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By A. Osko. Elms College.

Spasticity or leg spasms may be minimized by timing antispas- ticity medication so that it is maximally effective during sexual 133 PART III • Your Total Health activity purchase 20mg nexium visa. Having intercourse in a side position, with the knees bent or using pillows for support, may make a difference and should be tried. A vibrator may compensate for a loss of deep pressure sense, which is reflected as impaired sensation, numbness, and tingling. A number of different types are available, including hand-held, penis- shaped, and others. A new device called "Eros" has been approved by the FDA for sexual dys- function in the female. It places gentle suction on the clittoral region while applying a gentle vibration. The judicious use of a frozen bag of peas rubbed gently in the vaginal area has been reported to increase sensation and decrease pain for some people. Lubrication difficulties in women may be managed by vaginal pack- ets of lubricants that open on impact, such as Replens or Astroglide. Several alternatives are available if a man’s erections are insuf- ficient for penetration and intercourse. The use of surgically implanted penile prostheses has decreased dramatically as nonsur- gical alternatives have become popular. A solid erection may be obtained in most men with injectable prostaglandin, or Caverjet™, which is injected using a small needle approximately 30 minutes before intercourse and almost always creates a strong erection. An alternative involves the same prostaglandin medication administered into the opening of the penis (urethra) via an applica- tor. A rubber band placed at the base of the penis after erection occurs may hold the erection for a longer period of time. There are many penile vacuum devices, which consist of a tube that is placed over the penis with a rubber band around the top of the tube. A pump removes the air from the tube, creating a vacuum that draws blood into the penis to produce an erection.

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Whilst many of the common urinary problems above that people with MS experience are indeed a result of damage to the nervous system caused by the disease generic nexium 40 mg free shipping, others may be caused by ‘urinary tract infections’. Urinary tract infections are not caused directly by the MS itself, but are more likely in people with MS because of some of its functional effects – for example through infections from a failure to empty the bladder. Diagnosing a bladder problem in MS The most helpful information for a doctor or other health professional to assist in diagnosing your problems is a brief history of any bladder symptoms you may have, for example: • What is your major concern about your bladder/urination? If responses to these questions suggest the existence of bladder problems, then it is likely that you will asked to take some tests. Tests Increasingly there are different tests being used to determine more accu- rately what the exact problem is. Your GP will probably only undertake 46 MANAGING YOUR MULTIPLE SCLEROSIS tests for urinary tract infections, and it will be your neurologist who may refer you to specialists, e. The two most significant tests assess: • urinary tract infection, and • control of urinary flow. Doctors are recognizing that urinary tract infections are an increasing problem for people with MS and often associated with retention of urine in the bladder. However, it is important that you ask your doctor to undertake such tests regularly. If your doctor suspects that an infection is present, a ‘mid-flow’ sample of your urine is normally requested and, after the specimen has been ‘cultured’ to identify the particular bacteria present, you will be prescribed the most appropriate antibiotic. More and more sophisticated tests, known as ‘urodynamic’ tests, are being developed to measure ‘urinary flow’. A more recent test investigates this flow and the amount of urine remaining in the bladder after urination by taking a non-invasive ultrasound picture of your bladder. Of particular importance is the measurement of the amount of urine remaining in the bladder after you have urinated – it is this residue that can give rise to infection. This overall test, called an ‘ultrasound cystodynogram’ (USCD), is gradually replacing one that measures the rate of flow or urine by the introduction of a ‘catheter’ (a thin tube) through your urethra (the opening in your body from where urination occurs) to your bladder.

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