Characteristics and predictors of sexual dysfunction in men with multiple sclerosis

Purpose To validate and culturally adapt the Sexual Health Inventory for Men (IIEF-5) and the Premature Ejaculation Diagnostic Tool (PEDT), to compare the frequency and severity of erectile dysfunction (ED) and premature ejaculation (PE) in male individuals with MS (mwMS) in comparison with healthy controls (HC) and to investigate predictors of the severity of ED and PE in mwMS. Methods 216 consecutive mwMS and 37 HC completed IIEF-5 and PEDT. Additionally, 114 mwMS completed the Modified Fatigue Impact Scale (MFIS), Beck Depression Inventory (BDI-2), Composite Autonomic System Score-31 (COMPASS-31), and the 5-level EQ-5D questionnaire. Results The test-retest reliability was satisfactory for both questionnaires, with acceptable reliability for both questionnaires. mwMS scored less on IIEF-5 compared to HC (23, IQR 18.25-25 vs 24, IQR 20.25-25, p=0.028). ED was present in 39.4% of mwMS and 27.8% of HC (p=0.198). Definite PE was present in 12.1%, and possible PE in 7.8% of mwMS; and 5.6% and 11.1% of HC respectively (p=0.496). An increase in EDSS was a positive predictor (Exp(B) 1.455, 95%CI 1.135-1.886, p=0.003) and the presence of cremasteric reflex was a negative predictor (Exp(B) 0.381, 95%CI 0.183-0.790, p=0.010) for the presence of ED. For the PE, disease duration was the only positive predictor in a univariable logistic regression (Exp(B) 1.084, 95%CI 1.019-1.153, p=0.070). Conclusion SD is frequent in mwMS with EDSS being a positive and the presence of cremasteric reflex a negative predictor of ED and disease duration a positive predictor of PE symptoms.