Download fulltext
HTML
Afshar, B., Amini, L., Hasani, M., Jahanfar, S., & Massood Nabavi, S. (2022). The most effective sexual function and dysfunction interventions in individuals with multiple sclerosis: A systematic review and meta-analysis. International Journal of Reproductive BioMedicine (IJRM), 20(4), 241-254. https://doi.org/10.18502/ijrm.v20i4.10897
https://doi.org/10.18502/ijrm.v20i4.10897
statistics
- 217 Abstract Views
- 86 PDF Views
- 0 HTML Views
- Cited by 5 articles
authors
-
Bahare Afshar
Bahare Afshar
Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
-
Leila Amini
Leila Amini
Nursing Care Research Center (NCRC), Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
-
Maryam Hasani
Maryam Hasani
Department of Midwifery, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khoramabad, Iran.
-
Shayesteh Jahanfar
Shayesteh Jahanfar
MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, USA.
-
Seyed Massood Nabavi
Seyed Massood Nabavi
Department of Regenerative Biomedicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
Published Date
- May 23, 2022
The most effective sexual function and dysfunction interventions in individuals with multiple sclerosis: A systematic review and meta-analysis
Abstract
Background: Sexual dysfunction has many factors in multiple sclerosis, but there is no reliable treatment for this challenge.
Objective: Determining effective sexual function or dysfunction interventions in individuals with multiple sclerosis.
Materials and Methods: To find the relevant published interventional studies that at least had an English abstract or in Persian, we searched International Statistical Institute, PubMed, Scopus, Cochrane, Medline, PsycINFO, EMBASE, CINAHL, and Google Scholar from January 1990 to June 2021. The results were analyzed using RevMan 5.3 software. The p < 0.05 was considered significant.
Results: Out of 568 articles, 41 were included after deleting the duplicate and irrelevant articles. Studies were divided into 2 groups of sexual function (n = 27) and dysfunction (n = 14). Interventions in each category have 4 subgroups: psychoeducational, exercise and rehabilitation, and medical and multi-type interventions. For improving sexual function, more than half of psychoeducational interventions showed a significant improvement after interventions (p = 0.0003). In sexual dysfunction studies, most of the interventions (n = 13/14) had improved at least one subscale of sexual dysfunction. Medical interventions were effective on men’s sexual dysfunction, and psychoeducational interventions had been more effective in women’s sexual dysfunction.
Conclusion: Psychoeducational and medical interventions are the commonest effective interventions. The psychoeducational studies conducted specifically on women had a positive impact, and only 4 articles with medical interventions were specifically targeted at men, which had a positive effect.
Key words: Clinical trial, Multiple sclerosis, Sexual dysfunction, Systematic review.
References
[1] Goverover Y, Genova HM, DeLuca J, Chiaravalloti ND. Impact of multiple sclerosis on daily life. In: Chiaravalloti ND, Goverover Y. Changes in the Brain: Impoct on daily life. New York: Springer; 2017. 145–165.
[2] Hadgkiss EJ, Jelinek GA, Weiland TJ, Rumbold G, Mackinlay CA, Gutbrod S, et al. Health-related quality of life outcomes at 1 and 5 years after a residential retreat promoting lifestyle modification for people with multiple sclerosis. Neurol Sci 2013; 34: 187–195.
[3] Patil NJ, Nagaratna R, Garner C, Raghuram NV, Crisan R. Effect of integrated yoga on neurogenic bladder dysfunction in patients with multiple sclerosis: A prospective observational case series. Complement Ther Med 2012; 20: 424–430.
[4] Kessler ThM, Fowler CJ, Panicker JN. Sexual dysfunction in multiple sclerosis. Expert Rev Neurother 2009; 9: 341– 350.
[5] Lew-Starowicz M, Rola R. Sexual dysfunctions and sexual quality of life in men with multiple sclerosis. J Sex Med 2014; 11: 1294–1301.
[6] Forsythe E, Horsewell JE. Sexual rehabilitation of women with a spinal cord injury. Spinal Cord 2006; 44: 234–241.
[7] Guo ZhN, He SY, Zhang HL, Wu J, Yang Y. Multiple sclerosis and sexual dysfunction. Asian J Androl 2012; 14: 530–535.
[8] Calabrò RS. Sexual dysfunction in neurological disorders: Do we see just the tip of the iceberg? Acta Miomed 2018; 89: 274–275.
[9] Bronner G, Elran E, Golomb J, Korczyn AD. Female sexuality in multiple sclerosis: The multidimensional nature of the problem and the intervention. Acta Neurol Scand 2010; 121: 289–301.
