Monthly Archives: April 2016

When people start having trouble with sex, the first thing to realize is that they probably don’t know how sex works.

Actually, they might know one or two of the parts of sex but they don’t know that those parts can only work after other parts have done their job.

And I’m not talking about the rubbing and bumping parts.

The human sexual response cycle is a five-stage process. The stages are desire, arousal, plateau, orgasm, and resolution. The main rule guiding the cycle is that these stages must occur in sequence. If the sexual encounter is between two people, then both partners need to first pass through the desire stage before things can go any further. For the MSer, there are a few things that can get in the way of getting the sexual cycle going. First, let’s define desire. Desire is a strong wish in wanting something to happen. In some ways, it can be thought of as “sexual initiative.” If the MSer has trouble with initiative when the non-MSer has desire, we’re already a strike down in the count. If the stimulus presented to us by our partner is strong enough, then maybe the decreased sexual initiative can be overcome and the cycle can start. However, if the stimulus is not as enticing, then the MSer might not be able to get to the desire phase. The partner might take the MSers lassitude as sexual laziness. “Why do I have to be the one to turn you on?” they might ask. Or if they don’t say anything, they might start to think to themselves that their partner doesn’t find them appealing anymore and that the spark is gone.

The other way that the sexual cycle can get a flat is when the MSer has desire but their partner does not. In this case, the MSer can start to act like the child who cannot go to the amusement park right now. They can become impatient and force the sexual encounter, which turns their partner further away.

Both the desire (sexual initiative) and the childlike behavior are governed by the frontal lobes. Quite often treatment of attention deficit disorder, which usually involves increasing dopamine and norepinephrine levels, can help improve desire as well as helping better behaviors to surface. A thorough discussion of MS and sex can be found in the Sex chapter in my book, Multiple Sclerosis From Both Sides of the Desk.

The main point of this article is that sexual dysfunction in MS is not something that can be fixed with a drug for erectile dysfunction or vaginal lubrication. Sexual functioning starts with desire, which comes from the mind. If we think of desire as sexual initiative, we need to treat the sexual initiative first in order for the sexual cycle to start.

People have asked me, what are the symptoms of attention deficit disorder. Instead of listing a bunch of medical terms, I like to use examples. In my book, Multiple Sclerosis from Both Sides of the Desk, this is how I describe what MS attention deficit disorder is like:

AN EXAMPLE OF COMMON COGNITION
Here’s an example of cognitive functioning that goes on in many people’s lives. You’re eating breakfast when your wife tells you that she has a meeting this afternoon and the kids need to be picked up from school. You ask what time they need to picked up, and your spouse says three o’clock. You think about your schedule for the day. You remember that you have a hair appointment at the same time. You say to yourself that you have to change the time of your appointment. You make a mental note to call and reschedule your appointment when you get to work. You know that the school is on the way home from the hair place, so if you can get an earlier appointment, you’ll be able to pick up the kids after the haircut. You tell your wife, “No worries. I’ll pick them up.” You kiss her, finish your breakfast, and then leave for work.
When you get to work, you call your hair stylist and move the appointment up to 2:15 p.m. The day moves on. At two o’clock, you go for your appointment. You get your haircut. You look fantastic. You pay your bill. You pick up the kids. They comment on how great your hair looks. You return home. Life is good.
The spheres of cognition used in this example include attention (being able to focus on what your spouse is telling you), short-term memory (taking in new data), long-term memory (recalling known data), visual spatial (understanding the spatial relationship of items), executive functioning (making a decision about what to do with the data), verbal (communicating data through speech), and processing speed (doing all these things in a timely fashion).

AN EXAMPLE OF MS COGNITION
In the mind of the person with MS, the same situation commonly follows a slightly different course.
“Honey. I have a meeting today. Can you pick up the kids from school at three o’clock?”
“What?” you ask as your MS brain tries to focus on not pouring salt into your coffee like you’ve done every day since your beautiful wife bought new salt and sugar holders.
“Can you pick up the kids today for me?”
“Yeah. I guess.”
“Thanks,” she says, and turns toward the door.
“From where?” you ask.
“School.”
“What time?”
“Three o’clock,” she answers, with disappointment in her voice.
You notice that she’s unhappy, and you try to cover up by saying, “Of course! I know they’re at school, but I just thought maybe they had an afterschool thing going on.”
She has heard this before, so then she asks, “Do you want to put it in your PDA?”
“No,” you reply. “I can remember the kids!”
She leaves, and you finish your breakfast, proud that you avoided the sugar/salt coffee conflict. As you get cleaned up, you notice your hair is long and remember that you have a haircut appointment today. You say to yourself that you can’t miss that appointment. The day goes on, and the PDA alarm that you set when you made the haircut appointment goes off, saying you have a haircut appointment at three o’clock.
It’s not until you’re halfway through your haircut, when your stylist asks how your kids are doing, that you remember that you were supposed to pick them up today. You look at your watch and see that it’s 3:27 p.m. You start to pull the hairdressing gown off as you get up and tell the hairdresser that you have to go. You rush out to your car and drive rapidly to the school to get the kids, but when you arrive, no one is there. You then call your wife, who says that she called her friend to pick them up when the school called her and said no one was there to pick up the kids. She goes on to say that she had called you first, but your phone had gone to message, so she called her friend.
In this example, we see deficits in attention (being distracted by the salt-sugar coffee confusion), immediate memory (not paying attention prevents normal memory tracks from being laid down), remote memory (forgetting about the hair appointment until seeing long hair in the mirror), and executive functioning (running out of the hair salon right away without thinking about the best way to find out what has happened to the kids). The fact that you are walking around with half a haircut and a hairdressing gown wrapped around your leg, while inconsequential in comparison to the welfare of your children, really compounds the pathos of the situation.
That is not normal functioning.

The great thing is that I have been diagnosing and treating attention deficit disorder for the last five years using a combination of:

1. Getting a good history from my patient about what cognitive issues they have, their family life, their social life, their school or work environment and anything that is important to them.
2. Screening them for attention deficit disorder, hyperactivity, anxiety, depression, bipolar disease and addiction.
3. Having them take FDA approved computer based neurocognitive testing to see how their attention, memory judgment and processing speed are (along with a few other things)
4. Treatment each patient as indicated by discussing the various therapies for treatment including, but not limited to, computer based neurocognitive training (found on home gaming systems and online), noradrenergic and/or dopaminergic (releasing and/or reuptake inhibiting) medications and behavioral therapies.

The beautiful thing about treating attention deficit disorder appropriately is that once a person can start thinking the way they did before they got MS induced attention deficit disorder other areas of their lives can get better. If they previously had anxiety about losing their job, the anxiety can get better because they can do their job again. If they were anxious about failing out of school because they couldn’t concentrate, their anxiousness can resolve as their grades go up.  If they were depressed because they felt estranged from family and friends because their attention deficit disordered brain made them unreliable, the depression can improve as things get back to the way they once were.

Treating attention deficit disorder doesn’t always have the same effect on everyone, but if it does work, it can help a person to get their life back.