Sex life after a stroke. Sex and Intimacy after Stroke.



Sex life after a stroke

Sex life after a stroke

Changes in sexual function after the stroke were not related to the gender and marital status of the patients, etiology of stroke, or location of the lesion. We also analyzed the agreement between the answers of the stroke patients and their spouses, considering the couple as a unit of analysis. Discussion The results of the present study, aimed at assessing the effects of stroke on sexual functioning, reveal a significant decline in libido, coital frequency, sexual arousal, and satisfaction with sexual life in both stroke patients and their spouses.

Moreover, sexual dysfunction was related to the presence and degree of depression, diabetes mellitus, and cardiovascular medication. The etiology or location of the stroke and the gender or marital status of the patients were not associated with changes in poststroke sexuality in patients in the present study.

A few previous studies 3 4 5 6 7 8 suggest that cerebrovascular diseases may commonly result in sexual dysfunction, leading to a marked decrease in sexual activity. They also reported that sexual activity, measured as frequency of intercourse, had decreased markedly as a consequence of stroke. Significantly decreased poststroke libido, 5 8 coital frequency, 3 7 8 and erectile and orgastic ability 4 5 have also been reported by other authors.

The different findings of these studies are likely to be related to discrepancy in the basic characteristics of the patients, ie, age, previous diseases, and prestroke sexual habits, but they may also reflect different attitudes toward sexuality in different cultures and societies.

Sexual dysfunction in stroke patients is known to be complex and multifactorial. Monga and Ostermann 2 suggested in their review that sexual problems in these patients are never a consequence of stroke alone; rather, they may be due to a variety of associated medical conditions and psychosocial factors. Although other authors 5 6 7 11 have also suggested that psychological and social factors may significantly affect poststroke sexual functioning, none of these factors has been systematically investigated, and some suggested factors would seem to conflict with each other.

In the present study, we have for the first time demonstrated that psychosocial factors play a crucial role in determining sexual drive, activity, and satisfaction after stroke, and their influence is even stronger than that of medical factors.

On the other hand, recruiting patients from adjustment courses may overemphasize the role of sexual dysfunction, because stroke patients willing to participate in the courses may have more psychosocial adjustment problems than stroke patients in general.

It is also possible that in some patients psychosocial disorders are a cause of poststroke sexual dysfunction instead of being a consequence of sexual problems. In patients in the present study, poststroke sexual dysfunction was also closely related to the degree of depression measured by the Geriatric Depression Scale, which is also a novel finding. Antidepressant medication, which may sometimes cause sexual disorders, did not explain this finding, because sexual functions were similar in the patients with and without antidepressant medication.

Actually, only 7 of our patients used tricyclic antidepressants, which are known to frequently cause sexual disorders, while 43 patients used serotonin reuptake inhibitors and 1 patient used moclobemide, which seldom cause decline in sexual activities. Our results agree with the previous suggestions that other diseases and medication, such as antihypertensives and antidepressants, may modify the effects of stroke on the sexual behavior of patients and their spouses.

We found a similar association between disorders of erection and the presence of diabetes mellitus in the male patients and between disorders of sexual arousal and previous cardiovascular medication in both genders. Another interesting finding in the present study was that 19 of our patients, but none of the spouses, reported increased libido after the stroke in comparison with the prestroke libido. These patients were younger mean age, There is also a previous description 19 of 3 stroke patients who demonstrated hypersexuality and deviant sexual behavior appearing 3 months after the stroke and remaining stable for years.

All 3 patients had temporal lobe lesions and had a history of poststroke seizure activity. Recently, hypersexuality has also been described as a reversible side effect of antidepressant treatment moclobemide in 2 patients with ischemic stroke.

Because different stroke and disability scales are used in various Finnish hospitals and rehabilitation centers, we were not able to compare the severity of stroke using these scales. Although these high figures may partly be related to the retrospective behavior of the present study, the decline of satisfaction, particularly among the spouses, is remarkable and is likely caused by the stroke itself. Approximately half of the stroke patients and spouses in the present study reported an interest in sexual counseling and regarded it as an essential part of stroke rehabilitation, but only a few of them had received it.

Although there may be a lack of highly trained sexual counselors, the attitudes toward intimate sexual questions among rehabilitation professionals may also reduce discussion of this topic. The present results, however, suggest that a need clearly exists for sexual counseling after stroke, and we recommend that such counseling be included in the basic information given to stroke patients and their spouses.

