b'Symptom Managementand knowledge about giving pleasure to onepump removes the air, causing blood to ow another in general. After practicing a few timesinto the penis, which is kept in the penis by for about 15 minutes each, then touching theplacing a rubber ring around the base of the genitals can be included in the exercise, but itpenis. Vibrators and sex toys can also make is important to not focus on achieving orgasm,sex more pleasurable and playful. just focus on maximizing your partners overallManagement of sexual dysfunction in pleasure according to the feedback you receive.women, when there is decreased sensation The idea is to avoid goal oriented sex whenin the vaginal and vulvar area, may include the focus is on obtaining orgasm, rather thanincreasing the stimulation through oral sex or enjoying the pleasure and your partner.the use of vibrators. If there are painful vulvar Medical Management paresthesias, medications such as phenytoin, Management of sexual dysfunction in mencarbamazepine, and duloxetine hydrochloride may include:may provide relief. Vaginal dryness is commonly reported in women with MS. Generous application Oral medications such as sildenal citrateof water-soluble lubricants (e.g., K-Y Jelly, Astro (Viagra), vardenal (Levitra), and tadalal (Cialis).glide) can enhance comfort. Pelvic oor exercises These medications help to maintain an erection,(e.g., Kegel) may enhance sensation and but do not initiate an erection. If an erectionorgasmic response, and physical therapy can cannot be initiated, intracavernousal injectionreduce painful sex. therapy (alprostadil, papaverine, and others)Other problemsis highly effective, which is prescribed by anIf fatigue interferes with sexual desire, consult urologist who teaches proper technique andyour healthcare providers. Stimulant medicines, dosage. An autoinjector hides the smallphysical therapy, and energy conservation needle, and there is very high satisfaction withstrategies can be helpful. Arranging to have a this approach. There are also intraurethralsexual encounter at a time of day or night when suppositories (alprostadil) or topical medicationsfatigue is low is also helpful (e.g., become a that enhance erections. morning person for sex if your energy is For those men who do not want to takedepleted in the evening). medicine, a vacuum erection device can beIf bladder dysfunction interferes, there are quite effective. This is essentially a plasticmany things that can be done. Tailoring tube placed over the penis, while a vacuumsymptomatic treatments (medications and intermittent catheterization) around times of COOLING VESTSanticipated sexual activities can help. Coping YOU WANTwith urinary leakage by avoiding uid intake for a few hours prior to sex can minimize TO WEAR. incontinence during sexual activities. Learning how to position catheters and engaging in sex positions that minimize irritation is helpful. When spasticity makes sex uncomfortable, MSF cooling program supplier utilizing sexual positions that minimize 855-232-7233 discomfort (e.g., nestled spoon position) can help. Insummary,althoughsexualconcerns msfocusmagazine.org 20'