How Sexuality Changes After Stroke

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Sexuality can change after a stroke. Strokes are rarely a direct cause of sexual dysfunction. But the stress brought on by a stroke may contribute to sexual changes.

The stress of a stroke begins almost immediately, and continues after a stroke survivor and loved ones leave the hospital. A stroke survivor and loved ones must meet new challenges after a stroke, such as:

  • Keeping track of new medications

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. The dynamics of the relationship and the sexual aspects of the relationship may be 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 (partial weakness of one side of the body.)

Sexual Function After a Stroke

By itself, stroke is almost never a direct cause of sexual dysfunction.

Studies show that there appears to be a temporary time of adaptation after the stroke in which sex life is halted. For instance, one study found that 80% of men who report erectile dysfunction after stroke regained function 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.

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 a disability.

Alternatively, decreased libido can be caused by some medications including antidepressants, and high blood pressure medicines (e.g., beta blockers.).

Immobility

Strokes 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 than others by this, depending on the extent of damage to the brain caused 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 the treatment of depression, 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 .

A Word From Verywell

Sex therapy can be one of the most effective ways to improve sexual issues after stroke. Other approaches and strategies include:

  • Open communication between partners
  • Tell you doctor and/or pharmacist so that they can decide whether it is possible to change medications in your regimen, which could be affecting your sexual drive.
  • Address your own anxiety and understand that it is unusual for sex to cause a stroke. This can be reassuring for you and your partner.
  • 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.

Sources:
Poststroke depression: risk factors and potential effects on functional recovery, Karaahmet OZ, Gurcay E, Avluk OC, Umay EK, Gundogdu I, Ecerkale O, Cakci A, Int J Rehabil Res. 2017 Mar;40(1):71-75

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