There can be life... and sex after stroke

STROKES are a leading cause of disability in older adults and, increasingly, younger adults. As Malaysians become more affluent, incidences of diet and lifestyle-associated diseases like diabetes, high blood pressure, heart disease and strokes affect men and women in the prime of their lives.

Stroke patients in their 30s and 40s have to bear the burden of living with strokes for many decades. One concern that many have is sex after stroke. Many patients fear that stroke means the end of their sexuality.

Initially, after a stroke occurs, sex is furthest from the mind of the patient. However, as recovery progresses, the patient often begins to have sexual feelings again and may want to resume sexual activity. This is very normal and should be encouraged.

Sex is generally not detrimental to the health of the stroke patient and it can have positive effects on the patient's well-being. It improves self-esteem and is an important source of pleasure, relaxation and intimacy for the patient and his or her partner.

One question that many patients have is how having a stroke affects them sexually. Many physicians are not very comfortable addressing these concerns and patients may feel too shy to bring up the subject with their doctors.

Concerns and limitations

Concerns and limitations

First of all, it is unrealistic to assume that sexual ability will remain unchanged by the stroke. Often, couples affected by stroke will experience frustration when trying to resume sexual activity. When a patient understands the way stroke affect the human brain and body, he or she will be able to adapt to new ways to attain a satisfying sexual relationship with his or her healthy partner.

Stroke affects a person's ability to have sex in a number of ways. Psychologically, the patient may fear getting another stroke during sex. This is usually unfounded as sexual excitement does increase blood pressure but not sufficiently to cause a stroke in most cases.

Strokes can lead to depression and loss of interest in the pleasures of life, including desire for sex. Changes in physical appearance often affect the patient's view of his or her own sexual attractiveness and result in loss of self confidence. The patient may shy away from sexual intimacy because of these emotional changes.

With physical disability of one partner, the relationship between spouses changes from one of interdependence to one of dependence between care recipient and caregiver. It may be hard (but not impossible) to view one's partner in a sexual way after one had just feed one's drooling spouse or clean up his or her soiled clothing.

Stresses on the relationship are especially overwhelming if there is poverty and poor social support for the patient.

The stroke itself may cause cognitive problems that interfere with normal sexual activity. Strokes affecting the right half of the brain, for example, can cause short attention span, poor judgment and difficulty with planning.

On the other hand, strokes affecting the dominant half of the brain may cause the patient to lose the ability to speak or understand others and he or she may have very much difficulty communicating sexual needs to his or her partner.

Physical weakness and fatigue in stroke patient can impede his or her ability to perform the sexual act. The patient will not have the physical endurance that he or she had prior to the stroke.

In severe cases, fixed deformities in the limbs called contractures may prevent a couple from getting physically close. This may be extremely frustrating, especially for the non-disabled partner.


Counselling will help both patients and partners

Counselling for both patients and their partners is very helpful as sexual satisfaction in a relationship depends on both parties having their sexual needs met.

Negative feelings need to be shared openly and dealt with. Relationships that are based on mutual respect and understanding tend to do better in dealing with these issues.

It is vital to remember that the pattern of sexual activity prior to the stroke is an important factor to consider. If sex before the stroke was terrible because of relationship issues, it is unlikely to get better after the stroke.

Psychiatrist can help patients suffering from depression and loss of self-confidence by using antidepressant medications and counselling sessions.

For patients with language problems, a speech therapist can help couples to learn new and sometimes, non-verbal ways to communicate sexual needs.

Physicians need to reassure patients that it is generally safe to resume sex after a stroke if they have well-controlled blood pressure.

In patients with bleeding strokes, it may be prudent to avoid sex from the first few weeks as elevation in the blood pressure may be dangerous.

The practicalities

The practical matters

Difficulties experienced by physically disabled patients can be overcome by experimenting with different positions. Some couples find that having sex lying on their sides (facing each other) with the weaker side supported by pillows helps. Patients having bladder catheters can still have sex by taping these tubes to the penis and the thigh.

Stroke patients with difficulty getting an erection can consider using medications such as Viagra or Cialis but only six months after the stroke.

For women of child-bearing age who have had strokes, it is important to avoid contraceptives with estrogen as they have a slightly higher risk of causing strokes. Progesterone-only contraceptive medication or other methods such as intrauterine devices or (male) condoms may be better choices.

Female patients can expect normal pregnancies in most cases. However, in subarachnoid haemorrhage, a kind of bleeding stroke which occurs when an aneurysm (a dilated, thinned walled blood vessel with weakened walls) ruptures in the brain, it is important to have the aneurysm repaired before pregnancy occurs.

Finally, the conventional idea that men need to take the active roles during sex or that sexual intercourse is the only way to experience sexual fulfillment need to be reevaluated.

It is important to remember that sex is really about conveying feelings of love and tenderness and promoting intimacy between two people.

Some amount of frustration is expected but with patience, good humour and love, patients and their partners can resume sexual activity and have a satisfying sex life.

Dr Lim is a consultant neurologist with UPM. This article was first published in New Straits Times in November 2007.