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

Abstract

<h4>Background</h4>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).<h4>Aim</h4>This meta-analysis evaluates the effectiveness of non-pharmacological interventions for MS-related SD.<h4>Methods</h4>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.<h4>Outcomes</h4>The primary outcomes were changes in sexual function, satisfaction, and QOL.<h4>Results</h4>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, <i>P</i> = .84). However, structured exercise protocols (treadmill, aerobic, and aquatic exercises) showed significant improvements in sexual function (SMD = 2.88, <i>P</i> = .04), with aquatic exercise being particularly effective (SMD = 14.76, <i>P</i> = .0001). Mindfulness interventions also enhanced sexual function (SMD = 4.40, <i>P</i> < .0001). While psychoeducational programs did not significantly improve overall sexual QOL (SMD = 16.40, <i>P</i> = .18), they significantly improved sexual function (SMD = 3.46, <i>P</i> = .004) and satisfaction (SMD = 7.73, <i>P</i> = .028).<h4>Clinical implication</h4>Tailored exercise and psychoeducational interventions can be recommended to improve sexual function and satisfaction in patients with MS.<h4>Strengths and limitations</h4>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.<h4>Conclusion</h4>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.