Multiple Sclerosis (MS) is an autoimmune disease affecting the central nervous system, primarily disabling young adults aged 20 to 40, with a higher prevalence in women. Its varied clinical presentation makes diagnosis and treatment challenging [1]. The quality of life in individuals with MS is receiving increasing attention, with sexual health being a key component. Literature indicates that sexual dysfunction affects 42% to 73% of this population [2]. Sexual dysfunction in MS can be classified into three types: primary (direct nervous system damage), secondary (symptoms hindering sexual function), and tertiary (emotional, mood, and cognitive disorders related to disability and social role changes) [3]. The benefits of physiotherapy for sexual dysfunction are well-studied, but there is a gap in research regarding MS patients, both in terms of prevalence and treatment methods. 
The aim of this review was to identify research on physiotherapeutic approaches for managing sexual dysfunction in individuals with MS.

Data collection commenced with a search in PubMed and Google Scholar, utilizing the following search terms: multiple sclerosis, sexual dysfunction, clinical trials, and randomized clinical trials. Review articles, case reports, observational studies without a control group, and opinion pieces were excluded from the analysis. The focus of the analysis was on the methodologies employed, the effects of the therapies, sample sizes, and the control mechanisms used.

Six randomized controlled trials (RCT) were identified that met the inclusion criteria. The research group included patients diagnosed with MS who reported various sexual dysfunctions, including orgasmic dysfunction, sexual arousal issues, and dysfunctions related to overactive bladder that affect sexual function. Most of the studies focused on women, although some studies also included men. The age of participants varied depending on the study, but generally, it involved individuals in young and middle adulthood, typically between the ages of 20 and 50, which is typical for the MS patient population. Physiotherapeutic interventions such as pelvic floor muscle training, tibial nerve stimulation (TNS), clitoral vacuum suction/vibration, and telerehabilitation methods were applied. Each study also included control groups that received alternative therapies or no therapy at all. In some protocols, different methods of intervention were combined, such as pelvic floor muscle training with mindfulness. Outcomes were assessed using questionnaires on sexual function and urological symptoms. The Female Sexual Function Index (FSFI) questionnaire was also used. A statistically significant improvement was observed in sexual satisfaction, particularly in control over sphincter muscles and sensations during intercourse, especially in the clinical trial group regarding pelvic floor muscle training combined with mindfulness techniques. This improvement in all trials also extended to sexual quality of life, indicating improvements in overall satisfaction and in experiencing sexual pleasure.

To our best knowledge, this is the first review on physiotherapy for MS-related sexual dysfunctions. Currently, few RCTs have assessed physiotherapeutic approaches for managing sexual dysfunction in MS patients. These therapies may offer significant benefits when incorporated into a comprehensive treatment plan. However, the existing data still require further investigation. Additional studies with larger sample sizes and a broader range of physiotherapeutic approaches are needed to confirm their long-term effectiveness. The current evidence suggests that combining therapies such as PFMT, TNS, and telerehabilitation can substantially improve sexual and urological health in individuals with MS.

Sexual dysfunctions are common in MS patients, with evidence-based physical therapy modalities improving sexual quality of life, including desire, arousal, and satisfaction. Recognizing the role of pelvic floor therapy ensures more targeted, holistic care, leading to better outcomes. This review emphasizes the importance of incorporating pelvic floor physical therapists into MS treatment teams and increasing attention to sexual dysfunctions within the MS population.

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