sclerosis. Journal of Neurology, Neurosurgery & Psychiatry. 2005; 76: 64-69.

Mitchell AJ, Benito-Leon J, Gonzalez JM, Rivera-Navarro J. Quality of life and its assessment in multiple sclerosis: integrating physical and psychological components of wellbeing. Lancet Neurol. 2005; 4: 556-566.

Janardhan V, Bakshi R. Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. J Neurol Sci. 2002; 205: 51-58.

Vermersch P, de Seze J, Delisse B, Lemaire S, Stojkovic T. Quality of life in multiple sclerosis: influence of interferon-beta1 a (Avonex) treatment. Mult Scler. 2002; 8: 377-381.

Nortvedt MW, Riise T, Myhr KM, Nyland HI. Quality of life in multiple sclerosis: measuring the disease effects more broadly. Neurology. 1999; 53: 1098-1103.

Marrie RA, Miller DM, Chelune GJ, Cohen JA. Validity and reliability of the MSQLI in cognitively impaired patients with multiple sclerosis. Mult Scler. 2003; 9: 621-626.

Tepavcevic DK, Kostic J, Basuroski ID, Stojsavljevic N, Pekmezovic T, Drulovic J. The impact of sexual dysfunction on the quality of life measured by MSQoL-54 in patients with multiple sclerosis. Mult Scler. 2008; 14: 1131-1136.

Schairer LC, Foley FW, Zemon V, Tyry T, Campagnolo D, Marrie RA, et al. The impact of sexual dysfunction on health-related quality of life in people with multiple sclerosis. Mult Scler. 2014; 20: 610-616.

Vitkova M, Rosenberger J, Krokavcova M, Szilasiova J, Gdovinova Z, Groothoff JW, et al. Health-related quality of life in multiple sclerosis patients with bladder, bowel and sexual dysfunction. Disabil Rehabil. 2014; 36: 987-992.

Kessler TM, Fowler CJ, Panicker, JN. Sexual dysfunction in multiple sclerosis. Neurother 2009; 9: 341-350.

Cordeau D, Courtois F. Sexual disorders in women with MS: assessment and management. Ann Phys Rehabil Med. 2014; 57: 337-347.

Barton D, Joubert L. Psychosocial aspects of sexual disorders. Australian family physician. 2000; 29: 527-531.

Lew-Starowicz M, Gianotten WL. Sexual dysfunction in patients with multiple sclerosis. Handb Clin Neurol. 2015; 130: 357-370.

Lew-Starowicz M, Rola R. Correlates of sexual function in male and female patients with multiple sclerosis. J Sex Med. 2014; 11: 2172-2180.

Foley FW, LaRocca NG, Sanders AS, Zemon V. Rehabilitation of intimacy and sexual dysfunction in couples with multiple sclerosis. Mult Scler. 2001; 7: 417-421.

Demirkiran M, Sarica Y, Uguz S, Yerdelen D, Aslan K. Multiple sclerosis patients with and without sexual dysfunction: are there any differences? Multiple Sclerosis Journal. 2006; 12: 209-211.

Christopherson JM, Moore K, Foley FW, Warren KG. A comparison of written materials vs. materials and counselling for women with sexual dysfunction and multiple sclerosis. J Clin Nurs. 2006; 15: 742-750.

Foley FW, LaRocca NG, Sanders AS, Zemon V. Rehabilitation of intimacy and sexual dysfunction in couples with multiple sclerosis. Mult Scler. 2001; 7: 417-421.

Merghati-Khoei E, Qaderi K, Amini L, Korte JE. Sexual problems among women with multiple sclerosis. J Neurol Sci. 2013; 331: 81-85.

Ashtari F, Rezvani R, Afshar H. Sexual dysfunction in women with multiple sclerosis: Dimensions and contributory factors. J Res Med Sci. 2014; 19: 228-233.

Margaret CW. Sexuality: A Critical Component of Quality of Life in Chronic Disease. Nursing Clinics of North America 2007; 42: 507–514.

Mohammadi K, Rahnama P, Montazeri A, Foley FW. The multiple sclerosis intimacy and sexuality questionnaire-19: reliability, validity, and factor structure of the Persian version. J Sex Med. 2014; 11: 2225-2231.

Goldman A, Carroll JL. Educational intervention as an adjunct to treatment of erectile dysfunction in older couples. J Sex Marital Ther. 1990; 16: 127-141.

