Click here to download

Taking care of the man, not the symptom: the promotion of sexual health in multiple sclerosis according to an integrated approach
Journal Title: RIVISTA DI SESSUOLOGIA CLINICA 
Author/s: Eloisa Dasara, Elisabetta Todaro 
Year:  2020 Issue: Language: Italian 
Pages:  23 Pg. 23-45 FullText PDF:  255 KB
DOI:  10.3280/RSC2020-002002
(DOI is like a bar code for intellectual property: to have more infomation:  clicca qui   and here 


Multiple sclerosis is a chronic and degenerative autoimmune disease of unknown etiology that affects the central nervous system. It is generally diagnosed between 20-40 years old and currently affects about 118,000 people in Italy, with an esti-mated 3,400 new cases a year; it has a double prevalence in women than in men. From a 2017 AISM-CENSIS survey, emerges that about 50% of people affected by this pathology complain psychological difficulties; this data can be explained with the gradual decrease in self-autonomy, with consequences in the quality of life and in relational functioning. This dimension becomes even more present in a couple relationship, which starts equal to become unequal and asymmetric. This aspect, concerning different areas of the couple’s dynamics, inevitably affects sexuality too. According to what is widely stated in the Declaration of Sexual Rights and in international scientific literature, sexual health is fundamental for the quality of personal and couple life. Consequently, it is necessary not only to investigate the possible presence of discomfort in the sexual response, but also to use integrated tools to be able to deal with it. The prevalence of sexual dysfunctions in patients with multiple sclerosis suggests the need to take care of the patient, including the investigation of sexuality. The presence of sexual dysfunctions was highlighted in men in the range of 50-73% of cases, and in women up to 82.5% of cases. These data are significantly higher than those of the general population. In the introduc-tion of the present work, is presented the clinical definition of multiple sclerosis, underlining how it manifests and investigating its epidemiological aspect. After-wards, different studies are discussed relating to the presence of sexual dysfunc-tions in multiple sclerosis and highlighting the consideration of multiple etiology. In fact, sexual dysfunctions in multiple sclerosis can be linked to different causes, such as the presence of lesions in the higher centers, which interrupt the variation and integration of stimuli able to activate and support the sexual response; injuries to the spinal cord and peripheral nerves and injuries to the hypogastric nerves. An-other important role in the development of sexual dysfunction in people with multiple sclerosis is related to alterations in hormone secretions. Multiple sclerosis lesions can affect the hypothalamus and the fibers that origi-nate from it, thus interfering with the hypothalamus-pituitary-gonadal axis. In ad-dition, the reduction in circulating testosterone levels is demonstrated in subjects with multiple sclerosis, both male and female. On the contrary, regular sexual ac-tivity increasing the circulating levels of testosterone and estriol, has neuroprotec-tive and anti-inflammatory effects, promoting muscle relaxation, facilitating sleep and decreasing depressed mood. For this reason, it is essential to deal with the evaluation and treatment of sexual dysfunctions, in order to restore a virtuous health circuit, following the bio-psycho-social model. Regarding treatment, sexual counseling is generally aimed at the evaluation of symptoms. From the literature considered, it emerges that, despite the amount of studies suggesting an integrated management between different medical skills, various difficulties emerge in har-monizing the various interventions in an integrated model of care. It is hypothe-sized that this scenario is a consequence of the split, still existing today in the treatment of chronic diseases, in the considering "body" or "psyche" with the lack of taking care of patients in their complexity. A chance towards integration comes from the integrated approach in Clinical Sexology. In conclusion, to provide a use-ful guideline for investigating of the patient’s sexuality, an example of an integrat-ed approach is presented through the PLISSIT model.
Keywords: Chronic disease, multiple sclerosis, sexual health, sexual rights, integrat-ed approach, bio-psycho-social model

