Hidden Challenges: A Cross-Sectional Study on Prevalence and Determinants of Sexual Dysfunction in Men and Women with Multiple Sclerosis

87.5% of men with relapsing-remitting MS screened positive for ED in a 37-person self-selected online survey

Journal: Medicina (Kaunas) | Published: 2026-03-11 | Type: Cross-sectional observational study | PMID: 41901603 Authors: Latella D, Giambò FM, La Rosa G, Bonanno L, Calabrò RS — IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy Funding/COI: Ministero della Salute; authors declare no conflicts of interest

Summary

This Italian group surveyed 37 people with relapsing-remitting MS (16 men, 21 women) about sexual dysfunction using validated instruments—IIEF-5 for men, FSFI for women, and the MS-specific MSISQ for all. Every single participant reported at least some sexual difficulty. Secondary dysfunction (symptom-related and functional interference, as opposed to direct neurogenic or psychosocial causes) was the dominant profile in roughly three-quarters of both sexes. Women reported substantially higher fatigue than men. The authors are careful throughout to label this exploratory and hypothesis-generating, which is accurate.

Claims

• 87.5% of the 16 men screened positive for erectile dysfunction: mild (37.5%), mild-to-moderate (12.5%), moderate (12.5%), severe (25.0%)
• 100% of participants scored above zero on all three MSISQ dysfunction domains (primary, secondary, tertiary)
• Secondary dysfunction was the predominant type in 75.0% of men and 76.2% of women (Fisher's exact p = 0.49 — no sex difference)
• Women reported markedly higher fatigue on the Fatigue Severity Scale (mean 46.1 ± 12.4 vs. 25.5 ± 12.7; p_FDR < 0.001)
• Women scored lower on physical health, physical function, role limitations, and pain-related QoL at uncorrected levels; many of these differences did not survive FDR correction
• Disease duration was longer in men (11.9 ± 7.4 years) vs. women (9.2 ± 11.7 years), significant at p = 0.04 but not after FDR correction (p_FDR = 0.08)

Study Quality

Cross-sectional design via an online Google Forms survey distributed by QR code — participants self-selected and self-reported their MS diagnosis, comorbidities, and exclusion criteria, none of which were independently verified against medical records. The statistical approach is reasonably careful: the authors applied both FDR and Bonferroni corrections for multiple comparisons, and several initially significant findings—including the women-vs-men secondary dysfunction score difference—did not survive correction. The MSISQ, IIEF-5, and FSFI are validated instruments, which is a genuine methodological asset. The authors explicitly frame the entire paper as exploratory and hypothesis-generating, and they are not shy about the sample size problem.

With 16 men and 21 women, the study is drastically underpowered for the questions it asks. Subgroup analyses and between-sex comparisons at this sample size are largely decorative. The 87.5% ED prevalence figure is attention-grabbing but comes from 14 out of 16 men — two people swinging either way would move that number substantially. Medication effects (disease-modifying therapies, antidepressants, antispastics) were not controlled for, and the authors acknowledge this could confound the secondary dysfunction findings entirely.

Red Flags

• N = 37 total; N = 16 men. Statistical comparisons at this sample size are unreliable and the authors know it
• Online QR-code recruitment with no clinician verification of MS diagnosis, comorbidities, or exclusion criteria
• Strong selection bias: voluntary participation in a survey about sexual dysfunction almost certainly over-represents people experiencing sexual dysfunction
• Medication use not recorded or controlled — antidepressants, antispastics, and disease-modifying therapies all affect sexual function and could drive the secondary dysfunction predominance finding
• Several between-sex differences lost significance after FDR correction, suggesting low statistical power rather than true null effects
• 100% of participants reporting some dysfunction is plausible but also consistent with floor effects or ceiling effects on survey scales in a self-selected symptomatic sample

Strengths

• Uses three validated, sex-appropriate instruments (IIEF-5, FSFI, MSISQ) rather than a single generic scale
• Applied multiple comparison corrections (FDR and Bonferroni), and honestly reported when findings did not survive correction
• Authors are explicit and consistent about the exploratory, hypothesis-generating nature of the work — no overclaiming
• Multidomain framework (primary/secondary/tertiary SD) captures neurogenic, symptom-mediated, and psychosocial contributors separately, which is clinically meaningful for MS
• Ethics committee approval obtained; electronic informed consent documented

Verdict

This is a methodologically conscientious pilot study that is also, by design, too small to tell us much. The 87.5% ED rate and the secondary-dysfunction predominance findings are plausible and consistent with existing MS literature, but they come from a self-selected online sample of 16 men and cannot be generalized. The study does what it says it does — describes a pattern in a specific convenience sample — and the authors are admirably restrained about what that means. Read it as the kind of preliminary data you'd want to see replicated with a properly powered clinical cohort before drawing any conclusions. Don't cite the prevalence figures in isolation; they will mislead.