Sex after stroke illness

Sex after stroke illness

Your recovery from a stroke will have taken you through various stages. Coming to terms with what has happened to you takes time and initially you will have been focusing on the more functional aspects of your stroke such as learning to walk, talk and care for yourself.

Further down the line your mind may turn to more personal matters such as establishing or renewing a sexual relationship. If being sexually active was important to you before your stroke it is likely that you will feel that way again. However there may be some physical and emotional issues that now have to be considered.

Stroke affects everyone differently and to different degrees so it is very unlikely for two people to have exactly the same experience. This section looks at some of the issues involved in being sexually active after stroke and will hopefully answer some questions that you may have.

Fear

The common fear following a stroke is that having sex will bring on another stroke. There is no reason why after a couple of weeks you cannot begin to have sex if you feel ready to do so. Medical evidence supports this. If you still feel unsure about having sex then arrange to speak to your General Practitioner (GP).

Physical changes

Having a stroke does not have to mean the end of being sexually active, although changes may be involved. Physically stroke can affect men and women in different ways.

Decrease in libido: Both may find that libido (sex drive) is lessened due to tiredness, anxiety, depression, doubts about self-image and concerns for the future. A woman may find that sexual arousal takes longer after her stroke. There may be a loss of sensation or a degree of vaginal dryness, which may hinder sexual activity.

A man is more likely to be concerned if he finds he is unable to achieve or sustain an erection. This can happen after a stroke for many reasons but it is also common after any serious illness. Unfortunately many men equate this with their masculinity and worrying about failing to have an erection can have that very effect. So a vicious circle begins. After a stroke, even if one side of the body has been affected, the nerve processes involved on the unaffected side are usually enough to sustain an erection.

The side effect of some prescribed antidepressants, conditions such as diabetes and prostate problems may also cause erection problems in men. These types of problems may require further intervention by your GP, who may review your medications and if needed refer you to a specialist.

Increase in libido: A minority of people experience an increased libido and sexual activity after a stroke. In the most part, this is probably explained by improved relations with your partner and by improvement in the emotional and social aspects experienced.

Very rarely a stroke can cause a disorder called hypersexuality, which can be related to the area of brain damaged by the stroke. This is described as an abnormal, increased sexual desire.

Blood Pressure: Many people worry that having sex will raise their blood pressure too high. In fact sex only affects your blood pressure in the same way as exercise does. It is very rare for strokes to happen during sexual activity, but if this is worrying you, you should speak to your doctor for reassurance.

Unfortunately, some blood pressure lowering drugs can cause impotence in some men. This is completely reversible by changing to a different group of drugs. Therefore, it is vital that you discuss this with your doctor so that something can be done about it.

Emotional changes

Both men and women experience similar emotional problems after a stroke. How you feel about yourself and how you perceive others feel towards you, can lead to you losing confidence in yourself. Adjusting to the changes in your life after a stroke can take time to come to terms with and many people experience anxiety and depression as a result. This can have a knock on affect on your desire for sex.

There can be a subtle change within a relationship when a partner becomes a carer, especially when assistance is needed with personal care. This can sometimes cause embarrassment or affect the way you feel about each other.

Communication is important: Retaining closeness and intimacy within your relationship will help to overcome difficulties. It is important to keep communicating with each other. You can express your feelings in many different ways, through talking but also with body language and physical contact such as kissing and cuddling. Getting the better of anxiety and shyness in taking the first step may be the biggest hurdle to overcome.

Potential Difficulties

It is very important to remember that there are physical, emotional and social reasons for a decline in sexual function and satisfaction after a stroke.

Physical difficulties Emotional difficulties Social difficulties and general attitude towards sexuality

Tiredness
Delayed arousal
Vaginal dryness
Medication induced impotence
Loss of movement
Loss of sensation
Having a urinary catheter

Fear of impotence or loss of sex drive
Actual loss of sexual desire
Changes in self image
Decreased confidence
Low self esteem
Change in social role - in family and community
Embarrassment
Anxiety
Depression

Inability to discuss sexuality
Unwillingness to participate in sexual activity
Degree of physical disability involved

Contraception and pregnancy

Following stroke there is no reason why you cannot conceive, have a normal pregnancy and have a healthy baby. Because there is a small risk attached to taking the combined oral contraceptive pill, alternative methods of family planning may need to be explored; you should discuss this further with your doctor.

Practical steps to improve things

Plan for sexual activity in advance, just as you would plan for any other activity.
Pay attention to personal hygiene and grooming as this makes most of us feel more attractive and better about ourselves.

Choose a time when both of you are feeling rested, relaxed and when privacy is guaranteed.

Avoid a heavy meal or wait a couple of hours after eating.
Avoid excessive alcohol as this can have an effect on the ability to achieve or maintain an erection.
Alcohol can also increase tiredness and drowsiness.
If your stroke restricts your movement and /or sensation, explore different positions, which might suit you both better.
Try talking with your partner, and identify any problems you are experiencing. Ways around any difficulties can be found.
Having a urinary catheter need not prevent you from having penetrative sex. Females can tape the tube out of the way; males can wear a condom with the tube folded back over the penis.
Try using lubrication jelly.

Sexual fulfilment

There are other ways of expressing your feelings for someone and achieving sexual fulfilment even if you cannot manage penetrative sex. Most people feel the need for and benefit from physical contact and you can give and receive a lot of pleasure through kissing, cuddling and massage.

Remember if sex was important to you before your stroke there is no reason why you cannot have a sex life after your stroke, whether this is initiating a new relationship or resuming an old one. However, keeping an open mind and giving yourself time to adjust is often the solution to getting your sex life back on track.

The information on this page has been adapted from the CHSS leaflet Sex after stroke illness.

Last updated: 19/11/2007