  1. Abbruzzese M.T.L. (2016). Psicoterapia e sclerosi multipla. Fondazione Cesare Serono informa. -- Articolo consultato dal sito: https://www.fondazioneserono.org/sclerosi-multipla/ultime-notizie-sclerosi-multipla/psicoterapia-sclerosi-multipla/.
  2. AISM-Onlus (2017). Barometro della Sclerosi Multipla 2017. AISM-Onlus.
  3. AISM-Onlus (2018). Barometro della Sclerosi Multipla 2018. AISM-Onlus.
  4. American Psychiatric Association (2013). DSM-5. Manuale diagnostico e statistico dei disturbi mentali (tr. it. Raffaello Cortina, Milano, 2014).
  5. Annon, J.S. (1974). The behavioral treatment of sexual problems. Vol. 1. Brief therapy. Honolulu: Enabling Systems.
  6. Balon R. (2007a). Is medicalization and dichotomization of sexology the answer? A Commentary. Journal of Sex & Marital Therapy, 33: 405-409., DOI: 10.1080/0092623070147707
  7. Balon R. (2007b). It was the best of times; It was the worst of times. Journal of Sex & Marital Therapy, 33: 399-403., DOI: 10.1080/0092623070147704
  8. Calabrò R.S. (2019). When healthcare providers do not ask, patients rarely tell: The importance of sexual counselling in multiple sclerosis. Journal of the National Medical Association, 111(6): 682-687.
  9. Carmignano S.M., Panelli E., D’Ettole S., Di Stefano A., Capogrosso F., Barassi G., Bellomo R.G., Saggini R. (2013). Riabilitazione del pavimento pelvico in soggetti con sclerosi multipla: Metodiche a confronto. Presentazione al 41° Congresso Nazionale SIMFER, 13-16 Ottobre 2013 Roma.
  10. Cohen B.L., Leboeuf L., Gousse A.E. (2008). Neurogenic bladder from multiple sclerosis. Current Bladder Dysfunction Reports, 3: 5-12.
  11. Consiglio Nazionale Ordine degli Psicologi. (2019). Il ruolo dello psicologo nel piano nazionale cronicità. Quaderni CNOP, 2.
  12. DasGupta R., Fowler C.J. (2003). Bladder, bowel and sexual dysfunction in multiple sclerosis: Management strategies. Drugs, 63(2): 153-166., DOI: 10.2165/00003495-200363020-0000
  13. Demirkiran M., Sarica Y., Uguz S., Yerdelen D., Aslan K. (2006). Multiple sclerosis patients with and without sexual dysfunction: Are there any differences? Multiple Sclerosis Journal, 12(2): 209-214.
  14. Engel G.L. (1977). The need for a new medical model: A challenge for a new medicine. Science, 196(4286): 129-136.
  15. Fletcher S.G., Castro-Borrero W., Remington G., Treadaway K., Lemack G.E., Frohman E.M. (2009). Sexual dysfunction in patients with multiple sclerosis: A multidisciplinary approach to evaluation and management. Nature Clinical Practice Urology, 6(2): 96-107.
  16. Ganty G., Gross-Paju K., Heerings M., Hooper K., King M., McDonald E., Teilimo E., Neild C. (2005) Intimità e sessualità. MS in focus, 6. Articolo reperibile dalla pagina: -- https://allegati.aism.it/manager/UploadFile/2/ms_in_focus_2005_6.2009420_135522.pdf
  17. Graziottin A. (2012). Sclerosi multipla: Impatto sulla sessualità e possibilità terapeutiche. -- Articolo consultato dal sito: https://www.alessandragraziottin.it/pdf/articoli.php?ART_TYPE=VODOM&EW_FATHER=9959.
  18. Hartmann U., Langer D. (1993). Combination of psychosexual therapy and intrapenile injections in the treatment of erectile dysfunctions: Rationale and predictors of outcome. Journal of Sex Education and Therapy, 19(1): 1-12., DOI: 10.1080/01614576.1993.1107406
  19. Huber M., Knottnerus J.A., Green L., van der Horst H., Jadad A.R., Kromhout D., Leonard B., Lorig K., Loureiro M.I., van der Meer J.W., Schnabel P., Smith R., van Weel C., Smid H. (2011). How should we define health? BMJ, 343: d4163.
  20. Hulter B.M., Lundberg P.O. (1995). Sexual function in women with advanced multiple sclerosis. Journal of Neurology, Neurosurgery & Psychiatry, 59(1): 83-86.
  21. Hussain R., Ghoumari A.M., Bielecki B., Steibel J., Boehm N., Liere P., Macklin W.B., Kumar N., Habert R., Mhaouty-Kodja S., Tronche F., Sitruk-Ware R., Schumacher M., Ghandour M.S. (2013). The neural androgen receptor: A therapeutic target for myelin repair in chronic demyelination. Brain, 136(1): 132-146.
  22. Ippolito R., Geremia L., Cariola M., Belluomo G., Vitale S.G., Sudano M.C., Minona P., Crapio D.M., Salvaggio C., Pandolfo M.C., Fava V., Caruso S. (2012). Sclerosi multipla e qualità di vita sessuale: Il ruolo del ginecologo. Giornale Italiano di Ostetricia e Ginecologia, 34(4): 467-473.
  23. Irwin D.E., Milsom I., Kopp Z., Abrams P., Cardozo L. (2006). Impact of overactive bladder symptoms on employment, social interactions and emotional wellbeing in six European countries. BJU International, 97: 96-100.
