الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Multiple sclerosis is a chronic neurodegenerative disease affecting the central nervous system. It is considered to be the most common chronic neurological disorder affecting young adults. There is a continuously increasing incidence of Multiple Sclerosis worldwide. It is well known that it’s more common among females.
The outcome of patients with Multiple Sclerosis is widely heterogeneous and may be due to interplay between many environmental, genetic and epigenetic factors in addition to modifiable personal risk factors.
Comorbidities have been of increased interest in order to explain partly the heterogeneity in the disease outcome. Moreover the presence of comorbidities may lead to diagnostic delay, poorer quality of life and disease progression. Some comorbidities are more common than others as depression, anxiety, hypertension, hypercholesterolemia and chronic lung disease.
While other comorbidities may be of great importance and highly prevalent but under diagnosed and under treated. Among female MS patients, SD prevalence might range from 40 to 80%. The World Health Organization (WHO) defines sexual dysfunction as the inability to engage in sexual activity as desired in a relationship. Female sexual function is considered to be a multidimensional subject where many factors can contribute together to its presence.
In patients with Multiple Sclerosis sexual dysfunction can be divided into primary which is due to direct affection of the neurologic pathways responsible for sexual response and sensation in the brain and the spinal cord.
Secondary sexual dysfunction refers to indirect alterations in sexual response brought on by symptoms of multiple sclerosis (MS), such as impaired mobility, spasticity, neuropathic pain, exhaustion, and bladder dysfunction, which is a common occurrence in MS patients.
And tertiary Sexual dysfunction which is due to psychosocial factors as depression, anxiety and cognitive impairment. It is also demonstrated that antidepressants as well as other medications might affect sexual functions.
Depression is a major health concern as it is a common comorbidity in addition to leading to more disease burden and disability to patients with chronic illnesses, depression may also have an impact on cognitive functions, fatigue and physical disability. Depression itself may lead to a progressive decline in sexual interest.
Physicians should be cautious when using antidepressants in patients with SD and its advised to avoid SSRI and better use mirtazapine, bupropion or trazadone. Psychotherapy and exercise therapy are also advised.
Although anxiety is common among people with MS little attention is paid to it. It is frequently under reported and under treated despite that MS patients are at risk of experiencing anxiety. Anxiety may lead to reduced frequency of intercourse.
Anxiety in MS is related to females, younger age and patients with RRMS. It is associated with poor cognitive evaluation.