[10] Kim D, Leurer C, So B, Casserly C, Seyman E, Baral S, et al. Sexual dysfunction in multiple sclerosis: A systematic review and meta-analysis of prevalence. Neurology 2019; 92: P5.2–089.
[11] Ghajarzadeh M, Jalilian R, Mohammadifar M, Sahraian MA, Azimi A. Sexual function in women with multiple sclerosis. Acta Med Iran 2014: 52: 315–318.
[12] Cordeau D, Courtois F. Sexual disorders in women with MS: Assessment and management. Ann Phys Rehabil Med 2014; 57: 337–347.
[13] Hess MJ, Hough S. Impact of spinal cord injury on sexuality: Broad-based clinical practice intervention and practical application. J Spinal Cord Med 2012; 35: 211– 218.
[14] Courtois F, Rodrigue X, Côté I, Boulet M, Vézina J, Charvier K, et al. Sexual function and autonomic dysreflexia in men with spinal cord injuries: How should we treat? Spinal Cord 2012; 50: 869–877.
[15] Landtblom AM. Treatment of erectile dysfunction in multiple sclerosis. Expert Rev Neurother 2006; 6: 931– 935.
[16] DasGupta R, Fowler CJ. Bladder, bowel and sexual dysfunction in multiple sclerosis. Drugs 2003; 63: 153– 166.
[17] Bagnato F, Centonze D, Galgani S, Grasso MG, Haggiag S, Strano S. Painful and involuntary multiple sclerosis. Expert Opin Pharmacother 2011; 12: 763–777.
[18] Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Ann Intern Med 2009; 151: W65–W94.
[19] Asadpour E, Veisi S. The effectiveness of emotionally focused couple therapy on sexual self-esteem and sexual function in women with multiple sclerosis. J Arak Univ Med Sci 2017; 20: 1–12.
[20] Ghazagh M, Zadhasan Z. The effect of group mindfulness-based stress reduction program on the quality of life and fatigue in patients with multiple sclerosis. Avicenna J Nurs Midwifery Care 2019; 27: 35–44.
[21] Hamidizadeh S, Masoudi R, Ahmadi F, Mohammadi E. Evaluation of the effect of self-care program based on the Orem framework on the physical quality of life in multiple sclerosis patients. J Shahid Sadooghi Univ Med Sci 2009; 17: 153–163.
[22] Khodaveisi M, Rahmati M, Falahinia Gh, Karami M, Vardanjani MM. The effect of Orem’s self care model on physical quality of life in patients with multiple sclerosis. Sci J Nurs Midwifery Paramed Faculty 2018; 3: 24–35.
[23] Mami Sh, Heidari M. [Effectiveness of intensive shortterm dynamic psychotherapy on sexual function and emotional expression in women with multiple sclerosis]. Health Psychol 2019; 7: 131–150. (in Persian)
[24] Mirzaei S. [Effect of seligman happiness program on improving quality of life, hope, and psychological wellbeing in women with M. SS]. Contemporary Psychology 2017; 12: 1710–1716. (in Persian)
[25] Sahebalzamani M, Zamiri M, Rashvand F. The effects of self-care training on quality of life in patients with multiple sclerosis. Iran J Nurs Midwifery Res 2012; 17: 7–11.
[26] Ahadi F, Tabatabaee SM, Rajabpour M, Ghadamgahi A, Pouryosef Kaljahi M. Effect of 8-week aerobic exercise and yoga training on depression, anxiety, and quality of life among multiple sclerosis patients. Iran Rehabil J 2013; 11: 75–80.
[27] Ahmadi A, Nikbakh M, Arastoo AA, Habibi AH. The effects of a yoga intervention on balance, speed and endurance of walking, fatigue and quality of life in people with multiple sclerosis. J Hum Kinetics 2010; 23: 71–78.
[28] Asadizaker M, Majdinasab N, Atapour M, Latifi SM, Babadi M. Effect of exercise on walking speed, fatigue and quality of life in patients with multiple sclerosis. Jundishapur Sci Med J 2010; 9: 189–198.
[29] Azimzadeh E, Hosseini MA, Nourozi Tabrizi K. [Effect of Tai Chi Chuan on quality of life in women with multiple sclerosis]. Hayat 2013; 19: 1–13.(in Persian)
[30] Kargarfard M, Etemadifar M, Baker P, Mehrabi M, Hayatbakhsh R. Effect of aquatic exercise training on fatigue and health-related quality of life in patients with multiple sclerosis. Arch Phys Med Rehabil 2012; 93: 1701–1708.
