Multiple sclerosis affects your abilities and the way your body functions, and this sometimes includes sexual function. Damage to the brain and spinal cord in MS can contribute to erectile dysfunction.

Multiple sclerosis (MS) leads to the breakdown of the protective fatty covering called myelin that wraps around nerves in your spinal cord and brain.

Loss of myelin leads to impaired nerve conduction and potential problems like:

  • vision loss
  • movement problems
  • numbness or loss of sensation

Erectile dysfunction (ED) is defined as a consistent inability to achieve an erection firm enough for sexual activity. It’s a common problem in people with a penis and becomes prevalent with age. MS and other conditions that cause neurological damage can potentially contribute to ED.

Read on to learn more about the connection between ED and MS.

Achieving an erection requires a complex interplay of biological processes involving your:

  • brain
  • spinal cord
  • nerves
  • blood vessels
  • hormones

ED affects about a quarter of cisgender men and more than half of men over the age of 75, based on American data from the 2021 National Survey of Sexual Wellbeing.

Even though ED is common among the general population, it’s thought to be even more common in people with a penis who have MS.

In a 2022 review of studies, researchers found the prevalence in a large group of people with MS was 49%. The overall risk was 3.17 times higher than in people without MS.

Other studies have also consistently found high rates of ED and sexual dysfunction among people with a penis who have MS. For example, in a 2024 review, researchers reported sexual dysfunction in 35% to 72% of males in the 34 studies they reviewed.

MS might contribute to the development of ED in several ways, such as:

  • degenerative changes to the part of your spinal cord that allow you to have an erection
  • degenerative changes to parts of your brain that control functions like:
    • arousal
    • orgasm
    • ejaculation
  • depression and anxiety due to MS, leading to ED

In a 2021 review, researchers reported the prevalence of sexual dysfunction among men with MS as 31% to 92%, with an average of 62.9% in all studies.

Along with ED, some other forms of sexual dysfunction that may occur in people with MS include:

Symptoms of ED in people with or without MS can include:

  • inconsistently being able to achieve an erection before sexual activity
  • complete inability to get an erection
  • requiring a lot of stimulation to maintain an erection
  • not being able to maintain an erection during sexual intercourse or masturbation

It’s important to get medical help if you’ve been experiencing symptoms of ED and it’s affecting your life. Occasionally having a problem with erections is expected and not a cause for concern. But repeated problems can be a sign of an underlying health problem.

In some cases, ED might not be directly related to MS but may have another underlying cause like:

  • increased stress from having to manage your disease
  • psychological stress from other causes
  • cardiovascular disease
  • medication side effects, such as from antihypertensives, a type of blood pressure medication
  • drinking large amounts of alcohol
  • smoking tobacco

It’s also important to visit a doctor if you develop early warning signs of MS, such as:

  • unexplained fatigue
  • changes to your vision
  • numbness or tingling

Here are some of the potential treatment options for people with MS and ED.

ED treatment

A doctor may recommend that you try phosphodiesterase type 5 (PDE5) inhibitors. These medications include:

Your doctor may also recommend other treatments, such as:

  • counseling for sexual dysfunction or to help reduce your stress
  • quitting smoking, if you smoke
  • increasing physical activity
  • maintaining a moderate body weight
  • modifying medications under a doctor’s supervision

Does Viagra work for people with MS?

Sildenafil (Viagra) works by allowing the blood vessels in your penis to easily relax. Along with potentially aiding in your ability to achieve an erection, some evidence from a 2019 study on rats also suggests that Viagra might benefit myelin regeneration.

In a 2022 review of clinical trials from 2010 to 2022, researchers found evidence that sildenafil didn’t improve MS-related sexual dysfunction, but tadalafil did lead to significantly improved erection quality.

Other sexual dysfunction treatment

If more conservative ED treatments aren’t effective, your doctor may recommend:

People with MS may develop neurological problems that increase their risk of developing ED. Other factors like increased stress or medication side effects can also potentially contribute to the development of ED.

If you’ve been having problems with your sexual health, it’s best to speak with your doctor about it. They can help identify the underlying cause and recommend potential treatments.