Neuromyelitis Optica Spectrum Disorder and Your Sexual Health

Any disease, whether chronic or acute, can have detrimental effects on a person's sex life. Erectile dysfunction (ED), vaginal dryness and low libido are a few issues that can occur due to a health condition's symptoms, treatment methods and prescription medications. For many people in the United States, cancer and diabetes are primary diseases that inhibit sexual function, but there are other lesser-known disorders that can affect a person's sex life, including neuromyelitis optica spectrum disorder (NMOSD).

Neuromyelitis optica spectrum disorder is an autoimmune disease within the central nervous system affecting a person's optic nerves and spinal cord. Also known as NMO or Devic's disease, this rare inflammatory disorder is diagnosed in 1 to 10 per 100,000 people.

Many patients with NMOSD may develop a second chronic disease, such as systemic lupus erythematosus, Sjögren's syndrome or systemic sclerosis.

What causes NMOSD?

Neuromyelitis optica spectrum disorder occurs when a person's immune system targets healthy cells, tissues and proteins, primarily in the eyes and spinal cord.

Men of African ancestry are more likely to receive an NMOSD diagnosis. However, this disease is not necessarily inherited, but the chances of being diagnosed with NMOSD increases when a patient has a family history of autoimmune disorders.

In addition, there's a possibility NMOSD arises due to infection or another autoimmune disorder.

"The origin of the autoimmunity is unknown but has been linked to either being a sequela from an infection or else goes along with other preexisting autoimmune conditions," said Lana Butner, N.D., L.Ac., founder of the Dr. Lana Wellness practice based in New York City and Connecticut.

Signs and symptoms

The symptoms of neuromyelitis optica spectrum disorder range from mild to severe, depending on each patient's case. However, the most common symptom of this rare disorder is optic neuritis, when a patient experiences pain in one or both eyes and vision loss. In addition, if the spinal cord becomes inflamed and swollen, the patient could be dealing with another common presentation of NMOSD called transverse myelitis.

Other symptoms of NMOSD may include:

• Difficulty walking
• Numbness or tingling
• Painful spasms
• Nausea, vomiting or hiccups
• Problems with bladder control or bowel movements
• Weakness or paralysis in arms and legs
• Heightened sensitivity to cold and heat
• Sexual difficulties

Neuromyelitis optica spectrum disorder can be a one-time or recurring condition, varying by patient. For example, a patient might experience one optic neuritis or transverse myelitis attack and have a smooth recovery without relapse. However, some patients may relapse, having several attacks debilitating them for hours or days.

NMOSD and sexual function

One of the more challenging symptoms of neuromyelitis optica spectrum disorder is its effect on a patient's sexual function. A research study published in 2019 involving 102 sexually active patients with NMOSD examined how the autoimmune disorder affected their sex lives.

The study evaluated the following areas for each patient:

• Female sexual dysfunction
• Premature ejaculation
• Erectile dysfunction
• Disability
• Lower urinary tract dysfunction
• Fatigue
• Depression
• Anxiety

The study results suggested sexual dysfunction is common among patients with NMOSD. The prevalence of sexual dysfunction, including female sexual dysfunction, erectile dysfunction and premature ejaculation, was significantly higher in NMOSD patients than in control subjects.

The study also noted that other factors—age, depression, anxiety, disability and fatigue—are important, but the conclusion was that more attention needs to be focused on sexual dysfunction in patients with NMOSD.

Testing and diagnosis

To receive an official diagnosis for neuromyelitis optica spectrum disorder, a physician examines a patient's medical history, facilitates a neurological physical exam and requests diagnostic tests. In addition, diagnostic tests can help rule out other autoimmune disorders with similar symptoms to NMOSD.

Diagnostic tests for neuromyelitis optica spectrum disorder might involve:

• Blood test. Looks for antibodies such as anti-AQP4 and anti-MOG, which are primary indicators of NMOSD.
• Lumbar puncture. Also known as a spinal tap, this examination may show heightened white blood cells and protein, indicating spinal cord inflammation.
• Magnetic resonance imaging (MRI). Examines any damage or abnormality in the optic nerve or spinal cord.

Treatment

While a cure for neuromyelitis optica spectrum disorder does not exist, patients can seek treatment options to help alleviate symptoms and control inflammation, thus, preventing or limiting potential attacks or relapses.

Some of the treatment options available for NMOSD are:

• Steroids
• Rituximab, which can reduce inflammation
• Rehabilitation
• Plasmapheresis, a process where antibodies are filtered from the blood
• Therapy

In addition, there are methods patients with NMOSD can use to make sex more pleasurable. For example, male patients may pursue over-the-counter drugs to increase libido and sexual function.

"Men may be offered treatments such as Viagra [sildenafil] and other medication that works by increasing the blood supply to the penis," said Hana Patel, M.B.B.S., a family medicine practitioner and mental health coach at the Women's Health Dulwich clinic in London.

Patel added that women with NMOSD might pursue medications that assist with potential sexual dysfunction issues such as reduced vaginal lubrication.