[31] Pilutti LA, Lelli DA, Paulseth JE, Crome M, Jiang Sh, Rathbone MP, et al. Effects of 12 weeks of supported treadmill training on functional ability and quality of life in progressive multiple sclerosis: A pilot study. Arch Phys Med Rehabil 2011; 92: 31–36.
[32] Rampello A, Franceschini M, Piepoli M, Antenucci R, Lenti G, Olivieri D, et al. Effect of aerobic training on walking capacity and maximal exercise tolerance in patients with multiple sclerosis: A randomized crossover controlled study. Phys Ther 2007; 87: 545–555.
[33] Romberg A, Virtanen A, Ruutiainen J. Long-term exercise improves functional impairment but not quality of life in multiple sclerosis. J Neurol 2005; 252: 839–845.
[34] Sutherland G, Andersen MB, Morris T. Relaxation and health-related quality of life in multiple sclerosis: The example of autogenic training. J Behav Med 2005; 28: 249–256.
[35] Sutherland G, Andersen M, Stoové M. Can aerobic exercise training affect health-related quality of life for people with multiple sclerosis? J Sport Exercise Psychol 2001; 23: 122–135.
[36] Najafi Dolatabad S, Noureyan K, Najafi Dolatabad A, Mohebbi Z. [The effect of Yoga techniques on quality of life among women with multiple sclerosis]. Hormozgan Med J 2012; 16: 143–150. (in Persian)
[37] Attar Sayyah AE, Hoseini Kakhk SAR, Hamedinia MR, Mehrjoo M. Effect of 8-week combined training (resistance and proprioceptive neuromuscular facilitation) on fatigue and quality of life in multiple sclerosis patients. Horizon Med Sci 2016; 22: 43–50.
[38] Sadeghi Bahmani D, Motl RW, Razazian N, Khazaie H, Brand S. Aquatic exercising may improve sexual function in females with multiple sclerosis: An exploratory study. Mult Scler Relat Disord 2020; 43: 102106.
[39] Simone IL, Ceccarelli A, Tortorella C, Bellacosa A, Pellegrini F, Plasmati I, et al. Influence of interferon beta treatment on quality of life in multiple sclerosis patients. Health Qual Life Outcomes 2006; 4: 96.
[40] Mokhber N, Azarpazhooh A, Orouji E, Khorram B, Modares Gharavi M, Kakhi S, et al. Therapeutic effect of avonex, rebif and betaferon on quality of life in multiple sclerosis. Psychiatry Clin Neurosci 2015; 69: 649–657.
[41] Zarabadipour S, Amini L. The effect of vitamin D tablets on menstrual pattern, steroid hormone levels and sexual function in women with multiple sclerosis [M.Sc. thesis]. Tehran: Iran University of Medical sciences; 2017.
[42] Nozari E, Ghavamzadeh S, Razazian N. The effect of vitamin b12 and folic acid supplementation on quality of life in patients with relapsing-remitting multiple sclerosis. Clin Nutr Res 2019; 29: 736–745.
[43] Hazrati M, Zahmatkeshan N, Dejbakhsh T, Nikseresht A, Zeyghami B. [The effect of rehabilitation process on the quality of life in multiple sclerosis patients]. Armaghane Danesh 2005; 10: 53–65. (in Persian)
[44] Li MPM, Jelinek GA, Weiland TJ, Mackinlay CA, Dye S, Gawler I. Effect of a residential retreat promoting lifestyle modifications on health-related quality of life in people with multiple sclerosis. Qual Primary Care 2010; 18: 379– 389.
[45] Nedeljkovic U, Dackovic J, Tepavcevic DK, Basuroski ID, Mesaros S, Pekmezovic T, et al. Multidisciplinary rehabilitation and steroids in the management of multiple sclerosis relapses: A randomized controlled trial. Arch Med Sci 2016; 12: 380–389.
[46] Hocaloski Sh, Elliott S, Brotto LA, Breckon E, McBride K. A mindfulness psychoeducational group intervention targeting sexual adjustment for women with multiple sclerosis and spinal cord injury: A pilot study. Sex Disabil 2016; 34: 183–198.
[47] Alexander M, Bashir K, Alexander C, Marson L, Rosen R. Randomized trial of clitoral vacuum suction versus vibratory stimulation in neurogenic female orgasmic dysfunction. Arch Phys Med Rehabil 2018; 99: 299–305.
[48] Azari-Barzandig R, Sattarzadeh-Jahdi N, Nourizadeh R, Malakouti J, Mousavi S, Dokhtvasi G. The effect of counseling based on EX-PLISSIT model on sexual dysfunction and quality of sexual life of married women with multiple sclerosis: A randomized controlled clinical trial. Sex Disabil 2020; 38: 271–284.
