How does ALS affect sexuality?

ALS affects sexuality, even though physical functions (preserved sensory, motor, and autonomic functions of the external genitalia) remain intact.

Despite the anatomical integrity of the primary sexual characteristics, sexual experience may be limited. The mere diagnosis of ALS constitutes a psychologically stressful situation that can lead to a reduced capacity for sexual experience.

In addition, there are physical symptoms and deficits affecting the tongue and throat (bulbar syndrome), as well as arm, leg, and trunk function (paresis of the extremities and trunk; muscle atrophy, spasticity), which can lead to a reduction in intimacy and sexual experience for both the affected individual and their sexual partner.

Systematic surveys of affected couples have revealed a significant decline in sexual activity as the disease progresses. At the same time, a smaller group of couples reports continuing to have a satisfying sex life. Among some members of this group, there was an increase in their ability to experience intimacy and sexuality.

This should be distinguished from hypersexuality (an increased sexual desire) in the person with the condition, which can develop in the context of frontotemporal dementia. The topic of sexuality, particularly hypersexuality in frontotemporal dementia, should be addressed in the doctor-patient dialogue.

There are various medication options for treating erectile dysfunction in men. At the same time, various medications are used to treat ALS (e.g., certain antidepressants) that may be associated with a loss of sexual interest (decreased libido). When prescribing these medications, a balance must be struck between the treatment goals (mood stabilization) and the side effects (decreased libido).