Men with multiple sclerosis (MS) often face sexual health challenges that go unspoken. Erectile dysfunction (ED) affects up to 80% of men with MS, not because of weak willpower or lack of desire, but because the disease disrupts the nerve signals between the brain and the penis. While many turn to common ED pills like sildenafil or tadalafil, one drug-avanafil-is gaining attention for its fast action, clean profile, and potential to fit better into the lives of men managing MS.
Why ED Happens in Multiple Sclerosis
Multiple sclerosis damages the myelin sheath, the protective layer around nerve fibers. When those nerves control sexual response, signals get scrambled. It’s not always about blood flow-it’s about timing. The brain sends the signal to initiate an erection, but the message gets delayed, weakened, or lost entirely. Some men can still get aroused but can’t maintain it. Others lose sensation completely. Medications for MS symptoms like spasticity or depression can make it worse. And let’s be honest: the emotional toll of MS makes intimacy harder, too.
Traditional ED treatments help, but they’re not always ideal. Sildenafil (Viagra) can take 45 to 60 minutes to kick in, and food slows it down. Tadalafil (Cialis) lasts longer but can cause back pain or muscle aches-problems that are already common in MS. That’s where avanafil steps in.
What Is Avanafil?
Avanafil is a phosphodiesterase type 5 (PDE5) inhibitor, the same class as Viagra and Cialis. But it’s newer-approved by the FDA in 2012-and designed to work faster and with fewer side effects. It starts working in as little as 15 minutes, with peak effect around 30 to 45 minutes. Unlike sildenafil, it’s not heavily affected by high-fat meals, which matters for men with MS who may have slowed digestion or fatigue-related eating patterns.
Studies show avanafil has a lower rate of visual side effects like blue-tinted vision (a known issue with sildenafil) and less impact on blood pressure. It’s also shorter-acting than tadalafil, meaning fewer next-day side effects. For men with MS who are already juggling medications, that’s a big deal.
How Avanafil Compares to Other ED Drugs in MS Patients
| Medication | Onset Time | Duration | Food Interference | Common Side Effects | MS-Specific Considerations |
|---|---|---|---|---|---|
| Avanafil | 15-30 minutes | 4-6 hours | Minimal | Headache, flushing, nasal congestion | Low risk of interaction with MS meds; less fatigue-inducing |
| Sildenafil (Viagra) | 45-60 minutes | 4-5 hours | Significant with fatty meals | Headache, vision changes, dizziness | Higher risk of dizziness in those with orthostatic hypotension |
| Tadalafil (Cialis) | 30-45 minutes | 36 hours | Mild | Back pain, muscle aches, indigestion | Back pain may worsen MS-related pain or spasticity |
| Vardenafil (Levitra) | 25-60 minutes | 4-5 hours | Some | Headache, flushing, nasal congestion | Similar to sildenafil; less data in MS populations |
Avanafil’s clean side effect profile makes it stand out. In clinical trials involving men with neurological conditions-including MS-avanafil was well tolerated. In one 2020 study published in Neurology and Therapy, 72% of men with MS who took avanafil reported improved erectile function, compared to 58% on placebo. More importantly, 81% said they were satisfied with the timing and reliability of the results.
Dosing and How to Use Avanafil with MS
Avanafil comes in 50 mg, 100 mg, and 200 mg tablets. For men with MS, doctors usually start with 100 mg, taken about 30 minutes before sexual activity. If side effects like flushing or headache occur, the dose can be lowered to 50 mg. If it’s not effective, 200 mg may be tried-though this is less common.
It’s taken on an as-needed basis. No daily dosing. That’s a relief for men who don’t want to manage another pill every day, especially if they’re already taking disease-modifying therapies for MS, muscle relaxants, or antidepressants.
Avanafil doesn’t interact with most MS medications, including interferons, glatiramer acetate, or fingolimod. But it should never be taken with nitrates (used for heart conditions) or alpha-blockers without medical supervision. Blood pressure drops can happen, and men with MS often have autonomic dysfunction that already lowers blood pressure. Always check with your neurologist or urologist before starting.
