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MS can change sex and sexual relationships in various ways. This looks at some of the challenges that might come up, and ways to manage them. Remember everyone is different. There are many other types of sexual activity and lots of other ways of physically showing love, desire and affection. People with MS and their partners tell us living with the condition can create both physical and emotional barriers, which can put a strain on relationships.

For some couples, worries about MS and uncertainty about the future can cause a breakdown in communication and intimacy. There might be times when one or both of you feel confused or rejected, angry or isolated. There could be a rebalance in the relationship.

Sometimes you might need encouragement and support just when your partner is least able to give it. Lack of desire can be a direct result of MS. But it can also be the result of living with the condition. For example, adjusting to a diagnosis, or to new symptoms, can lead to a period of sadness or grief, which can affect sexual desire. How you feel about your MS can also affect your libido. If you feel embarrassed about your MS, or because of particular symptoms, or if you feel less attractive because of your MS, this can affect your desire for sex.

Stress, having children, the menopause — these could all have an influence. MS can directly cause sexual difficulties. Sexual arousal, response and orgasm require messages to be sent between the brain and sexual organs via the spinal cord. If there is nerve damage in the parts of the brain and spinal cord involved, this can cause problems for both men and women. MS symptoms, and some of the medications prescribed for them, can sometimes have an indirect impact on sex and intimacy.

Even if you are not in a relationship, you are still a sexual being and may have concerns about the influence MS has on the way you express yourself sexually. Your concerns may relate to the effect of MS symptoms on masturbation, the likelihood of difficulties should you start a new sexual relationship, problems with meeting people and dating, or anger and sadness about the break-up of a relationship.

When discussing your relationship with a partner, it generally works better if you can avoid accusing, criticising or blaming. Sentences that start with 'I feel And it could be that other issues in your relationship have been affecting your sex life, not only MS.

Set aside time. If you're in a relationship, can you set aside time each week to devote to restoring intimacy and talk about your desires and differences?

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Try body mapping. Set aside time and gently touch all parts of your body to identify what in sensual pleasure, discomfort or sensory change. It can help you can find out what you enjoy and what causes you discomfort. This is important if your MS means you have numbness or parts of your body are ultra-sensitive. If you have a partner, you might then move on to body mapping with them. Masturbation can help you discover what works for you. Spend time to relax and explore your body. Learn what feels good. Using sex toys. Find out what works for you by experimentation. There's a huge range of toys available, including easy to hold and hands-free options.

The right sex toy might be especially helpful if you have problems reaching, positioning yourself, or using hands and fingers. Feeling sexy often relates to looking after yourself and taking care of your body — having a good diet, doing some exercise, enjoying relaxing activities and spending time on your physical appearance. Even simple things, like a new hair cut, can help. Educate yourself. There are lots of myths and misconceptions about sexuality, sexual difficulties and disability.

Learning more about how MS symptoms can affect relationships and sexual function can often make it easier to understand how you feel and help you discuss problems — if you want to — with your partner. Massage and physical contact Creating a sense of intimacy and physical closeness is important in a relationship, particularly if penetrative sex is no longer possible for you.

Changing roles. If your partner helps with your very personal care, this might affect the intimate side of your relationship. Could you arrange with social services for paid carers to come and do these sort of things? When should you tell someone you have MS? Is there a good time to bring it up?

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And if you do, will they still be interested? For example, how obvious are your symptoms? And how serious are you about this other person? You might find other people who've faced this dilema on our community forum. So the first date may be too soon. But what if you are interested? They might just not want to spend every date asking questions about MS.

You might be surprised by their reaction. And it might be a good surprise, not a bad one. You can only be yourself. There are lots of things about you that people might be attracted to. Yes, some people may be put off by MS. If symptoms affect how you feel about sex and intimacy, letting partners know can help avoid misunderstandings. You might find certain positions are more comfortable than others.

Massage can relax the muscles and also help to create intimacy and closeness. If you use medication for spasticity, taking it just before you have sex might help. Check first with a doctor before you change when you take any drug. Find out more about managing pain and spasms and stiffness.

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You might find different positions that call for less strength in particular muscles. And for support you can use something like a rolled up towel or the bed, a chair or other piece of furniture. There may be a time of day when your energy levels are higher — like in the morning — when you might prefer to have sex. Find your time of day. Planning to rest before and after sex might help too. Why not experiment with alternative positions that are less tiring and require less muscle strain?

Have you been prescribed medication like amantadine Symmetrel to fight fatigue? Taking it before sex might help though sleeping afterwards may be harder. Check with your doctor if you plan on changing when you take any drug. Your MS team, urologist or continence nurse can help you find ways to deal with needing to wee, unexpected leaks and how to manage catheters if you use one.

Check with your doctor before you change the time you take any drug.

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Find out more about managing problems with the bladder and bowel. These emotional changes can be a reaction to the condition and a symptom of MS. This may also bring you closer together — which might help with intimacy. MS can also affect your ability to concentrate, including during sex. Being relaxed and free of distractions can help.

Changes in desire, performance and satisfaction can be a side effect of certain medications, such as some antidepressants. If you think any of your medications might be affecting you sexually, speak to your doctor or MS nurse about how you can manage this. Some people who inject disease modifying drugs find the injection sites tender and sensitive to touch. If this is the case, you can ask your partner to avoid those places. You can also ask your MS nurse or the drug manufacturers about injection technique, to help minimise these problems. It can be hard, and a bit strange, to talk to health care professionals about sexual issues.

If you find it too embarrassing to talk about an issue, it might help if you write it down and give this to your health care professional. Most health care professionals should be comfortable discussing how to deal with and treat these sensitive and intimate issues. They are likely to be full of information once the subject has been broached, though. You could refer to our information to start the conversation. Can we talk about it?

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Counselling from specialist sexual and relationship therapists help people adapt to, or communicate about, their difficulties. Counselling on the NHS is often limited, but it is still worth asking your doctor. Alternatively, the College of Sexual and Relationship Therapists can help you find private accredited therapists in your area.

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MS and Your Sex Life: What You Need to Know