{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T02:23:41Z","timestamp":1773368621086,"version":"3.50.1"},"reference-count":27,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["RRC-2026-23688274"],"award-info":[{"award-number":["RRC-2026-23688274"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Sexual dysfunction (SD) is common in multiple sclerosis (MS) but remains under-recognized in routine care. This study aimed to quantify the burden of SD in men and women with relapsing\u2013remitting MS (RRMS), describe sex-stratified patterns across primary\/secondary\/tertiary domains, and examine associations with fatigue and MS-related health-related quality of life (HRQoL). Materials and Methods: In this cross-sectional observational study, RRMS participants were voluntarily recruited online via a QR code linking to a Google Forms survey. Men completed the International Index of Erectile Function-5 (IIEF-5), and women the Female Sexual Function Index (FSFI). MS-specific SD domains were assessed using the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ), alongside the Fatigue Severity Scale (FSS) and the Multiple Sclerosis Quality of Life questionnaire (MSQOL-54). Sex differences were tested using parametric\/non-parametric methods as appropriate, with false discovery rate (FDR) and Bonferroni adjustments for multiple comparisons. Results: Thirty-seven participants were included (16 men; 21 women). Mean age did not differ by sex (35.9 \u00b1 4.0 vs. 38.9 \u00b1 10.4 years; p = 0.23). All participants reported at least some degree of difficulty across MSISQ domains. Among men, 87.5% screened positive for erectile dysfunction within this sample (mild 37.5%, mild-to-moderate 12.5%, moderate 12.5%, severe 25.0%). When dysfunction type was defined as the highest MSISQ domain score, secondary SD was most frequent in both sexes (75.0% men; 76.2% women; p = 0.49). Women showed higher secondary domain scores at the uncorrected level (p = 0.04), but this did not survive FDR correction. In HRQoL and symptom measures, women reported markedly higher fatigue (FSS 46.1 \u00b1 12.4 vs. 25.5 \u00b1 12.7; p_FDR &lt; 0.001) and poorer physical health indices, including pain-related outcomes. Conclusions: SD has represented a substantial burden within this RRMS sample, with secondary domain predominance in both sexes, highlighting the clinical relevance of symptom-related and functional interference. These findings support the value of multidimensional sexual health assessment in clinical research settings and may be relevant for clinical assessment and future research in MS.<\/jats:p>","DOI":"10.3390\/medicina62030522","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T16:41:47Z","timestamp":1773247307000},"page":"522","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hidden Challenges: A Cross-Sectional Study on Prevalence and Determinants of Sexual Dysfunction in Men and Women with Multiple Sclerosis"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1812-8454","authenticated-orcid":false,"given":"Desir\u00e8e","family":"Latella","sequence":"first","affiliation":[{"name":"Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6843-4153","authenticated-orcid":false,"given":"Fabio Mauro","family":"Giamb\u00f2","sequence":"additional","affiliation":[{"name":"Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluca","family":"La Rosa","sequence":"additional","affiliation":[{"name":"Department of Pneumology, AOU Policlinico Universitario in Messina, 98125 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0282-405X","authenticated-orcid":false,"given":"Lilla","family":"Bonanno","sequence":"additional","affiliation":[{"name":"Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8566-3166","authenticated-orcid":false,"given":"Rocco Salvatore","family":"Calabr\u00f2","sequence":"additional","affiliation":[{"name":"Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/S0140-6736(23)01473-3","article-title":"Multiple sclerosis","volume":"403","author":"Jakimovski","year":"2024","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1136\/practneurol-2019-002321","article-title":"A practical approach to assessing and managing sexual dysfunction in multiple sclerosis","volume":"20","author":"Li","year":"2020","journal-title":"Pract. Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Marck, C.H., Jelinek, P.L., Weiland, T.J., Hocking, J.S., De Livera, A.M., Taylor, K.L., Neate, S.L., Pereira, N.G., and Jelinek, G.A. (2016). Sexual function in multiple sclerosis and associations with demographic, disease and lifestyle characteristics: An international cross-sectional study. BMC Neurol., 16.","DOI":"10.1186\/s12883-016-0735-8"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13643-020-01560-x","article-title":"Prevalence of sexual dysfunction in men with multiple sclerosis: A systematic review and meta-analysis","volume":"10","author":"Dastoorpoor","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_5","first-page":"408","article-title":"Prevalence of Sexual Dysfunction in Women with Multiple Sclerosis: A Systematic Review and Meta-Analysis","volume":"14","author":"Azimi","year":"2019","journal-title":"Maedica"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Yazdani, A., Ebrahimi, N., Mirmosayyeb, O., and Ghajarzadeh, M. (2023). Prevalence and risk of developing sexual dysfunction in women with multiple sclerosis (MS): A systematic review and meta-analysis. BMC Women\u2019s Health, 23.","DOI":"10.1186\/s12905-023-02501-1"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1111\/ene.15696","article-title":"Sexual dysfunction in female and male people with multiple sclerosis: Disability, depression and hormonal status matter","volume":"30","author":"Zinganell","year":"2023","journal-title":"Eur. J. Neurol."},{"key":"ref_8","first-page":"274","article-title":"Sexual dysfunction in Neurological disorders: Do we see just the tip of the iceberg?","volume":"89","year":"2018","journal-title":"Acta Biomed."