Changes in Sexual Function After Stroke

Do you need to use your brain for sex? Research shows that a healthy brain is indeed an important part of being able to maintain normal sexual behavior. While the clichés certainly imply that some people have 'nothing' on their minds besides sex, it turns out that your mind has to be in pretty good shape to be able to think about sex. 

A stroke can have a big impact on sexual abilities. It is rare, but not unheard of for a stroke to increase sexual desire, causing hyper-sexuality.

And one case reported a male stroke survivor who reported a change in his sexual preference after a stroke. But the vast majority of stroke survivors experience a significant decline in sexual desire and sexual behavior after a stroke. 

Why does a stroke affect sexual function?

There is not just one single reason that a stroke decreases sexual abilities, there are a number of reasons. Many stroke survivors have more than one of these causes of sexual dysfunction after a stroke.

Brain damage 

The brain damage of a stroke itself can impair the complex neural activity that controls sexual interest and functioning. This has been noted with strokes on either the left side of the brain or the right side of the brain, and with large cortical strokes as well as small subcortical strokes. There doesn’t seem to be one isolated area of the brain that is responsible for normal sexual behavior, but instead, normal sexual functioning is controlled by a sophisticated interaction between several regions of a healthy brain.

Anxiety about another stroke

Stroke survivors and their spouses often feel worried and even afraid that sex may cause another stroke. But reports show that, in fact, documented cases of stroke during sexual activity are quite rare. One research study suggested that extramarital encounters are more likely to result in a stroke than married sexual encounters.

This is might be due to the anxiety and hypertension that may result from sneaking and the threat or fear of being caught. So, it is the fear of having a stroke during sex that is more of a problem than any real danger of having a stroke.  


When you think of the effects of a stroke, you don’t usually think of depression, but depression is a frequent consequence of strokes- even mild strokes. Depression and apathy and lack of motivation all contribute to low sex drive, which, in turn, contributes to diminished sexual abilities. If you have depression, it is important for you to know that while some antidepressants are known to cause side effects that include decreased sexual function, not all antidepressants have that effect. 

Changed roles of stroke survivor and spouse 

Sometimes, after a stroke, the caregiver/ survivor dependence can change the relationship dynamic so much that the stroke survivor or the caregiver may find themselves less inclined to think of the relationship in the same way as it was prior to the stroke.


What to do?

Discuss your fears, your low sex drive or your impaired sexual function with your doctor, who can provide treatment for sexual dysfunction after a stroke. In some situations, counseling can help. Antidepressant medication or medication for sexual dysfunction might be the best option in some circumstances. 


It is important for you to make sure that any medication you take for sexual dysfunction is prescribed by a licensed health care professional. It is unequivocally safer to stick with well-known medications that have a long history of use and a well-documented side effect profile than to use unknown or obscure herbal supplements to treat sexual dysfunction.


Cheasty M, Condron R, Cooney C, Altered sexual preference, and behavior in a man with vascular ischaemic lesions in the temporal lobe, International Journal of Geriatric Psychiatry, January 2002

Boller F, Agrawal K,Romano A, Sexual function after strokes, Handbook of Clinical Neurology, 2015

Rosenbaum T, Vadas D, Kalichman L, Sexual Function in Post-Stroke Patients: Considerations for Rehabilitation, The Journal of Sexual Medicine, October 2013

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