Sensory Issues and Fatigue Are Key Factors Contributing to Sexual Dysfunction in Women With Multiple Sclerosis

Background/Aim Sexual dysfunction (SD) is a prevalent yet underrecognized concern among women with multiple sclerosis (MS), substantially affecting quality of life. This study was aimed at investigating the magnetic resonance imaging (MRI) correlates of SD, with a particular focus on the spinal cord (SC), and to explore associations between SD and other disability metrics. Methods SD was assessed using the Female Sexual Function Index (FSFI) questionnaire, administered to 251 female patients with multiple sclerosis (PwMSs). All PwMSs underwent brain and cervical SC MRI at 3T, alongside EDSS, assessment of depression, fatigue, cognition, manual dexterity, and gait. Quantitative brain and SC MRI measures were obtained, including global and regional brain volumes, SC volume, and lesion counts in the brain and SC. Associations between quantitative MRI metrics, disability, and SD were analyzed using partial correlation, controlling for age and disease duration. Subsequently, the predictive value of MRI and clinical variables for SD severity was evaluated using linear regression models adjusted for age and disease duration. Results The response rate was 58.5%, with 32.7% PwMS meeting the criteria for SD. PwMS with SD exhibited significantly reduced right and left cingulate ( p = 0.03 and 0.04) volumes. However, no significant correlations were observed between SD severity and quantitative MRI measures when controlling for age and disease duration. Fatigue and depression demonstrated moderate correlations with overall SD severity (rho = −0.491/−455, p < 0.001). Shorter 2‐min walking test distance was associated with a higher risk of SD ( p = 0.029). Sensory dysfunction ( p = 0.025) and depression ( p < 0.030) were the only independent predictors of SD severity. Conclusion Among MRI predictors of SD, we identified only a reduction of cingulate volume in PwMS with SD. Walking performance, depression, and sensory dysfunction were key predictors for SD presence and severity, highlighting the need for targeted screening for SD in PwMS with these risk factors. Exploring the role of contributing factors (use of antidepressants and medication for neuropathic pain) and interventions, that is, physical exercise, is warranted.