Sexual dysfunction in multiple sclerosis: prevalence, risk factors, and impact on quality of life in a large cohort study.

BACKGROUND: Sexual dysfunction (SD) is a prevalent but underreported symptom in people with multiple sclerosis (pwMS), significantly affecting quality of life (QoL). Despite its clinical relevance, SD is often overlooked during routine care. This study aimed to determine the prevalence of SD, identify associated risk factors, assess its impact on depression and QoL, and explore help-seeking behaviors among pwMS. METHODS: A cross-sectional study was conducted with 504 pwMS followed at a tertiary MS clinic between November 2023 and May 2024. Data on demographics, disease characteristics, and medications were collected. The Arizona Sexual Experiences Scale (ASEX) was used to assess SD, the Beck Depression Inventory (BDI) for depression, and the Short Form-12 (SF-12) for QoL. EDSS scores were used to evaluate disability. Statistical analyses included t-tests, ANOVA, chi-square, correlation analyses, and univariate and multivariate logistic regression, with significance set at p < 0.05. RESULTS: SD was identified in 69.0% of patients (73.9% of women, 57.6% of men). SD was significantly associated with female gender (p = 0.001), older age (p = 0.006), higher EDSS scores (p = 0.046), and increased depression levels (r = 0.38). SF-12 scores were significantly lower among those with SD (p < 0.001). In multivariate analysis, female gender (aOR = 2.01, p = 0.002) and higher BDI scores (aOR = 1.09, p < 0.001) remained independently associated with SD, while age and EDSS did not. No significant associations were found between SD and MS type, disease duration, or type of disease-modifying therapy. Only 9.8% of patients with SD sought medical help, while 83.1% did not seek support. CONCLUSION: SD is highly prevalent among pwMS and is closely linked to age, disability, depression, and reduced QoL. Depression emerged as a strong independent predictor. Despite this burden, most patients do not seek help. Multidisciplinary approaches and routine screening are essential to address SD in clinical settings.