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.