[49] Christopherson JM, Moore K, Foley FW, Warren KG. A comparison of written materials vs. materials and counselling for women with sexual dysfunction and multiple sclerosis. J Clin Nurs 2006; 15: 742–750.
[50] Khakbazan Z, Daneshfar F, Behboodi-Moghadam Z, Nabavi SM, Ghasemzadeh S, Mehran A. The effectiveness of the permission, limited information, specific suggestions, intensive therapy (PLISSIT) model based sexual counseling on the sexual function of women with multiple sclerosis who are sexually active. Mult Scler Relat Disord 2016; 8: 113–119.
[51] Zamani M, Tavoli A, Khasti BY, Sedighimornani N, Zafar M. Sexual therapy for women with multiple sclerosis and its impact on quality of life. Iran J Psychiatry 2017; 12: 58– 65.
[52] Lúcio AC, D’Ancona CAL, Lopes MHB, Perissinotto MC, Damasceno BP. The effect of pelvic floor muscle training alone or in combination with electrostimulation in the treatment of sexual dysfunction in women with multiple sclerosis. Mult Scler 2014; 20: 1761–1768.
[53] Fowler CJ, Miller JR, Sharief MK, Hussain IF, Stecher VJ, Sweeney M. A double blind, randomised study of sildenafil citrate for erectile dysfunction in men with multiple sclerosis. J Neurol Neurosurg Psychiatry 2005; 76: 700–705.
[54] Safarinejad MR. Evaluation of the safety and efficacy of sildenafil citrate for erectile dysfunction in men with multiple sclerosis: A double-blind, placebo controlled, randomized study. J Urol 2009; 181: 252–258.
[55] Francomano D, Ilacqua A, Cortese A, Tartaglia G, Lenzi A, Inghilleri M, et al. Effects of daily tadalafil on lower urinary tract symptoms in young men with multiple sclerosis and erectile dysfunction: A pilot study. J Endocrinol Invest 2017; 40: 275–279.
[56] Lombardi G, Macchiarella A, Del Popolo G. Efficacy and safety of tadalafil for erectile dysfunction in patients with multiple sclerosis. J Sex Med 2010; 7: 2192–2200.
[57] Dasgupta R, Wiseman OJ, Kanabar G, Fowler CJ, Mikol DD. Efficacy of sildenafil in the treatment of female sexual dysfunction due to multiple sclerosis. J Urol 2004; 171: 1189–1193.
[58] Giannantoni A, Proietti S, Giusti G, Gubbiotti M, Millefiorini E, Costantini E, et al. OnabotulinumtoxinA intradetrusorial injections improve sexual function in female patients affected by multiple sclerosis: Preliminary results. World J Urol 2015; 33: 2095–2101.
[59] Mosalanejad F, Afrasiabifar A, Zoladl M. Investigating the combined effect of pelvic floor muscle exercise and mindfulness on sexual function in women with multiple sclerosis: A randomized controlled trial. Clin Rehabil 2018; 32: 1340–1347.
[60] Chow KM, Chan JCY, Choi KKC, Chan CWH. A review of psychoeducational interventions to improve sexual functioning, quality of life, and psychological outcomes in gynecological cancer patients. Cancer Nurs 2016; 39: 20–31.
[61] Pourmousavi Khoshnab L, Nikseresht A. Comparison of the effect of aerobic exercise and antidepressant medications on depression and sexual desire of depressed middle-aged women. International Journal of Women’s Health and Reproduction Sciences 2017; 5: 119–122.
[62] Jalali-Chimeh F, Gholamrezaei A, Vafa M, Nasiri M, Abiri B, Darooneh T, et al. Effect of vitamin D therapy on sexual function in women with sexual dysfunction and vitamin D deficiency: A randomized, double-blind, placebo controlled clinical trial. J Urol 2019; 201: 987– 993.
[63] Azami M, Yekta Kooshali MH, Shohani M, Khorshidi A, Mahmudi L. Epidemiology of multiple sclerosis in Iran: A systematic review and meta-analysis. PloS One 2019; 14: e0214738.
[64] Frühauf S, Gerger H, Schmidt HM, Munder T, Barth J. Efficacy of psychological interventions for sexual dysfunction: A systematic review and meta-analysis. Arch Sex Behav 2013; 42: 915–933.
[65] Zahariou AG, Karamouti MV, Papaioannou PD. Pelvic floor muscle training improves sexual function of women with stress urinary incontinence. Int Urogyneco J Pelvic Floor Dysfunct 2008; 19: 401–406.
