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Brain, Vol. 117, No. 6, 1303-1310, 1994
© 1994 Guarantors of Brain

research-article

Erectile dysfunction in multiple sclerosis Associated neurological and neurophysiological deficits, and treatment of the condition

C. D. Beits1,2, S. J. Jones1, C. G. Fowler1,2 and Clare J. Fowler1,

1Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery London, UK 2The Academic Department of Urology, The Royal London Hospital London, UK

Correspondence to: Correspondence to: Clare J. Fowler, Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK

Forty-eight men with multiple sclerosis and erectile dysfunction were evaluated. Emphasis was placed on the neurological features and the relationship between impotence and the bladder dysfunction in multiple sclerosis. Erectile failure was invariably associated with pyramidal signs in the lower limbs and with urinary symptoms. All of the men with impotence and marked pyramidal dysfunction in their legs were found by cystometric studies to have bladder hyperreflexia. The severity of the urinary symptoms was related to the degree of pyramidal impairment in the lower limbs. The posterior tibial and the pudendal cortical evoked potentials were abnormal in most of the men with multiple sclerosis and erectile failure. However, recording the pudendal cortical responses in patients with multiple sclerosis and impotence provided no more information than the tibial cortical evoked potentials. The neurological examination findings together with the results of the neurophysiological and cystometric tests suggest that erectile dysfunction in multiple sclerosis is due to spinal lesions situated proximal to the sacral cord. The feasability of papaverine intracorporeal injection therapy for men with multiple sclerosis and impotence was assessed. Papaverine intracorporeal injections produced satisfactory erections in the majority of the impotent men. Erectile failure in patients with multiple sclerosis was successfully managed for up to 2 years, by intracorporeal self-injection therapy.

multiple sclerosis; impotence; somatosensory evoked potentials; urinary incontinence

Received March 21, 1994. Revised May 16, 1994. Accepted July 8, 1994.


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