Sexual function in people with multiple sclerosis: a systematic review and meta-analysis.

Introduction: Sexual dysfunction is prevalent in people with multiple sclerosis (PwMS) and considerably affects their quality of life. Although sexual function (SF) is crucial in PwMS, its relationship with other characteristics remains insufficiently understood.

Objective: This review aimed to consolidate the evidence comparing SF between PwMS and healthy controls (HCs) and to explore its correlation with various demographic, clinical, and psychological factors.

Methods: The PubMed/MEDLINE, Embase, Scopus, and Web of Science databases were systematically searched up to July 28, 2024, to identify studies comparing SF between PwMS and HCs or assess its correlation with various demographic, clinical, and psychological characteristics. Random effects models were used in R software version 4.4.0 to estimate the pooled standardized mean difference (SMD) and pooled correlations, with their 95% CIs as the effect size metrics.

Results: In this review, 61 studies comprising 16 266 PwMS were included. The meta-analysis indicated that SF was significantly reduced in PwMS compared to HCs, with females with MS (FwMS) showing lower Female Sexual Function Index scores (SMD: -0.41, 95% CI, -0.61 to -0.20, P < .0001) and males with MS (MwMS) demonstrating reduced International Index of Erectile Function scores (SMD: -0.77, 95% CI, -1.32 to -0.22, P < .01). Correlation analyses highlighted associations between reduced SF and higher Expanded Disability Status Scale (EDSS), longer disease duration, and depression in gender-aggregated analyses. Reduced SF was also found to correlate with older age, higher EDSS scores, depression, and fatigue in FwMS.

Conclusion: The findings of the included studies indicated that SF is lower in PwMS compared to HCs and is influenced by age, disease duration, depression, and the EDSS. Further studies on the effects of comorbidities, medications, and MS classification on the SF of PwMS are warranted.