[66] Doggrell SA. Comparison of clinical trials with sildenafil, vardenafil and tadalafil in erectile dysfunction. Expert Opin Pharmacother 2005; 6: 75–84.
[67] Zeinalzadeh S, Akbarzadeh M, Faridi P, Mohagheghzadeh AA, Sayadi M. Effect of sildenafil citrate on women affected by sexual dysfunction referred to health clinics. Family Med Prim Care Rev 2017; 19: 167–172.
[68] Lilius H, Valtonen EJ, Wikström J. Sexual problems in patients suffering from multiple sclerosis. J Chronic Dis 1976; 29: 643–647.
[69] Betts CD, Jones SJ, Fowler CG, Fowler CJ. Erectile dysfunction in multiple sclerosis associated neurological and neurophysiological deficits, and treatment of the condition. Brain 1994; 117: 1303–1310.
[70] Campagnolo DI, Foley FW, Sipski M. Sexual problems in persons with multiple sclerosis. MS Quarterly Report 2005; 24: 5–10.
[71] McCabe MP, McDonald E, Deeks AA, Vowels LM, Cobain MJ. The impact of multiple sclerosis on sexuality and relationships. J Sex Res 1996; 33: 241–248.
[72] Melnik T, Soares BG, Nasello AG. The effectiveness of psychological interventions for the treatment of erectile dysfunction: Systematic review and metaanalysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices. J Sex Med 2008; 5: 2562–2574.
[2] Hadgkiss EJ, Jelinek GA, Weiland TJ, Rumbold G, Mackinlay CA, Gutbrod S, et al. Health-related quality of life outcomes at 1 and 5 years after a residential retreat promoting lifestyle modification for people with multiple sclerosis. Neurol Sci 2013; 34: 187–195.
[3] Patil NJ, Nagaratna R, Garner C, Raghuram NV, Crisan R. Effect of integrated yoga on neurogenic bladder dysfunction in patients with multiple sclerosis: A prospective observational case series. Complement Ther Med 2012; 20: 424–430.
[4] Kessler ThM, Fowler CJ, Panicker JN. Sexual dysfunction in multiple sclerosis. Expert Rev Neurother 2009; 9: 341– 350.
[5] Lew-Starowicz M, Rola R. Sexual dysfunctions and sexual quality of life in men with multiple sclerosis. J Sex Med 2014; 11: 1294–1301.
[6] Forsythe E, Horsewell JE. Sexual rehabilitation of women with a spinal cord injury. Spinal Cord 2006; 44: 234–241.
[7] Guo ZhN, He SY, Zhang HL, Wu J, Yang Y. Multiple sclerosis and sexual dysfunction. Asian J Androl 2012; 14: 530–535.
[8] Calabrò RS. Sexual dysfunction in neurological disorders: Do we see just the tip of the iceberg? Acta Miomed 2018; 89: 274–275.
[9] Bronner G, Elran E, Golomb J, Korczyn AD. Female sexuality in multiple sclerosis: The multidimensional nature of the problem and the intervention. Acta Neurol Scand 2010; 121: 289–301.
[10] Kim D, Leurer C, So B, Casserly C, Seyman E, Baral S, et al. Sexual dysfunction in multiple sclerosis: A systematic review and meta-analysis of prevalence. Neurology 2019; 92: P5.2–089.
[11] Ghajarzadeh M, Jalilian R, Mohammadifar M, Sahraian MA, Azimi A. Sexual function in women with multiple sclerosis. Acta Med Iran 2014: 52: 315–318.
[12] Cordeau D, Courtois F. Sexual disorders in women with MS: Assessment and management. Ann Phys Rehabil Med 2014; 57: 337–347.
[13] Hess MJ, Hough S. Impact of spinal cord injury on sexuality: Broad-based clinical practice intervention and practical application. J Spinal Cord Med 2012; 35: 211– 218.
[14] Courtois F, Rodrigue X, Côté I, Boulet M, Vézina J, Charvier K, et al. Sexual function and autonomic dysreflexia in men with spinal cord injuries: How should we treat? Spinal Cord 2012; 50: 869–877.
[15] Landtblom AM. Treatment of erectile dysfunction in multiple sclerosis. Expert Rev Neurother 2006; 6: 931– 935.
[16] DasGupta R, Fowler CJ. Bladder, bowel and sexual dysfunction in multiple sclerosis. Drugs 2003; 63: 153– 166.
[17] Bagnato F, Centonze D, Galgani S, Grasso MG, Haggiag S, Strano S. Painful and involuntary multiple sclerosis. Expert Opin Pharmacother 2011; 12: 763–777.