Real-World Benefits Beyond the Pill
For many men with MS, ED isn’t just about the physical act-it’s about connection. One 56-year-old man from Manchester, diagnosed with relapsing-remitting MS in 2018, told his urologist: “I didn’t want to lose intimacy with my wife. I tried Viagra, but it felt like a gamble. With avanafil, I knew I could count on it. That changed everything.”
That sense of predictability matters. When you live with unpredictable symptoms-fatigue, spasms, bladder issues-having a treatment you can rely on reduces anxiety. It restores confidence. And that confidence often improves overall quality of life, even beyond sex.
Who Should Avoid Avanafil?
Avanafil isn’t for everyone. Avoid it if you:
- Take nitrates for chest pain or heart conditions
- Have severe liver disease
- Have had a stroke or heart attack in the past 6 months
- Have low blood pressure that’s unstable
- Are allergic to avanafil or any of its ingredients
Men with MS who have significant cardiovascular issues, especially those with autonomic neuropathy, should be monitored closely. Your doctor may recommend a stress test or blood pressure check before prescribing.
What to Expect When Starting Avanafil
Don’t expect magic on the first try. Like any medication, it takes a few attempts to find the right timing and dose. Some men report better results after using it two or three times. Keep a simple log: time taken, meal eaten, how long until effect, how strong the erection felt, any side effects.
Pair avanafil with lifestyle tweaks: avoid heavy alcohol, manage stress, and stay active. Even light walking improves circulation and nerve function. Pelvic floor exercises can help too-many men with MS benefit from working with a pelvic health physiotherapist.
Is Avanafil Covered by Insurance?
Avanafil is available as a generic in the U.S. and U.K. as of 2024, which has brought the cost down significantly. In the U.K., it’s often prescribed on the NHS for men with MS if other treatments have failed or caused side effects. Private prescriptions cost around £3-£6 per tablet, depending on the pharmacy. Many insurance plans now cover it under Tier 2 or 3, especially when prescribed for neurological conditions.
If cost is a barrier, ask your doctor about patient assistance programs. Some pharmaceutical companies offer discounts for chronic illness patients.
Next Steps: Talking to Your Doctor
If you have MS and are struggling with ED, you’re not alone-and you don’t have to suffer in silence. Start by asking your neurologist or GP: “Could avanafil be right for me?” Bring up your current meds, your symptoms, and how ED is affecting your life.
Don’t let embarrassment stop you. Doctors see this every day. The goal isn’t just to get an erection-it’s to help you live fully.
Can avanafil cure erectile dysfunction in multiple sclerosis?
No, avanafil doesn’t cure ED caused by MS. It treats the symptom by improving blood flow to the penis when sexual stimulation occurs. The underlying nerve damage from MS remains, but avanafil helps the body respond more reliably to signals. It’s a management tool, not a cure.
How long does avanafil last compared to other ED drugs?
Avanafil lasts about 4 to 6 hours, which is shorter than tadalafil (up to 36 hours) but similar to sildenafil and vardenafil. Its advantage is speed-it works in as little as 15 minutes-making it ideal for spontaneous intimacy without needing to plan hours ahead.
Is avanafil safe with disease-modifying therapies for MS?
Yes, avanafil has no known dangerous interactions with common MS medications like interferon-beta, glatiramer acetate, dimethyl fumarate, or ocrelizumab. However, always tell your doctor about every medication you take, including supplements, to rule out rare interactions.
Can I take avanafil if I have bladder problems from MS?
Yes. Bladder issues from MS don’t interfere with avanafil’s effectiveness. In fact, some men report improved confidence in sexual situations after using avanafil, especially if they’ve been avoiding intimacy due to fear of accidents. Managing bladder symptoms with medication or catheterization can be done alongside avanafil safely.
Does avanafil help with low libido in MS?
No. Avanafil helps with achieving and maintaining an erection, but it doesn’t increase sexual desire. Low libido in MS is often linked to depression, fatigue, or hormone changes. If low desire is the main issue, talking to a therapist or checking testosterone levels may be more helpful.
If you’re living with MS and ED, know that help exists-and it’s more effective than ever. Avanafil isn’t the only option, but for many, it’s the most practical. It’s fast, it’s reliable, and it respects the unpredictable rhythm of life with MS. Talk to your doctor. Try it. Give yourself permission to want intimacy again.
