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

Abstract

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