[18] Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Ann Intern Med 2009; 151: W65–W94.
[19] Asadpour E, Veisi S. The effectiveness of emotionally focused couple therapy on sexual self-esteem and sexual function in women with multiple sclerosis. J Arak Univ Med Sci 2017; 20: 1–12.
[20] Ghazagh M, Zadhasan Z. The effect of group mindfulness-based stress reduction program on the quality of life and fatigue in patients with multiple sclerosis. Avicenna J Nurs Midwifery Care 2019; 27: 35–44.
[21] Hamidizadeh S, Masoudi R, Ahmadi F, Mohammadi E. Evaluation of the effect of self-care program based on the Orem framework on the physical quality of life in multiple sclerosis patients. J Shahid Sadooghi Univ Med Sci 2009; 17: 153–163.
[22] Khodaveisi M, Rahmati M, Falahinia Gh, Karami M, Vardanjani MM. The effect of Orem’s self care model on physical quality of life in patients with multiple sclerosis. Sci J Nurs Midwifery Paramed Faculty 2018; 3: 24–35.
[23] Mami Sh, Heidari M. [Effectiveness of intensive shortterm dynamic psychotherapy on sexual function and emotional expression in women with multiple sclerosis]. Health Psychol 2019; 7: 131–150. (in Persian)
[24] Mirzaei S. [Effect of seligman happiness program on improving quality of life, hope, and psychological wellbeing in women with M. SS]. Contemporary Psychology 2017; 12: 1710–1716. (in Persian)
[25] Sahebalzamani M, Zamiri M, Rashvand F. The effects of self-care training on quality of life in patients with multiple sclerosis. Iran J Nurs Midwifery Res 2012; 17: 7–11.
[26] Ahadi F, Tabatabaee SM, Rajabpour M, Ghadamgahi A, Pouryosef Kaljahi M. Effect of 8-week aerobic exercise and yoga training on depression, anxiety, and quality of life among multiple sclerosis patients. Iran Rehabil J 2013; 11: 75–80.
[27] Ahmadi A, Nikbakh M, Arastoo AA, Habibi AH. The effects of a yoga intervention on balance, speed and endurance of walking, fatigue and quality of life in people with multiple sclerosis. J Hum Kinetics 2010; 23: 71–78.
[28] Asadizaker M, Majdinasab N, Atapour M, Latifi SM, Babadi M. Effect of exercise on walking speed, fatigue and quality of life in patients with multiple sclerosis. Jundishapur Sci Med J 2010; 9: 189–198.
[29] Azimzadeh E, Hosseini MA, Nourozi Tabrizi K. [Effect of Tai Chi Chuan on quality of life in women with multiple sclerosis]. Hayat 2013; 19: 1–13.(in Persian)
[30] Kargarfard M, Etemadifar M, Baker P, Mehrabi M, Hayatbakhsh R. Effect of aquatic exercise training on fatigue and health-related quality of life in patients with multiple sclerosis. Arch Phys Med Rehabil 2012; 93: 1701–1708.
[31] Pilutti LA, Lelli DA, Paulseth JE, Crome M, Jiang Sh, Rathbone MP, et al. Effects of 12 weeks of supported treadmill training on functional ability and quality of life in progressive multiple sclerosis: A pilot study. Arch Phys Med Rehabil 2011; 92: 31–36.
[32] Rampello A, Franceschini M, Piepoli M, Antenucci R, Lenti G, Olivieri D, et al. Effect of aerobic training on walking capacity and maximal exercise tolerance in patients with multiple sclerosis: A randomized crossover controlled study. Phys Ther 2007; 87: 545–555.
[33] Romberg A, Virtanen A, Ruutiainen J. Long-term exercise improves functional impairment but not quality of life in multiple sclerosis. J Neurol 2005; 252: 839–845.
[34] Sutherland G, Andersen MB, Morris T. Relaxation and health-related quality of life in multiple sclerosis: The example of autogenic training. J Behav Med 2005; 28: 249–256.
[35] Sutherland G, Andersen M, Stoové M. Can aerobic exercise training affect health-related quality of life for people with multiple sclerosis? J Sport Exercise Psychol 2001; 23: 122–135.
[36] Najafi Dolatabad S, Noureyan K, Najafi Dolatabad A, Mohebbi Z. [The effect of Yoga techniques on quality of life among women with multiple sclerosis]. Hormozgan Med J 2012; 16: 143–150. (in Persian)
[37] Attar Sayyah AE, Hoseini Kakhk SAR, Hamedinia MR, Mehrjoo M. Effect of 8-week combined training (resistance and proprioceptive neuromuscular facilitation) on fatigue and quality of life in multiple sclerosis patients. Horizon Med Sci 2016; 22: 43–50.
