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

BACKGROUND: 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). AIM: This meta-analysis evaluates the effectiveness of non-pharmacological interventions for MS-related SD. METHODS: 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. OUTCOMES: The primary outcomes were changes in sexual function, satisfaction, and QOL. RESULTS: 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, P = .84). However, structured exercise protocols (treadmill, aerobic, and aquatic exercises) showed significant improvements in sexual function (SMD = 2.88, P = .04), with aquatic exercise being particularly effective (SMD = 14.76, P = .0001). Mindfulness interventions also enhanced sexual function (SMD = 4.40, P < .0001). While psychoeducational programs did not significantly improve overall sexual QOL (SMD = 16.40, P = .18), they significantly improved sexual function (SMD = 3.46, P = .004) and satisfaction (SMD = 7.73, P = .028). CLINICAL IMPLICATION: Tailored exercise and psychoeducational interventions can be recommended to improve sexual function and satisfaction in patients with MS. STRENGTHS AND LIMITATIONS: 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. CONCLUSION: 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.