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Gustavsen, S., Olsson, A., S\u00f8ndergaard, H.B., Andresen, S.R., S\u00f8rensen, P.S., Sellebjerg, F., and Oturai, A. (2021). The association of selected multiple sclerosis symptoms with disability and quality of life: A large Danish self-report survey. BMC Neurol., 21.","DOI":"10.1186\/s12883-021-02344-z"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"158","DOI":"10.7224\/1537-2073.2018-087","article-title":"Effect of Multiple Sclerosis on Daily Activities, Emotional Well-being, and Relationships: The Global vsMS Survey","volume":"22","author":"Bass","year":"2020","journal-title":"Int. J. MS Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1177\/1352458512471876","article-title":"The Multiple Sclerosis Intimacy and Sexuality Questionnaire\u2014Re-validation and development of a 15-item version with a large US sample","volume":"19","author":"Foley","year":"2013","journal-title":"Mult. Scler."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"P\u00f6ttgen, J., Rose, A., Van De Vis, W., Engelbrecht, J., Pirard, M., Lau, S., Heesen, C., and K\u00f6pke, S. (2018). Sexual dysfunctions in MS in relation to neuropsychiatric aspects and its psychological treatment: A scoping review. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0193381"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Maier, S., Bajk\u00f3, Z., Ro\u0219escu, R., B\u0103rcu\u021bean, L., S\u0103rm\u0103\u0219an, E., Void\u0103zan, S., and B\u0103la\u0219a, R. (2023). Sociodemographic and Clinical Determinants of Fatigue in Multiple Sclerosis. Life, 13.","DOI":"10.3390\/life13112132"},{"key":"ref_14","first-page":"11","article-title":"Sexual Dysfunction and Depression in Individuals with Multiple Sclerosis: Is there a Link?","volume":"12","author":"Russo","year":"2015","journal-title":"Innov. Clin. Neurosci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.fertnstert.2007.07.1297","article-title":"Are aspects of study design associated with the reported prevalence of female sexual difficulties?","volume":"90","author":"Hayes","year":"2008","journal-title":"Fertil. Steril."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"104907","DOI":"10.1016\/j.msard.2023.104907","article-title":"Sexual dysfunction in multiple sclerosis: The impact of different MSISQ-19 cut-offs on prevalence and associated risk factors","volume":"78","author":"Petracca","year":"2023","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.1743-6109.2007.00668.x","article-title":"The Epidemiology of Sexual Dysfunctions","volume":"5","author":"DeRogatis","year":"2008","journal-title":"J. Sex. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"101636","DOI":"10.1016\/j.arr.2022.101636","article-title":"Neurogenesis in aging and age-related neurodegenerative diseases","volume":"78","author":"Culig","year":"2022","journal-title":"Ageing Res. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"23743735221077512","DOI":"10.1177\/23743735221077512","article-title":"Breaking the Ice of Erectile Dysfunction Taboo: A Focus on Clinician-Patient Communication","volume":"9","year":"2022","journal-title":"J. Patient Exp."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1038\/sj.ijir.3900472","article-title":"Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction","volume":"11","author":"Rosen","year":"1999","journal-title":"Int. J. Impot. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/00926230590475206","article-title":"The Female Sexual Function Index (FSFI): Cross-Validation and Development of Clinical Cutoff Scores","volume":"31","author":"Wiegel","year":"2005","journal-title":"J. Sex. Marital. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e70635","DOI":"10.1002\/brb3.70635","article-title":"Determining the Effects of Emotional Freedom Techniques on Sexual Dysfunction and Self-Care Management in Women Diagnosed with Multiple Sclerosis","volume":"15","author":"Kehaya","year":"2025","journal-title":"Brain Behav."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/BF02260859","article-title":"A health-related quality of life measure for multiple sclerosis","volume":"4","author":"Vickrey","year":"1995","journal-title":"Qual. Life Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4925","DOI":"10.1007\/s10072-022-06080-1","article-title":"Italian translation and validation of fatigue symptoms and impacts questionnaire in relapsing multiple sclerosis (FSIQ-RMS)","volume":"43","author":"Ruotolo","year":"2022","journal-title":"Neurol. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Totuk, O., T\u00fcrkkol, M., Yadi, F., G\u00fcdek, H.C., Erci, G.\u00c7., Do\u011fan, \u0130.G., Tezer, D.\u00c7., Sahin, S., and Demir, S. (2025). Sexual dysfunction in multiple sclerosis: Prevalence, risk factors, and impact on quality of life in a large cohort study. BMC Neurol., 25.","DOI":"10.1186\/s12883-025-04492-y"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3131","DOI":"10.1007\/s00415-024-12366-5","article-title":"Clinical trial evidence of quality-of-life effects of disease-modifying therapies for multiple sclerosis: A systematic analysis","volume":"271","author":"Hirt","year":"2024","journal-title":"J. Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Nazari, F., Shaygannejad, V., Mohammadi Sichani, M., Mansourian, M., and Hajhashemi, V. (2020). Sexual dysfunction in women with multiple sclerosis: Prevalence and impact on quality of life. BMC Urol., 20.","DOI":"10.1186\/s12894-020-0581-2"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/522\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T14:43:40Z","timestamp":1773326620000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/522"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["medicina62030522"],"URL":"https:\/\/doi.org\/10.3390\/medicina62030522","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,11]]}}}