(212) Do Women with Remittent-Recurrent Multiple Sclerosis (RRMS) have Higher Prevalence of Sexual Dysfunction? A Transversal Analytic Study of Brazilian Patients
Authors: Melo E , Ruano F F L D O , Olival G S D O 
Published: May 2023

Abstract

Introduction
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) which is characterized by inflammation, demyelination, axon loss and gliosis. More than 2.8 million people worldwide are affected by MS, mainly young people at reproductive age with significant lifelong repercussions. Among several MS symptoms, sexual dysfunction (SD) is one of the most neglected during routine clinical care.

Objective
We aimed to evaluate the prevalence of SD in female patients diagnosed with Remitting-Recurrent MS (RRMS), compared with a control group of women without comorbidity and to stratify the different causes and factors that can lead to SD.

Methods
This transversal analytic study was carried out by Santa Casa de São Paulo, Faculdade de Ciências Médicas, São Paulo/SP, Brazil, between November 2020 and November 2021. Our sample included 80 patients diagnosed with RRMS and 106 control group. We have collected demographic data and all participants underwent neurological examination. Questionnaires about sexual dysfunction (Multiple Sclerosis Intimacy and Sexuality Questionnaire - MSISQ-19- and Female Sexual Function Index - FSFI) and about depression and anxiety (Hospital Anxiety and Depression Scale – HADS, Beck's Depression Inventory – BDI- and Beck anxiety inventory-BAI) were applied. Baseline characteristics were reported as proportions and mean ± SD or median ± IQR as appropriate according to data distribution. The presence of SD was described according to the evaluated qualitative parameters and the association with the use of Chi-square tests or exact tests was verified and the quantitative characteristics were compared according to the presence of dysfunction with the use of t-Student tests or Mann-Whitney tests. Statistical analyses were performed using IBM-SPSS for Windows versão 20.0

Results
We observed high prevalence of SD in both groups (43.4% and 38.8%, respectively, patients with RRMS and control group) according to FSFI analysis. A higher statistically prevalence (56.3%) of sexual dysfunction in patients with RRMS was observed when using the MSISQ-19 as a tool for assessing sexuality in this population, in comparison with FSFI scale (p = 0.016). The presence of anxious (53.2% to RRMS and 47.2% to control group by BAI) and depressive symptoms (37.2% to RRMS and 38.8% control group, by BDI) were statistically similar between the groups (p &gt; 0.05). Both groups revealed high rates of anxious and depressive symptoms. There were no other statistically significant factors associated with RRMS on the prevalence of SD.

Conclusions
We did not find a higher prevalence of SD in MS patients when compared to the control group. Nevertheless we found a higher prevalence in both groups and the specific tool (MSISQ-19) was able to reveal that MS patients did have higher prevalence of SD. Besides that, anxious and depressive symptoms were also statistically significant in MS patients and are related to SD, so we strongly suggest that healthcare providers assess and treat these comorbidities in all RRMS patients in paralel with sexual dysfunction approach and we also suggest the use of the specific questionnaire to deal with their sexual function.

Disclosure
No