ABSTRACT
Neurogenic dysfunction is estimated to be a major contributing factor in 20% of patients with erectile dysfunction (ED) (1). The sequelae of neurologic disorders may affect sexual functioning in an indirect manner. For example, patients with neurologic disorders may have language, auditory, visual, or sensory deficits, which could make it difficult to comprehend sexual cues, to experience cognitive and sensory stimulation, and to express their sexual desires, feelings, and interests. Fatigue, weakness, ataxia, and spasticity may also interfere with sexual functioning (2). Men with multiple sclerosis (MS) reported fatigue (47%), muscle weakness (32%), muscle spasms (10%), loss of sensation (13%), and pain (16%) as generalized conditions contributing to their sexual dysfunction (3). Patients may also fear poor performance that results in rejection from their partners, and further, that any deterioration in sexual relations may lead to progression of their neurologic disease, such as precipitating a second cerebrovascular accident (CVA) (4). Additionally, changes in the partner’s perception of the patient with regard to his neurologic disorder may alter the partner's attitude toward the place for sexuality in their relationship. Neurological diseases can thus have a profound impact on the patient’s relationship with his partner as well as his personal self-image.
