Sexuality after stroke can be unrecognizable, even depressing. This is in spite of the fact that strokes, by themselves, are rarely a direct cause of sexual dysfunction. But the stress brought on by a stroke is as difficult as any a couple can ever face. Such stress begins shortly after a patient and his loved one leave the hospital, and helplessly begin to watch their lives become flooded with new challenges such as learning to navigate an unfriendly 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.
Inevitably this unexpected deluge of new challenges can affect a romantic relationship, not to mention what the physical and mental disabilities brought on by the stroke itself can do to change a couple's interactions. Whether they like it or not, sex dynamics are changed, at least temporarily, by problems 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) or hemiparesis.
Together with some of the elements described below, these challenges conspire against the intimate life of a stroke survivor, unless he/she is prepared to deal with the nuances of a new sex life after a stroke.
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 the stroke in which sex life is halted. Studies show that this is a temporary stage. For instance, one study found that 80% of men who report erectile dysfunction after stroke regained function spontaneously a few months later. However, the couple may continue to suffer from sexual dysfunction for years after a stroke. Here is a brief list of some of the most common reasons for this:
Fear of another stroke:Many people believe that once a person has suffered one stroke, excitement from sexual activity could cause them another stroke. This is rarely the case. In rare occasions a patient with advanced heart disease, might be asked by his doctor to minimize physical demands on the heart (even from sex) 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 a torn blood vessel. This is done to avoid sex-induced increases in blood pressure which might cause affected blood vessels 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 be caused by some medications including antidepressants, and high blood pressure medicines (e.g., beta blockers.).
ImmobilityStrokes can affect the areas of the brain that control arm and leg movements, thus preventing couples from achieving the sexual positions they enjoy most. Of course some people are more affected thank others by this, depending on the extent of damage to the brain caused by the stroke, and the sexual gymnastics of a couple was used to performing before being affected by the stroke.
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 affect a person's sexual drive. In some rare instances a stroke can also cause increased sexuality, or unusual and inappropriately explicit sexual behavior, is caused by .
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, which 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 re-establishing your sexual life.
- Be bold and explore your sexuality in new ways whether you do this alone or with a partner.
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.