Intimacy and Sexuality After a Stroke
- More than half (57%) of stroke survivors surveyed by the Stroke Association say their sex life has changed since their stroke.
- Stroke is almost never the cause of sexual dysfunction. Research has shown that stroke can impact many aspects of sexual function.
Changes in Sexual Function:
Where the stroke occurs in your brain may determine how you are affected:
- Frontal lobe: less inhibited
- Temporal lobe: low arousal and libido
- Left side of brain can affect speech and language, memory, vision, right sided paralysis
- Right side of brain can affect attention and memory, vision/perception, left sided paralysis
Changes in Sexual Function and What You Can Do:
- High blood pressure medications, antidepressants, spasticity medications can lower your libido.
- Isolation from others can impact your ability to express yourself sexually.
What you can do:
- Having an active, healthy lifestyle, including eating a healthy diet and doing regular gentle exercise can improve libido.
- Connect with other stroke survivors in a support group and share your feelings.
- Relationship counseling can give you a safe space to find a way through the difficulties you're facing.
Fear/anxiety of recurrent stroke:
- A recent study evaluated 290 patients who were diagnosed with stroke and reported that only 5 of the patients specified sexual activity as a triggering event. If you ever experience a severe headache during sexual activity, you need to call your doctor, who will perform a thorough medical evaluation. Some people who experience a severe headache during sex do not go on to suffer from a stroke, but about 30-50%5 are at risk of having a stroke. Sexual activity is a risk factor for those who are diagnosed with a brain aneurysm.
Erectile and orgasm problems:
- Sensory loss due to the stroke can lead to numbness around genitals
What you can do: Explore alternative areas of body to produce desired outcome (breasts, neck). Lubrication, alternative devices (vibrator, oral/digital sex) prescription medication (Viagra, Levitra, Cialis), vacuum pump, Alprostadil (artificial hormone).
- Sex can introduce bacteria into the urethra which may lead to urinary tract infections.
What you can do: Empty your bladder before sex, if you have a catheter, your doctor or nurse can show you how to remove and replace it. Wash your genitals prior to and after sex.
- Women who have had an ischemic stroke or transient ischemic attack (TIA) probably won't be able to use the combined oral contraceptive pill (combi pill). The combi pill contains estrogen which raises the risk of blood clots.
What you can do: Speak with your doctor about alternative means of birth control.
- Weakness on one side of the body can prevent one from transitioning into some sexual positions.
What you can do: Explore alternative positions (eg. pillows for positioning, seated positions). Explore intimacy when you have the most energy.
- Pain can reduce one's libido and spasticity can prevent one from transitioning into some sexual positions.
What you can do: Let go of the expectation of spontaneity. Allow enough time and patience. Plan to be sexual when medications for symptoms that interfere with sexual activity (pain, spasticity) are most effective.
American Stroke Association: https://www.stroke.org
UK Stroke Association: https://www.stroke.org.uk
Stroke support group finder: https://www.stroke.org/en/stroke-support-group-finder
American Association of Sexuality Counselors. https://www.aasect.org/
Hall, J. (2013). Sexuality and stroke: The effects and holistic management. British Journal of Nursing, 22(10), 556-559. doi:10.12968/bjon.2013.22.10.556
McHugh-Pendleton, H. & Schultz-Krohn, W. (2006). Pedretti's Occupational Therapy Practice Skills for Physical Dysfunction. Sixth ed. Mosby Elsevier. St. Louis, Missouri.
Naphtall, K., MacHattie, E., Krassioukov, A., & Elliot, S. (2009). PleasureAble: Sexual device manual for persons with disabilities. Disabilities Health Research Network. https://sci-bc.ca/resource/pleasureable-sexual-device-manual-for-pwd/
Stroke Association (2018). Sex after stroke. https://www.stroke.org.uk/resources/sex-after-stroke