White LJ, McCoy SC, Castellano V, Gutierrez G, Stevens JE, Walter GA, et al. Resistance training improves strength and functional capacity in persons with multiple sclerosis. Mult Scler. 2004; 10: 668-674.

Stuifbergen AK, Becker H, Blozis S, Timmerman G, Kullberg V. A randomized clinical trial of a wellness intervention for women with multiple sclerosis. Arch Phys Med Rehabil. 2003; 84: 467-476.

Petajan JH, Gappmaier E, White AT, Spencer MK, Mino L, Hicks RW. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol. 1996; 39: 432-441.

Ghafari S, Ahmadi F, Nabavi M, Anoshirvan K, Memarian R, Rafatbakhsh M. Effectiveness of applying progressive muscle relaxation technique on quality of life of patients with multiple sclerosis. J Clin Nurs. 2009; 18: 2171-2179.

Sutherland G, Andersen M. Exercise and multiple sclerosis: physiological, psychological, and quality of life issues. Journal of Sports Medicine and Physical Fitness. 2001; 41: 421-432.

Lee M, Trost SG, Dixon A, Park S, Vanderbom K, Guzman R, McCubbin J. Influence of Social Support and Personal Barriers on Physical Activity and Health-Related Quality of Life in Persons with Multiple Sclerosis. Medicine & Science in Sports & Exercise. 2010; 42: 654-655.

Darija KT, Tatjana P, Goran T, Nebojsa S, Irena D, Sarlota M, et al. Sexual dysfunction in multiple sclerosis: A 6-year follow-up study. J Neurol Sci. 2015; 358: 317-323.

Dubey D, Sguigna P, Stuve O. Managing Disability in Progressive Multiple Sclerosis. Curr Treat Options Neurol. 2016; 18: 27.

Najafidoulatabad S, Mohebbi Z, Nooryan K. Yoga effects on physical activity and sexual satisfaction among the Iranian women with multiple sclerosis: a randomized controlled trial. Afr J Tradit Complement Altern Med. 2014; 11: 78-82.

Bronner G, Elran E, Golomb J, Korczyn AD. Female sexuality in multiple sclerosis: the multidimensional nature of the problem and the intervention. Acta Neurol Scand. 2010; 121: 289-301.

Ward-Abel N, Sykes J. Sexuality and MS: a guide for women. London: Multiple Sclerosis Trust 2011.

Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992; 30: 473-483.

Vickrey BG, Hays RD, Harooni R, Myers LW, Ellison GW. A health-related quality of life measure for multiple sclerosis. Qual Life Res. 1995; 4: 187-206.

BorhaniHaghighi A. The MS Quality of Life- 54 (MSQOL-54): translation and validation study of the Iranian version. Iranian Journal of Brain 2005; 4:10-11.

Mohammadi K, Heydari M, Faghihzadeh S. The female sexual function index (FSFI): validation of the Iranian version. Payesh 2008, 7: 269-278.

Stroud NM, Minahan CL. The impact of regular physical activity on fatigue, depression and quality of life in persons with multiple sclerosis. Health and quality of life outcomes 2009; 7: 68.

McCabe MP, McDonald E, Deeks AA, Vowels LM, Cobain MJ. The impact of multiple sclerosis on sexuality and relationships. Journal of sex research 1996; 33: 241-248.

Lehman DR, Hemphill KJ. Recipients' perceptions of support attempts and attributions for support attempts that fail. Journal of Social and Personal Relationships 1990; 7: 563-574.

Blackmore DE, Hart SL, Albiani JJ, Mohr DC. Improvements in partner support predict sexual satisfaction among individuals with multiple sclerosis. Rehabil Psychol 2011; 56: 117-122.

Foley F and Sanders A. Sexuality, multiple sclerosis and women. MS Management 1997; 4: 1–10.

Moore LA. Intimacy and multiple sclerosis. Nursing Clinics of North America 2007; 42: 605-619.

Vermillion ST, Holmes MM. Sexual dysfunction in women. Primary Care Update for OB/GYNS 1997; 4: 234-240.

Stepleman LM, Lopez EJ, Stutts LA, Hudson WH, Goodworth M-CR, Rahn R. Physician–Patient Communication About Sexual Functioning in Patients with Multiple Sclerosis. Sexuality and Disability 2016; 34: 239-254.

How to Cite
Zamani M, Tavoli A, Yazd Khasti B, Sedighi mornani N, Zafar M. Sexual Therapy for Women with Multiple Sclerosis and Its Impact on Quality of Life. Iran J Psychiatry. 12(1):58-65.
Original Article(s)