Sexual dysfunction in Men

How does NMO affect sexual function in men?

Erections in men can occur either in response to physical stimulation of the genital area, and/or to erotic situations or thoughts. Erections in response to genital stimulation use nerves in the lower part of the spinal cord, and messages do not need to be sent from the brain to the sexual organs via the spinal cord. On the other hand, erections in response to erotic situations and thoughts do require brain processing and therefore need the nerve pathways between the brain and the bottom of the spinal cord to be undamaged. This means that, depending on where the nerve damage is, a man with NMO may find that he is able to get an erection in response to genital stimulation, but not in response to erotic situations, or vice versa.

Ejaculation and orgasm are much more complicated processes than genital arousal, and are almost impossible to achieve without intact connections between the spinal cord and brain. Problems can include delayed ejaculation or not being able to ejaculate at all.

If you experience sexual difficulties, do not automatically assume they are directly linked to NMO related nerve damage. There are various other potential causes of erectile dysfunction such as side effects of medication or an unrelated health condition. By talking to a health care professional, such as your doctor or NMO nurse, you can ensure the causes are accurately identified, and you receive the most appropriate treatment.

 

What drug treatments are there for sexual dysfunction in men?

Treating erectile dysfunction successfully can have a very positive effect on someone’s quality of life. Viagra (sildenafil citrate), Levitra (vardenafil) and Cialis (tadalafil) can all be effective for some people. All three drugs work in a similar way, but vary in how quickly they take effect and how long they remain active.

 

How do Viagra and other similar drugs work?

The drugs work by enhancing blood flow into the penis, and increasing any erectile response that can naturally occur – either through genital stimulation, or erotic thoughts and situations. Viagra takes between 30 minutes and two hours to take effect and lasts for up to four hours.

Levitra acts after 25 to 60 minutes and its effect lasts for four to five hours. Cialis is available as both an ‘as-needed’ tablet and as a ‘one-a-day’ tablet. The as-needed tablet acts within 30 minutes and its effect lasts more than 24 hours. The shorter response time and longer duration of Levitra and Cialis might have advantages in that less ‘planning’ is required and sexual activity can be a more spontaneous event. In the case of the Cialis ‘one-a-day’ tablet, it takes away the need for planning completely. It’s aimed at men who expect to engage in sexual activity at least twice a week.

One study looking at Viagra in men with MS experiencing erectile problems found that 95% of participants showed both improved erections and levels of sexual activity after taking the drug. Research has shown Cialis and Levitra to help in 80% of men experiencing erectile problems.

 

Are these drugs available on the NHS?

The National Institute for Health and Clinical Excellence (NICE) guideline, which outlines best practice for the treatment and management of MS in the NHS inEngland,WalesandNorthern Ireland, recommends Viagra as the first line of treatment for erectile dysfunction. However, at the time the guideline was published neither Cialis nor Levitra was widely available. You should discuss with your doctor which drug might be suitable for you. Sometimes the first time you take the drug it may not work that well. It’s worth trying it a few times to see how effective it is for you and your partner. If one drug does not work for you then you may want to try one of the others.

NMO is also on the list of conditions for which erectile dysfunction treatments can be prescribed on the NHS. So your GP can prescribe you one of these pro-erectile treatments and you would just pay the prescription charge. With the exception of Cialis one-a-day, prescriptions will generally be limited to one dose per week, and it is normally recommended that you only take one dose in a 24-hour period.

 

What about buying online?

Even though there are all sorts of drugs for sale on the internet, medications for sexual dysfunction do need to be prescribed by your doctor who knows your medical history and the other medicines you take (and any possible interactions), and can discuss any potential side effects. This group of drugs may not be suitable for everyone and it’s important to discuss their use with your doctor. They are not always appropriate for men with certain conditions such as heart disease or hypotension.

 

What other treatments are available for sexual dysfunction in men?

Not all men find pills effective in treating erectile dysfunction. There are other treatments available, though these are generally less successful.

Prostaglandins

Prostaglandins are a hormone-like substance naturally produced in the body. Synthetic versions of prostaglandins can be effective for treating erectile dysfunction. They work by enhancing blood flow into the penis, which leads to the penis becoming rigid and erect. There are two different methods for using prostaglandins. The first option is by self-injecting prostaglandins directly into the base of the penis. This can result in an erection five to 20 minutes after injection. This treatment is only recommended for use once a day and no more than three times a week.

There are currently two branded drugs for this treatment: Caverject and Viridal Duo. The second option is to insert a small pellet of prostaglandin (branded drug name, MUSE) into the urethra – the tube through the penis from the bladder, through which urine passes. The effect can start from about five minutes after application and lasts for about 30 minutes to an hour. MUSE does not work for men who have a permanent urethral catheter or who intermittently self-catheterise.

Prostaglandins are not suitable for all people, and you should discuss their use with your GP or specialist.

You will get detailed instruction and regular check-ups from a health care professional if you are prescribed either of these methods of treatment.

 

Vacuum devices

Vacuum devices can also be helpful. They work by fitting a plastic tube over the penis and use a hand pump to create vacuum pressure that results in blood flow into the penis. A ring is then placed around the base of the penis to maintain the erection created. The ring is removed after intercourse. Unfortunately, whilst this can help with erection, it will not bring back sensation.

 

Is there a treatment that helps with ejaculation?

Although the treatments described above are all potentially effective for erectile dysfunction, there is no treatment as yet that really helps with ejaculation. Being able to maintain an erection for longer can help, but ejaculation may remain a problem. Although NMO does not affect fertility itself, men who are unable to ejaculate will clearly have a problem if trying to father a child. If this is the case, you should ask to be referred to a fertility clinic for help.

 
 

If you have any tips that you have found beneficial, please let us know as it may help others nmo.advice@thewaltoncentre.nhs.uk