Engaging in sexual activities after a stroke can be a daunting task for some couples. Going through activities of daily living, and the challenges that come with it may make one uncomfortable, not to talk of being intimate with one’s partner. Some reasons sex after a stroke could be difficult or near impossible include psychological, physical and emotional issues. However, some of these challenges can be treated. When the major issues are identified, practical solutions can be proffered by the Physiotherapist and other members of the medical team. Some factors that may cause sexual difficulties are – reduced desire, erectile dysfunction, vaginal dryness, paraparesis ( one-sided weakness), pain, spasticity, fatigue, hypotonicity, aphasia (problems with verbal expressions), concrete thinking, emotional lability, shame, fear [including fear of another stroke], embarrassment, depression and neurogenic bladder/incontinence.
A study done to assess the effect of stroke on sexual functioning on survivors and their partners found that there was a significant reduction in all sexual parameters [libido, coital frequency, sexual arousal including erectile and orgastic ability and vaginal lubrication, and sexual satisfaction] measured after a stroke as compared to before the stroke occurred. In that research, 57% of patients and 65% of their spouses said they’d experienced a reduced libido after the event of a stroke as compared to before. It was also observed that participants had stopped any forms of sexual activities post-stroke, despite being sexually active pre-stroke. Here, most participants viewed sex as unimportant, some were afraid of now being impotent and some thought that their limited functional abilities would prevent them from engaging in sexual intimacy. Also, partners who took this study reported that they rarely discussed sex after the stroke, and were often unwilling to participate in any sexual activity. Some of these may have been caused by the level(s) of functional disability as well. What I mean is that the more severe the paralysis and consequences of a stroke, the less likely the patient and or their spouse wanted sex.
With all these statistics staked up against stroke survivors and their partners, you can imagine my joy when during a physiotherapy assessment for a long-standing stroke survivor, his wife, brought up the issue of sex – frequency and intensity. We were open to having a continuous conversation on it and we mapped out a solution specific to them. However, for everyone, we will briefly outline possible solutions that are relatable.
• Talk about your feelings and desires with your partner
• Consider speaking to your physical therapist about adaptation forms including positioning during sex, breathing techniques
• Stay true to your exercise routines and home programs as prescribed by your Physiotherapist
• See a certified Clinical Psychologist or Therapist for any mental health concerns, for example, if you’re depressed
• Speak to your Cardiologists about the possible side-effects of some meds you may be taking if you feel they may be affecting your sexuality, e.g. altered state of consciousness
• If you experience any erectile dysfunction see your GP as this may be caused by a raised blood pressure, diabetes etc
• Do not be afraid to explore new ways of having sexual relations with your partner
• Vaginal dryness can be addressed by using lubricants and other safe medical options
• If using a catheter, consider speaking to your nurse about possible ways to seal, empty or cover it up without causing harm
• Best to empty one’s bladder before sex
• Speak to your doctor about appropriate times to use your blood pressure medications (before or after sex will be determined by your doctor)
Having sex is most likely not going to make you suffer another stroke. Yes, your blood pressure may increase when you orgasm, but speaking to your doctor ahead about medication times will help. Also, remember that the ultimate is to build intimacy with your partner and not let a medical condition pull you apart.
If you decide to expand your family and get pregnant or want to prevent pregnancy, kindly consider speaking to your GP about your options.
I hope you have found this article helpful. For more information kindly visit the sources below
Kautz, D. D, & Van Horn, E. R. (2016). Sex and Intimacy after Stroke. Rehabilitation Nursing, 42(6), 333-340. Doi: 10. 1002/rnj.296
Juha, T. K, Penttii N, Vilho V. M. (1999). Sexual Functioning Among Stroke Patients and Their Spouses. Stroke.; 30:715-719
Stroke Association 2017 https://www.stroke.org.uk/sites/default/files/sex_after_stroke.pdf
University of Wisconsin https://www.uwhealth.org/healthfacts/stroke/7699.pdf