[38] Sadeghi Bahmani D, Motl RW, Razazian N, Khazaie H, Brand S. Aquatic exercising may improve sexual function in females with multiple sclerosis: An exploratory study. Mult Scler Relat Disord 2020; 43: 102106.
[39] Simone IL, Ceccarelli A, Tortorella C, Bellacosa A, Pellegrini F, Plasmati I, et al. Influence of interferon beta treatment on quality of life in multiple sclerosis patients. Health Qual Life Outcomes 2006; 4: 96.
[40] Mokhber N, Azarpazhooh A, Orouji E, Khorram B, Modares Gharavi M, Kakhi S, et al. Therapeutic effect of avonex, rebif and betaferon on quality of life in multiple sclerosis. Psychiatry Clin Neurosci 2015; 69: 649–657.
[41] Zarabadipour S, Amini L. The effect of vitamin D tablets on menstrual pattern, steroid hormone levels and sexual function in women with multiple sclerosis [M.Sc. thesis]. Tehran: Iran University of Medical sciences; 2017.
[42] Nozari E, Ghavamzadeh S, Razazian N. The effect of vitamin b12 and folic acid supplementation on quality of life in patients with relapsing-remitting multiple sclerosis. Clin Nutr Res 2019; 29: 736–745.
[43] Hazrati M, Zahmatkeshan N, Dejbakhsh T, Nikseresht A, Zeyghami B. [The effect of rehabilitation process on the quality of life in multiple sclerosis patients]. Armaghane Danesh 2005; 10: 53–65. (in Persian)
[44] Li MPM, Jelinek GA, Weiland TJ, Mackinlay CA, Dye S, Gawler I. Effect of a residential retreat promoting lifestyle modifications on health-related quality of life in people with multiple sclerosis. Qual Primary Care 2010; 18: 379– 389.
[45] Nedeljkovic U, Dackovic J, Tepavcevic DK, Basuroski ID, Mesaros S, Pekmezovic T, et al. Multidisciplinary rehabilitation and steroids in the management of multiple sclerosis relapses: A randomized controlled trial. Arch Med Sci 2016; 12: 380–389.
[46] Hocaloski Sh, Elliott S, Brotto LA, Breckon E, McBride K. A mindfulness psychoeducational group intervention targeting sexual adjustment for women with multiple sclerosis and spinal cord injury: A pilot study. Sex Disabil 2016; 34: 183–198.
[47] Alexander M, Bashir K, Alexander C, Marson L, Rosen R. Randomized trial of clitoral vacuum suction versus vibratory stimulation in neurogenic female orgasmic dysfunction. Arch Phys Med Rehabil 2018; 99: 299–305.
[48] Azari-Barzandig R, Sattarzadeh-Jahdi N, Nourizadeh R, Malakouti J, Mousavi S, Dokhtvasi G. The effect of counseling based on EX-PLISSIT model on sexual dysfunction and quality of sexual life of married women with multiple sclerosis: A randomized controlled clinical trial. Sex Disabil 2020; 38: 271–284.
[49] Christopherson JM, Moore K, Foley FW, Warren KG. A comparison of written materials vs. materials and counselling for women with sexual dysfunction and multiple sclerosis. J Clin Nurs 2006; 15: 742–750.
[50] Khakbazan Z, Daneshfar F, Behboodi-Moghadam Z, Nabavi SM, Ghasemzadeh S, Mehran A. The effectiveness of the permission, limited information, specific suggestions, intensive therapy (PLISSIT) model based sexual counseling on the sexual function of women with multiple sclerosis who are sexually active. Mult Scler Relat Disord 2016; 8: 113–119.
[51] Zamani M, Tavoli A, Khasti BY, Sedighimornani N, Zafar M. Sexual therapy for women with multiple sclerosis and its impact on quality of life. Iran J Psychiatry 2017; 12: 58– 65.
[52] Lúcio AC, D’Ancona CAL, Lopes MHB, Perissinotto MC, Damasceno BP. The effect of pelvic floor muscle training alone or in combination with electrostimulation in the treatment of sexual dysfunction in women with multiple sclerosis. Mult Scler 2014; 20: 1761–1768.
[53] Fowler CJ, Miller JR, Sharief MK, Hussain IF, Stecher VJ, Sweeney M. A double blind, randomised study of sildenafil citrate for erectile dysfunction in men with multiple sclerosis. J Neurol Neurosurg Psychiatry 2005; 76: 700–705.