  24. Kisic Tepavcevic D., Pekmezovic T., Dujmovic Basuroski I., Mesaros S., Drulovic J. (2015). Sexual dysfunction in multiple sclerosis: A 6-year follow-up study. Journal of the Neurological Sciences, 358(1-2): 317-323.
  25. Kümpfel T., Schwan M., Weber F., Holsboer F., Trenkwalder C., Then Bergh F. (2014). Hypothalamo-pituitary-adrenal axis activity evolves differentially in untreated versus treated multiple sclerosis. Psychoneuroendocrinology, 45: 87-95.
  26. Kurth, F., Luders E., Sicotte N.L., Gaser C., Giesser B.S., Swerdloff R.S., Montag M.J., Voskuhl R.R., Mackenzie-Graham A. (2014). Neuroprotective effects of testosterone treatment in men with multiple sclerosis. NeuroImage: Clinical, 4: 454-60.
  27. Lew-Starowicz M., Gianotten W. (2015). Sexual dysfunction in patients with multiple sclerosis. Handbook of Clinical Neurology, 130: 357-370., DOI: 10.1016/B978-0-444-63247-0.00020-
  28. Lew-Starowicz M., Rola R. (2013). Prevalence of sexual dysfunctions among women with multiple sclerosis. Sexuality and Disability, 31(2): 141-153.
  29. Lombardo L., Rossi R. (2011). Disfunzioni sessuali e sclerosi multipla: Aspetti epidemiologici, eziopatogenetici e clinici. Rivista di Sessuologia Clinica. XVIII-2011/1.
  30. Luchetti S., van Eden C.G., Schuurman K., van Strien M.E., Swaab D.F., Huitinga I. (2014). Gender differences in multiple sclerosis: Induction of estrogen signaling in male and progesterone signaling in female lesions. Journal of Neuropathology & Experimental Neurology, 73(2): 123-135., DOI: 10.1097/NEN.000000000000003
  31. Lúcio A., DʼAncona C.A., Perissinotto M.C., McLean L., Damasceno B.P., de Moraes Lopes M.H. (2016). Pelvic floor muscle training with and without electrical stimulation in the treatment of lower urinary tract symptoms in women with multiple sclerosis. Journal of Wound, Ostomy, and Continence Nursing, 43(4): 414-419., DOI: 10.1097/WON.000000000000022
  32. Melnik T., Abdo C.H.N. (2005). Psychogenic erectile dysfunction: Comparative study of three therapeutic approaches. Journal of Sex and Marital Therapy, 31(3): 243-255., DOI: 10.1080/00926230590513465
  33. Phelps J.S., Jain A., Monga M. (2004). The psychoedPlusMed approach to erectile dysfunction treatment: The impact of combining a psychoeducational intervention with Sildenafil. Journal of Sex & Marital Therapy, 30(5): 305-314., DOI: 10.1080/0092623049046323
  34. Rees P.M., Fowler C.J., Maas C.P. (2007). Sexual function in men and women with neurological disorders. The Lancet, 369(9560): 512-525., DOI: 10.1016/S0140-6736(07)60238-
  35. Secil Y., Yetimalar Y., Gedizlioglu M., Arpaci E., Tokuçoglu F., Kendir A.I., Basoglu M., Ertekin C. (2007). Sexual dysfunction and sympathetic skin response recorded from the genital region in women with multiple sclerosis. Multiple Sclerosis Journal, 13(6): 742-748., DOI: 10.1177/135245850607364
  36. Simonelli C. (a cura di) (2006). L’approccio integrato in sessuologia clinica. Milano: FrancoAngeli.
  37. Simonelli C. (a cura di) (2013). Le disfunzioni sessuali maschili e il modello integrato nel contesto pubblico. Milano: FrancoAngeli.
  38. Titta M., Tavolini I.M., Dal Moro F., Cisternino A., Bassi P. (2006). Sexual counseling improved erectile rehabilitation after non-nerve-sparing radical retropubic prostatectomy or cystectomy ‒ Results of a randomized prospective study. The Journal of Sexual Medicine, 3(2): 267-273.
  39. Tudor K.I., Eames S., Haslam C., Chataway J., Liechti M.D., Panicker J.N. (2018). Identifying barriers to help-seeking for sexual dysfunction in multiple sclerosis. Journal of Neurology, 265: 2789-2802.
  40. Voci C. (2014). Testicular hypofunction and multiple sclerosis: Cause or consequence? Reply. Annals of Neurololy, 76(5): 765-766.
  41. World Association for Sexual Health (2008). Sexual Health for the Millennium. A Declaration and Technical Document
  42. World Health Organization (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.
  43. World Health Organization (2001). International classification of functioning, disability and health. ICF, Geneva: World Health Organization.

Eloisa Dasara, Elisabetta Todaro, Taking care of the man, not the symptom: the promotion of sexual health in multiple sclerosis according to an integrated approach in "RIVISTA DI SESSUOLOGIA CLINICA" 2/2020, pp. 23-45, DOI:10.3280/RSC2020-002002

   

FrancoAngeli is a member of Publishers International Linking Association a not for profit orgasnization wich runs the CrossRef service, enabing links to and from online scholarly content