患有多发性硬化症的妇女的性功能障碍
PRIMARY SEXUAL DYSFUNCTION IN WOMEN WITH MS
女性中最常见的症状包括减少性欲，降低高潮，阴道润滑困难，以及干扰性活动的疲劳。减少阴道润滑可以用水溶性润滑剂治疗，并且可以通过药物治疗神经疼痛来缓解滤膜。
Similar to the male anatomy, nitrergic nerves are present in the corpus cavernosum of the clitoris and vaginal wall, so there is good rationale for expecting sildenafil (Viagra
®) to have a positive effect. A randomized control trial is currently under way.
对患有性功能障碍的女性的研究表明，西地那非可能是一部分患者的有益，特别是当润滑是一个问题时。
Decreased Vaginal Lubrication
Vaginal lubrication is controlled by multiple pathways in the brain and spinal cord, similar to the erectile response in men. Decreased vaginal lubrication can be addressed by using generous amounts of water-soluble lubricants, such as K-Y Jelly
®，回复
®, or Astroglide
®不建议使用基于石油的果冻（例如，凡士林
®）对于阴道润滑，由于细菌感染的风险大大增加。
感官变化
令人不舒服的生殖器感官紊乱，包括燃烧，疼痛或刺痛，有时可以用加巴亨坦（Neurontin
®），carbamazepine（Tegretol
®)、苯妥英(狄兰汀
®)或双丙戊酸(丙戊酸钠
®）或由amitriptyline等三环抗抑郁药（Elavil
®). Decreased genital sensation can sometimes be overcome by more vigorous stimulation, either manually, orally, or with the use of a vibrator. Exploring alternative sexual touches, positions, and behaviors, while searching for those that are the most pleasurable, is often very helpful. Masturbation with a partner observing or participating can provide important information about ways to enhance sexual interactions.
性能功能障碍
MS can interfere directly or indirectly with orgasm. In women and men, orgasm depends on nervous system pathways in the brain (the center of emotion and fantasy during masturbation or intercourse), and pathways in the sacral, thoracic, and cervical parts of the spinal cord. If these pathways are disrupted by plaques, sensation and orgasmic response can be diminished or absent.
此外，可以通过次要（间接物理）症状抑制性高潮，例如感官变化，认知问题和其他MS症状。第三节（心理社会或文化）的性能障碍患有焦虑，抑郁和性自信或性自尊的丧失，每个人都可以抑制性高潮。
Treatment of orgasmic loss in MS depends on understanding the factors that are contributing to the loss, and appropriate symptom management of the interfering problems.
Decreased Libido
性欲减少的性欲比男女女士更常见。迄今为止，没有出版的药物临床试验，恢复MS中的性欲。激素替代疗法有助于一些未经MS的绝经后妇女。在非MS人口中试图，在生理水平异常低的人中替代睾酮。然而，目前正在进行研究，评估增强同情令人信心的药物，看这种影响女士的女性中的性欲。此外，有研究评估阴蒂真空装置和振动器，以了解血流，性欲和感觉是否在女性女性中增强。
Pelvic floor or Kegel exercises are sometimes prescribed to enhance female sexual responsiveness. However, in women with significantly reduced sensation, EMG biofeedback is required to help them identify and contract the appropriate pelvic floor muscles in the prescribed manner. The rationale for Kegel exercises is that sensation and contraction of the muscles around the vagina are important parts of the female sexual response.
当欲望丧失是由于继发性功能障碍（例如，由于疲劳）或第三节性功能障碍（例如，由于抑郁症），治疗干扰次要或第三症状经常恢复性欲。当一个人的性欲是由女士减少时，他或她可能会开始避免以前与性别和亲密相关的情况。性避免是关系中误解和情绪困扰的源泉。伴侣可能会遭到拒绝，女士的人可能会遇到焦虑，内疚和减少的自尊。从性避免引起的误解往往会增加欲望的丧失和关系中的情绪亲密关系。
一些人和持续失去性欲丧失的男人和妇女，即使在没有性欲的情况下，他们仍然继续体验性享受和性高潮。他们可能会在没有感到性唤起的情况下启动或接受性活动，知道他们将开始以足够的情绪和身体刺激体验性愉悦。这种适应需要开发与想要参与性活动相关的新内部和外部“信号”。换句话说，而不是经历作为启动性行为的内部“信号”的性欲或物理欲望，可以体验到可能导致启动性行为和随后享受性活动的内部提示的近期或乐趣的预期。
在MS中的亲密和性行为通过Rosalind C. Kalb，Ph.D.
Assessment and Treatment of Sexual Dysfunction in Multiple Sclerosis由弗雷德里克W. Foley，PHD。
Clinical Bulletin / Information for Health Professionals.
©2008国家多发性硬化协会[原出版日期：2006]
了解更多信息：
CH Polman, AJ Thompson, TJ Murray, AC Bowling, and JH Noseworthy.
多发性硬化症: the Guide to Treatment and Management, 6th edition。
New York: Demos Medical Publishing, 2006.
（在线更新，2008）。
如何管理与MS相关的性功能障碍系列：第一部分：了解MS如何影响性功能
第二部分：MS的男性的主要性功能障碍
Part Three: Primary Sexual Dysfunction in Women with MS第四部分：男女中的继发性功能障碍第五部分：性，亲密和多发性硬化症Part Six:
多发性硬化症：性玩具，提示和工具