We thank the field workers of the Stroke and Aphasia Federation for assisting in the data collection. Received November 20, Revision received January 15, Accepted January 15,

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Sex life after a stroke

Changes in sexual function after the stroke were not related to the gender and marital status of the patients, etiology of stroke, or location of the lesion. We also analyzed the agreement between the answers of the stroke patients and their spouses, considering the couple as a unit of analysis. Discussion The results of the present study, aimed at assessing the effects of stroke on sexual functioning, reveal a significant decline in libido, coital frequency, sexual arousal, and satisfaction with sexual life in both stroke patients and their spouses.

Moreover, sexual dysfunction was related to the presence and degree of depression, diabetes mellitus, and cardiovascular medication. The etiology or location of the stroke and the gender or marital status of the patients were not associated with changes in poststroke sexuality in patients in the present study. A few previous studies 3 4 5 6 7 8 suggest that cerebrovascular diseases may commonly result in sexual dysfunction, leading to a marked decrease in sexual activity.

They also reported that sexual activity, measured as frequency of intercourse, had decreased markedly as a consequence of stroke. Significantly decreased poststroke libido, 5 8 coital frequency, 3 7 8 and erectile and orgastic ability 4 5 have also been reported by other authors. The different findings of these studies are likely to be related to discrepancy in the basic characteristics of the patients, ie, age, previous diseases, and prestroke sexual habits, but they may also reflect different attitudes toward sexuality in different cultures and societies.

Sexual dysfunction in stroke patients is known to be complex and multifactorial. Monga and Ostermann 2 suggested in their review that sexual problems in these patients are never a consequence of stroke alone; rather, they may be due to a variety of associated medical conditions and psychosocial factors.

Although other authors 5 6 7 11 have also suggested that psychological and social factors may significantly affect poststroke sexual functioning, none of these factors has been systematically investigated, and some suggested factors would seem to conflict with each other. In the present study, we have for the first time demonstrated that psychosocial factors play a crucial role in determining sexual drive, activity, and satisfaction after stroke, and their influence is even stronger than that of medical factors.

On the other hand, recruiting patients from adjustment courses may overemphasize the role of sexual dysfunction, because stroke patients willing to participate in the courses may have more psychosocial adjustment problems than stroke patients in general. It is also possible that in some patients psychosocial disorders are a cause of poststroke sexual dysfunction instead of being a consequence of sexual problems.

In patients in the present study, poststroke sexual dysfunction was also closely related to the degree of depression measured by the Geriatric Depression Scale, which is also a novel finding. Antidepressant medication, which may sometimes cause sexual disorders, did not explain this finding, because sexual functions were similar in the patients with and without antidepressant medication. Actually, only 7 of our patients used tricyclic antidepressants, which are known to frequently cause sexual disorders, while 43 patients used serotonin reuptake inhibitors and 1 patient used moclobemide, which seldom cause decline in sexual activities.

Our results agree with the previous suggestions that other diseases and medication, such as antihypertensives and antidepressants, may modify the effects of stroke on the sexual behavior of patients and their spouses.

We found a similar association between disorders of erection and the presence of diabetes mellitus in the male patients and between disorders of sexual arousal and previous cardiovascular medication in both genders. Another interesting finding in the present study was that 19 of our patients, but none of the spouses, reported increased libido after the stroke in comparison with the prestroke libido. These patients were younger mean age, There is also a previous description 19 of 3 stroke patients who demonstrated hypersexuality and deviant sexual behavior appearing 3 months after the stroke and remaining stable for years.

All 3 patients had temporal lobe lesions and had a history of poststroke seizure activity. Recently, hypersexuality has also been described as a reversible side effect of antidepressant treatment moclobemide in 2 patients with ischemic stroke. Because different stroke and disability scales are used in various Finnish hospitals and rehabilitation centers, we were not able to compare the severity of stroke using these scales.

Although these high figures may partly be related to the retrospective behavior of the present study, the decline of satisfaction, particularly among the spouses, is remarkable and is likely caused by the stroke itself. Approximately half of the stroke patients and spouses in the present study reported an interest in sexual counseling and regarded it as an essential part of stroke rehabilitation, but only a few of them had received it.

Although there may be a lack of highly trained sexual counselors, the attitudes toward intimate sexual questions among rehabilitation professionals may also reduce discussion of this topic. The present results, however, suggest that a need clearly exists for sexual counseling after stroke, and we recommend that such counseling be included in the basic information given to stroke patients and their spouses.

We thank the field workers of the Stroke and Aphasia Federation for assisting in the data collection. Received November 20, Revision received January 15, Accepted January 15,

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  1. Discussion The results of the present study, aimed at assessing the effects of stroke on sexual functioning, reveal a significant decline in libido, coital frequency, sexual arousal, and satisfaction with sexual life in both stroke patients and their spouses.

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