[54] Safarinejad MR. Evaluation of the safety and efficacy of sildenafil citrate for erectile dysfunction in men with multiple sclerosis: A double-blind, placebo controlled, randomized study. J Urol 2009; 181: 252–258.
[55] Francomano D, Ilacqua A, Cortese A, Tartaglia G, Lenzi A, Inghilleri M, et al. Effects of daily tadalafil on lower urinary tract symptoms in young men with multiple sclerosis and erectile dysfunction: A pilot study. J Endocrinol Invest 2017; 40: 275–279.
[56] Lombardi G, Macchiarella A, Del Popolo G. Efficacy and safety of tadalafil for erectile dysfunction in patients with multiple sclerosis. J Sex Med 2010; 7: 2192–2200.
[57] Dasgupta R, Wiseman OJ, Kanabar G, Fowler CJ, Mikol DD. Efficacy of sildenafil in the treatment of female sexual dysfunction due to multiple sclerosis. J Urol 2004; 171: 1189–1193.
[58] Giannantoni A, Proietti S, Giusti G, Gubbiotti M, Millefiorini E, Costantini E, et al. OnabotulinumtoxinA intradetrusorial injections improve sexual function in female patients affected by multiple sclerosis: Preliminary results. World J Urol 2015; 33: 2095–2101.
[59] Mosalanejad F, Afrasiabifar A, Zoladl M. Investigating the combined effect of pelvic floor muscle exercise and mindfulness on sexual function in women with multiple sclerosis: A randomized controlled trial. Clin Rehabil 2018; 32: 1340–1347.
[60] Chow KM, Chan JCY, Choi KKC, Chan CWH. A review of psychoeducational interventions to improve sexual functioning, quality of life, and psychological outcomes in gynecological cancer patients. Cancer Nurs 2016; 39: 20–31.
[61] Pourmousavi Khoshnab L, Nikseresht A. Comparison of the effect of aerobic exercise and antidepressant medications on depression and sexual desire of depressed middle-aged women. International Journal of Women’s Health and Reproduction Sciences 2017; 5: 119–122.
[62] Jalali-Chimeh F, Gholamrezaei A, Vafa M, Nasiri M, Abiri B, Darooneh T, et al. Effect of vitamin D therapy on sexual function in women with sexual dysfunction and vitamin D deficiency: A randomized, double-blind, placebo controlled clinical trial. J Urol 2019; 201: 987– 993.
[63] Azami M, Yekta Kooshali MH, Shohani M, Khorshidi A, Mahmudi L. Epidemiology of multiple sclerosis in Iran: A systematic review and meta-analysis. PloS One 2019; 14: e0214738.
[64] Frühauf S, Gerger H, Schmidt HM, Munder T, Barth J. Efficacy of psychological interventions for sexual dysfunction: A systematic review and meta-analysis. Arch Sex Behav 2013; 42: 915–933.
[65] Zahariou AG, Karamouti MV, Papaioannou PD. Pelvic floor muscle training improves sexual function of women with stress urinary incontinence. Int Urogyneco J Pelvic Floor Dysfunct 2008; 19: 401–406.
[66] Doggrell SA. Comparison of clinical trials with sildenafil, vardenafil and tadalafil in erectile dysfunction. Expert Opin Pharmacother 2005; 6: 75–84.
[67] Zeinalzadeh S, Akbarzadeh M, Faridi P, Mohagheghzadeh AA, Sayadi M. Effect of sildenafil citrate on women affected by sexual dysfunction referred to health clinics. Family Med Prim Care Rev 2017; 19: 167–172.
[68] Lilius H, Valtonen EJ, Wikström J. Sexual problems in patients suffering from multiple sclerosis. J Chronic Dis 1976; 29: 643–647.
[69] Betts CD, Jones SJ, Fowler CG, Fowler CJ. Erectile dysfunction in multiple sclerosis associated neurological and neurophysiological deficits, and treatment of the condition. Brain 1994; 117: 1303–1310.
[70] Campagnolo DI, Foley FW, Sipski M. Sexual problems in persons with multiple sclerosis. MS Quarterly Report 2005; 24: 5–10.
[71] McCabe MP, McDonald E, Deeks AA, Vowels LM, Cobain MJ. The impact of multiple sclerosis on sexuality and relationships. J Sex Res 1996; 33: 241–248.
[72] Melnik T, Soares BG, Nasello AG. The effectiveness of psychological interventions for the treatment of erectile dysfunction: Systematic review and metaanalysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices. J Sex Med 2008; 5: 2562–2574.