International Journal of MS Care
page 2, Volume 5, Issue 2
Deborah M. Miller, PhD, LISW
This issue of the International Journal of MS Care includes an informative report of clinicians’ attitudes toward addressing sexual dysfunction with their multiple sclerosis (MS) patients. A key point in the literature review of the Foley et al article is that sexual dysfunction is a common disorder among men and women with MS and that this impairment has a significant impact on patients’ quality of life. The data reported in the article also make clear that a sample of MS clinicians are understanding of sexual dysfunction in their MS patients. They believe that most patients require professional intervention to address the issue and that there are useful treatments to help manage this condition. Nonetheless, these clinicians indicate that they seldom address this important topic. The primary reasons reported as to why they do not assess sexuality include limited time with patients, belief that assessment of sexual function is outside their domain, and being uncomfortable with addressing sexuality.
The regular use of patient questionnaires regarding sexuality and related concerns can be useful and practical in facilitating conversation during routine clinical transactions. Two such questionnaires, which patients can complete while waiting to see the health care professional, are the Derogatis Sexual Functioning Inventory,1 a multidimensional measure of sexual functioning, and the five-item Sexual Satisfaction Scale,2 which is a component of the Multiple Sclerosis Quality of Life Inventory. The questionnaire responses could be reviewed during the clinic visit, and if the patient has concerns, a plan can be developed to address them. This process would alleviate some of the issues identified by Foley et al. If patients are offered the opportunity but are not required to complete the questionnaire, they may be more comfortable revealing their concerns or may choose not to discuss the subject. Patients and clinicians could review the responses together and quickly determine if intervention is needed. As the treatment plan is developed, clinicians who are not comfortable managing sexual concerns can make appropriate referrals.
This process does not need to be limited to a review of sexuality. A range of patient concerns, including sexuality, is assessed in MS-specific quality-of-life measures such as the Multiple Sclerosis Quality of Life Inventory. The routine practice of having patients complete an MS-specific quality-of-life measure will encourage patient participation in the care process, allow for greater efficiency and meaningful interaction during the patient/clinician encounter, and provide another important data point for clinicians to use in the management of their patients.
1. Derogatis L, Melisaratos N. The DSFI: a multidimensional measure
of sexual functioning. J Sex Marital Ther. 1979;5:244-281.
2. Nowinski JK, LoPiccolo J. Assessing sexual behavior in couples. J Sex Marital Ther. 1979;5:225-243.
Copyright © 2003, International Journal of MS Care