Intimacy After Stroke

Stroke can cause big changes in the lives of couples who are sexually active — in body and in mind.

Insecurities, doubts and fears can throw even the most open and loving couples into a tangled web of emotions: Is sex safe? Am I still attractive? Can I be both caregiver and lover?

Here are some common issues and tips on overcoming them:

I’m worried that having sex will cause another stroke.

Having sex doesn’t put most survivors at risk of having another stroke. Making love takes about as much energy as walking up one or two flights of stairs. The heartbeat accelerates and breathing becomes heavier, but that’s normal. Talk to your doctor about any concerns.

I don’t have the desire or energy for sex.

Many survivors find that they’re not very interested in intercourse. There may be body image concerns because of hemiplegia (paralysis on one side of the body), drooling, facial droop or the inability to speak clearly.

Fatigue is another common problem, because survivors and caregivers may require more rest time throughout the day. The best time for sex may be after resting or in the morning.

My medications are getting in the way.

For some men, medication can prevent an erection. Some antidepressants and blood pressure medicines reduce libido (sexual desire) and performance. If you take medication for high blood pressure, plan sexual activity just before taking the pills. This may help you avoid impotence caused by medication. Don’t ever stop taking your medication without consulting your physician.

Your doctor may prescribe medication to treat impotence. Men should avoid erectile dysfunction drugs if they are taking medications for angina.

Depression and communication issues are taking a toll.

It’s understandable if you’re feeling depressed. Depression — and the drugs to treat it — may also reduce libido. There may also be cognitive changes, like a reduced ability to pay attention or short-term memory loss that can have an adverse effect on many focused activities, including lovemaking.

Those problems can be frustrating and may alter your sexual relationship more than paralysis. If you have problems with memory, depression or focus, ask your doctor to recommend someone who can help in behavior management and rebuilding your relationship.

Communication is a key ingredient in a satisfying sex life, and survivors with aphasia — or the loss of ability to understand or express speech — can still enjoy sex. Learn other ways to communicate your sexual needs. For instance, the use of touching and caressing needs no explanation.

Location matters.

Your behavior might be affected by where the stroke happened in the brain. If a stroke occurs in the frontal lobe, the survivor may be less aware of socially appropriate behavior and feel less inhibited. If it occurs in the temporal lobe, the survivor may have decreased sexual arousal. If the stroke occurs in the left brain, the survivor may be more depressed, which can also affect desire.

It’s possible (but rare) that a stroke can increase sex drive and even cause the survivor to become hypersexual and have an inappropriate approach to sex. In that case, it’s important to set boundaries.

Everything feels different.

Some couples must relearn which positions are the most comfortable. Pillows or props can protect the weaker side of the body, and the more mobile person should assume the top position.

Ask your therapist to recommend different positions. If you’re worried about urinary continence, it’s a good idea for the survivor to void prior to having sex.

Of course, the timing of when to resume sexual activity after a stroke is personal and will vary in each situation. Factors include medical stability, partner’s availability and privacy (if there are additional caregivers at home).

Don’t try to force the issue. Returning to sexual activity requires patience and the loving support of your mate. You’ll know when you’re ready. Here are some practical considerations before you get started:

Start slowly.

Perhaps just by being close and cuddling. Explore what feels good to you now that sensation on one side of your body may be different. Tell your mate what pleases you (he or she can’t read your mind.) Relax and focus on the intimacy that you’re building together and add intercourse only when you both feel ready.

Don’t forget about birth control.

If you’re a woman of childbearing age, talk to your healthcare provider about family planning. Generally, birth control pills are not recommended for stroke survivors because they increase the possibility of blood clots. However, other forms of contraception may be appropriate.

If a stroke survivor does get pregnant, it will most likely be considered a high-risk pregnancy.

Take a break and have fun.

It’s not easy to be a caregiver one minute and a lover the next. If you can, hiring someone else to help with day-to-day physical care can help. It’s important for the caregiver spouse to have breaks without feeling guilty. Both partners need time to themselves — and time to enjoy other activities. Playfulness can go a long way in maintaining an adult-to-adult relationship.