Non-pharmacological interventions for sexual health in multiple sclerosis: a systematic review and meta-analysis

Abstract Background Multiple sclerosis (MS), a neurodegenerative disease, frequently causes sexual dysfunction (SD) besides the well-known motor impairment, which significantly reduces patients’ quality of life (QOL). Aim This meta-analysis evaluates the effectiveness of non-pharmacological interventions for MS-related SD. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of PubMed, ScienceDirect, CINAHL, and Cochrane databases identified randomized and clinical trials; data were extracted, the risk of bias was assessed, and meta-analyses were conducted. Outcomes The primary outcomes were changes in sexual function, satisfaction, and QOL. Results A total of 34 studies were included and eligible for meta-analysis. Pooled analyses revealed that yoga did not significantly improve sexual function standardized mean difference (SMD = −0.18, P = .84). However, structured exercise protocols (treadmill, aerobic, and aquatic exercises) showed significant improvements in sexual function (SMD = 2.88, P = .04), with aquatic exercise being particularly effective (SMD = 14.76, P = .0001). Mindfulness interventions also enhanced sexual function (SMD = 4.40, P < .0001). While psychoeducational programs did not significantly improve overall sexual QOL (SMD = 16.40, P = .18), they significantly improved sexual function (SMD = 3.46, P = .004) and satisfaction (SMD = 7.73, P = .028). Clinical Implication Tailored exercise and psychoeducational interventions can be recommended to improve sexual function and satisfaction in patients with MS. Strengths and Limitations Strengths include adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and comprehensive analysis; limitations are the heterogeneity of interventions and the short-term nature of the included studies. Conclusion Tailored exercise and psychoeducation significantly benefit sexual function in MS, while other therapies like yoga require refinement; future research should investigate long-term outcomes and patient-specific factors.