Vaginal health and MS — a topic rarely discussed, yet deeply relevant for women living with multiple sclerosis. In this episode, Dr. Melika Arab Bafrani, postdoctoral researcher at the University of California, San Francisco (UCSF), shares her insights on how MS and its treatments can affect intimate health, why collaboration between neurologists and gynecologists is so important, and what every woman with MS should watch out for.Einleitung
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1. Introduction & Background
Melika, could you briefly introduce yourself and your background in working with MS patients?
Dr. Melika Arab Bafrani: Of course. I’m an MD-MPH graduate from Tehran University of Medical Sciences, Iran, and currently a postdoctoral researcher at UCSF’s Neurology Department. My work focuses on women with MS—particularly pregnancy, postpartum, and postmenopause. Before joining UCSF, I conducted MS-related research in Iran on environmental risk factors, disease progression, and population-based studies.
2. Why Talking About Vaginal Health Matters
Why is it important to talk about vaginal health in women with MS, even though it’s often overlooked?
Dr. Melika Arab Bafrani: Vaginal and gynecological health are key aspects of overall well-being, but often ignored in MS care. Women with MS experience hormonal and immunological changes throughout their lives—from puberty to menopause. Ignoring these can reduce quality of life. We must integrate intimate health into comprehensive MS management.
3. How MS and DMTs Affect Vaginal Health
What does current research suggest about how MS and disease-modifying therapies (DMTs) might affect vaginal health and the microbiome?
Dr. Melika Arab Bafrani: Evidence shows both MS and DMTs can influence the vaginal and urinary microbiome. MS involves immune dysregulation, which can alter mucosal immunity beyond the brain. Some DMTs—especially B-cell-depleting ones like ocrelizumab or rituximab—can lower immune surveillance, increasing the risk of vaginal or urinary infections and reducing microbial diversity.
4. Collaboration Between Neurology and Gynecology
Why is collaboration between neurologists and gynecologists so important for women with MS?
Dr. Melika Arab Bafrani: Because MS treatments can affect gynecological health. Complications may include HPV-related cervical changes, inflammatory or infectious vaginitis, and herpesvirus infections. Neurologists often don’t ask about these issues, while gynecologists might not be aware of MS therapies. By working together, they can educate patients, ensure routine Pap smears and HPV vaccination, and coordinate safer treatment plans.
5. Patient Advocacy for Intimate Health
What can patients do if their neurologist doesn’t ask about intimate health?
Dr. Melika Arab Bafrani: Bring it up yourself. Ask about possible side effects of your MS therapy, request a referral to a gynecologist, and educate yourself about infections and HPV-related complications. Empowerment starts with initiating the conversation.
6. Early Signs and Prevention
Are there early signs women should watch for?
Dr. Melika Arab Bafrani: Yes. Look out for abnormal discharge, color or odor changes, pain during sex or urination, itching, irritation, swelling, or unusual bleeding. Recurring infections or lesions should never be ignored. Early consultation can prevent major complications.
And what preventive habits would you recommend?
Dr. Melika Arab Bafrani: Maintain gentle hygiene, stay hydrated, eat a balanced diet, and avoid unnecessary probiotic supplements unless prescribed. Don’t smoke, practice safe sex, and schedule regular gynecological checkups. HPV vaccination and stress management are also crucial.
7. Research Gaps and Future Directions
Despite all the research, there are still gaps. What do we need to understand better?
Dr. Melika Arab Bafrani: Many areas! We need more data on how DMTs affect the vaginal microbiome and immunity, long-term risks, and maternal–fetal implications. Women with higher disability scores are often underrepresented in screening programs. We must also study how these factors could influence future personalized MS therapies.
8. Participating in Research
Why should women with MS consider participating in studies?
Dr. Melika Arab Bafrani: Because only we can generate the data we need. Participation helps improve maternal and reproductive health and directly benefits patients. One woman told me she could safely breastfeed her second child thanks to findings from a study she joined earlier—this is the power of research.
Quickfire Q&A Session
Complete the sentence: "For me, multiple sclerosis is...."
Dr. Melika Arab Bafrani: A condition where your body fights itself—and a reminder to be kind to your body.
What development would you like to see in the field of multiple sclerosis in the next 5 years?
Dr. Melika Arab Bafrani: I hope young women with MS feel more comfortable planning families and careers, and that we can help them feel secure and hopeful.
10. Final Thoughts
If someone feels hesitant to discuss this topic with their doctor, what’s your advice?
Dr. Melika Arab Bafrani: Just start the conversation. Mention you heard about vaginal health in MS, and express your concerns openly. Most neurologists welcome these discussions—they just need a cue.
And your closing message?
Dr. Melika Arab Bafrani: Please don’t ignore symptoms. Around 75% of women experience at least one sign of vaginal health issues but dismiss it as stress or diet. Paying attention early can prevent serious conditions like infection or cancer.
Follow Dr. Arab Bafrani
You can follow Dr. Arab Bafrani’s research on LinkedIn, via UCSF publications, or on PubMed.
See you soon and try to make the best out of your life,
Nele
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