Fear, frustration, the need to adjust to a self-image which has been shattered, adapting to a new, often very different "self", disappointment in terms of performance in many life areas, and doubts about one's capability of dealing with these changes-all these are part of recovery from a stroke. Hemiplegia, personality change, communication impairments, and a lessened ability to learn new things are additional factors that often have to be dealt with.
In the initial stages of recovery from a stroke, sex is less important than issues of mobility or speech. However, as recovery progresses, and survivors and their spouses begin again to have sexual feelings, an informed and positive approach to the effects of stroke on sexuality can enhance recovery and strengthen self-esteem. A stroke does not have to mean the end of one's sex life, which can often continue to be an important source of pleasure, relaxation, and intimacy.
What is the reality of sexuality after a stroke? There is rarely any medical reason why stroke survivors should not become sexually active again, should they wish to do so, and their doctor agrees. Sex is usually good for the physical and mental well-being of stroke survivors and their partners, improving their quality of life, and strengthening bonds of closeness.
However, though stroke survivors often continue to have sexual feelings and desires, these are often experienced through the filter of their disability. One study of 79 men and women who had had their strokes from three months to three years earlier found that only one couple in six had maintained their sexual relationship.
Sexual Consequences of Stroke
The possible and normal sexual consequences of a stroke include:
- a diminished self-image and self-esteem,
- fear of being rejected or no longer being loved,
- emotional and relationship changes that may alter interest in sex,
- fear of and anxiety about sexual failure,
- social change (the way that the disabled are viewed by others-this particularly applies to single, widowed, divorced or separated stroke survivors).
All these areas may be affected in the weeks or months following a stroke, resulting in less sexual activity, or a change in how sexual feelings are expressed. Sexual feelings may diminish or become less enjoyable, and often, sex ceases altogether.
Sexual activity may be reduced for any of the following reasons
- Fear of another stroke makes sex unattractive. (Your doctor can ease your mind about the safety of sex, or may suggest alternatives.)
- Depression in either partner dulls his or her sex drive.
- After the initial disruption of a stroke, couples may lose the habit of making love.
- The side effects of medications, particularly those for high blood pressure, may affect sex drive and performance. (Take all drugs as directed.)
- Right brain damage may alter attention span, judgment and planning, making previous patterns of sexual activity difficult or impossible.
- The non-disabled partner may lose sexual interest because of the spouse's altered appearance and manner.
- It may be hard for the caregiver to shift from giving physical care to being a lover.
Attitudes towards sexuality play an important part in an individual's and couple's adjustment to stroke. Most of us have learned to keep the details of our sexuality to ourselves, a tradition of privacy that often makes it difficult for survivors and their spouses to openly discuss the effects of stroke on their sexual relationships. Without frank, open communication, however, sexual readjustment following a stroke can't begin. Consider this-a brief period of discomfort could be the first step back to sexual fulfillment. Doctors or counsellors can help break the ice when partners are uncomfortable talking about sexual feelings.
Traditional sex roles can also work to the disadvantage of individuals and couples adjusting to a stroke. There are those, men in particular, who feel that without intercourse, their sexual lives are over. Reducing the emphasis on sexual intercourse as the only way to enjoy sex would make other types of sexual expression, such as tenderness, touching, self-pleasuring, and other types of sex more acceptable, and allow stroke survivors a more positive outcome when contemplating sex after a stroke.
Adjusting to Physical Changes in Sexual Functioning
- Adjusting for loss of sensation may require experimenting with new ways of touching.
- Different degrees of hemiplegia (one-sided weakness) may require adjustments in seeking a comfortable position for sex.
- This may be further complicated by muscle spasms or stiffness, bowel or bladder incontinence, fatigue, vision problems, and lack of balance.
- Your doctor can help by providing information, clearly discussing sexual function, arranging for sex counselling if necessary, or by prescribing an antidepressant if depression is a factor.
Planning for Success
- Sexual expression is a way to convey feelings of love and tenderness, reduce stress, and promote closeness.
- As much as possible, talk candidly about your desires and realistically discuss how you can achieve them.
- Make your sexual activity easy and comfortable.
- Look after your personal hygiene and appearance.
- It takes time to rediscover what works best for you as a couple. Expect a certain amount of frustration, and as much as possible, maintain good humour and don't take setbacks too seriously.
- Keep an open mind. There are many ways to enjoy sex.
In situations where sex is not possible, there are still options which will allow the expression of your closeness as a couple. The tenderness and warmth conveyed in cuddling and fondling can be a continuing source of physical satisfaction and fulfillment.