Strokes are life-changing events in many ways, but their effects on romantic relationships are often negative, especially when it comes to sex. Some of the most difficult stresses faced by couples after a stroke begin shortly after they leave the hospital, as they helplessly see their lives become flooded with new challenges such as navigating the medical system, dealing with the intricacies of insurance policies, keeping up with the demanding schedules of physical therapists, occupational therapists, and doctors, and getting used to reviewing endless forms and unfamiliar paperwork among many others. At the same time, they must adjust their interactions as a couple in order to accommodate for new disabilities such as aphasia (inability to speak or to understand spoken language), hemiplegia (paralysis of one side of the body usually involving the face, arm and leg), and dysphagia (difficulty or inability to swallow), not to mention urinary incontinence. Together with some of the elements described below, these challenges can damage or even destroy the intimate lives of stroke survivors.
Specific issues affecting intimacy after stroke:
By itself, stroke is almost never a direct cause of sexual dysfunction. Instead, there appears to be a time of adaptation after stroke in which the stresses mentioned halt the sex lives of stroke survivors. But studies suggest that this is a temporary stage. For instance, one study of men who reported erectile dysfunction after stroke found that over 80% of them spontaneously regained function a few months later. Some couples, however, continue to be affected by sexual dysfunction many months and even years after a stroke. Why is this? Here is a brief list of some of the most common causes:Fear of another stroke:
Many people believe that once a person has suffered one stroke, excitement from sexual activity could cause them another stroke. Fortunately, doctors almost never recommend that people avoid sex. They might do so, however, when a patient has very advanced heart disease, in which case they recommend it to minimize the physical demand on the heart in order to prevent a heart attack. Limited sexual activity is also recommended when a person is about to undergo surgery to repair a large aneurysm, or when he has a known large tear in a blood vessel, as even mild increases in blood pressure from sex might cause the affected vessel to rupture and bleed. Aside from these cases, there is almost never a good medical reason to refrain from sex.Unfortunately, some studies show that this type of fear is one of the most common causes of sexual dysfunction among stroke survivors. One study, for instance, shows that up to 50% of patients who recover from stroke limit their sexual activity because of fear that it might harm them. Furthermore, a large percentage of the partners of stroke survivors also report being afraid to initiate sex because of fear that their partner might suffer another stroke.
Decreased Libido:
Decreased libido after stroke can be expected from several psychological factors, including low self esteem, uncertainty about the future of a relationship, preoccupation with finances, and difficulties accepting a new life with disability. Alternatively decreased libido can also be caused by some medications including medications for depression, and medications for high blood pressure such as beta blockers. Rarely, a stroke can decrease a person's libido by damaging areas of the brain which are involved in the production of hormones (see below).Immobility
Strokes can affect the areas of the brain that control arm and leg movements, preventing a person, and a couple, from achieving the sexual positions they enjoy most. This of course depends on the sexual dynamics of a couple before one of its partners suffered a stroke. For instance, if a couple was used to advanced sexual gymnastics before one of the partners suffered a stroke, limited movement can change their sexual dynamics drastically.Depression:
Several studies suggest that depression dampens sex after a stroke by affecting both the stroke survivor, and his or her partner. There is still a question, however, about whether it is depression itself that dampens sex or whether it is its treatment, as decreased libido is one of the most common side effects of antidepressant medications.Damage to sex areas of the brain:
As stated above, strokes rarely are the direct cause of sexual dysfunction. However, some strokes can affect sensation from the genital area, leading people to feel numbness around their genitals. Other strokes can cause people to fail to recognize their own genitals. Of course, either of these cases would make sex difficult. Strokes that affect the hypothalamus, an area of the brain involved in the control sexual hormones, can also profoundly affect a person’s sexual drive. In some rare instances, increased sexuality, or unusual and inappropriately explicit sexual behavior, can also be caused by strokes.What can I do to improve my sexual life after stroke?
- Sex therapy is the most effective way to improve sex after stroke. It is expensive, however, and it might not be covered by your insurance.
- You must have open communication with your partner.
- Ask your doctor whether it is possible to change medications in your regimen, as they could be affecting your sexual drive.
- While you should strive to recover function every day, you should understand that accepting your disability is an important first step towards reestablishing your sexual life.
- Be bold and explore your sexuality in new ways whether you do this alone or with a partner.
Sources:[/br] Peter M Rees, Clare J Fowler, Cornelis P Maas. Sexual function in men and women with neurological disorders; The Lancet 2007. Vol. 369, Iss. 9560; 512.
Giaquinto S, Buzzelli S, Di Francesco L, Nolfe G Evaluation of sexual changes after stroke. J Clin Psychiatry. 2003 Mar;64(3):302-7
Juha T. Korpelainen, MD, PhD; Pentti Nieminen, PhD Vilho V. Myllyl, MD, PhD; Sexual Functioning Among Stroke Patients and Their Spouses Stroke 1999; Vol 30:715-719.
