Post-stroke management in sexual intimacy

It is very common to feel that your relationship has changed after a stroke. For example, you may feel low confidence of going out to meet friends and forming significant relationship. It is important to recognise that sexuality does not only refer to the act of sexual intercourse. It is about emotional engagement with your partner – the feeling of closeness and love. Good communication is the key to enhance this emotional intimacy. 

How stroke can affect intimacy?

There are several reasons why you may have difficulties with sexual intimacy after a stroke.

The changes that have happened to you after stroke will affect your sexual function to a certain degree.  You may feel anxious or having low mood and this may result in you losing interest in intimacy and/or sexual activities. Some may find it difficult to inhibit their sexual desire and hence feeling frustrated or angry at themselves. 

Stroke is likely to be a life-changing event for you and your partner. After a stroke, you may experience changes in your role, and this may put your relationship under a lot of strain. For example, if your spouse has taken on the role as a caregiver, this changes the dynamics and the equilibrium of the relationship.

Stroke may affect your self-confidence and self-esteem.  You may find it difficult to talk to your partner about “how you feel” as you don’t want to create unnecessary worry/concern for your partner. 

Muscle weakness or muscle stiffness may restrict how you move and how you can position yourself during sex. This could affect your enjoyment of sexual activities.

Changes in sensation, such as numbness or pin and needles, can cause you to be less sensitive to touch.

Tiredness and fatigue are common after stroke, and it will be harder for you to preform many activities that you used to enjoy. 

Continence problem may be a source of fear and embarrassment which may lead you to avoiding sexual activities.

Fear about resuming sex: You and your partner may have unspoken fear about resuming sex after stroke, and this could result in avoiding sexual encounters and delaying intimacy. It is highly unlikely that you will have another stroke during sexual intercourse. It is normal for you to have higher heart rate and to breathe faster during sexual intercourse.

Fear about partner rejection: you may think that your partner is turned off by your current appearance and you partner may also be afraid that sexual intercourse will cause pain to you. 

Just as how stroke may cause weakness in the arm and leg, it may also cause sexual dysfunction in the same way. Erectile dysfunction and low sexual desire/ arousal after stroke may be due to hormonal imbalance from dysregulated pituitary glands. This may lead to decreased sex drive and lower the person’s self-esteem. Some of the medications may cause decrease in sex drive.

What can help?

How you feel about sex can impact how you feel in general about yourself. It may not be easy to talk about the struggles you are facing. Taking the first step in voicing out is the key to solution. Here are some strategies that may help.

Acknowledge and address any emotional changes

• If depression or anxiety is affecting how you view sex, talk to your partner and seek help from your doctor. Your doctor may recommend a specialist or psychologist to help you.
• Doing things together such as having mutual hobbies or watching movies together can help strengthen the bond with your partner.
• Give yourself time to get into the mood before sex. Choose a time when
  you and your partner are both relaxed and will not be interrupted.
• You could start knowing your partner and yourself again physically, without attempting to reach orgasm. Foreplay activities such as cuddling, kissing and seductively touching each other can help with increasing physical attraction, and in turn, explore new ways of how both your bodies respond to sexual intimacy.

Discuss with your partner about relationship changes

• To improve sexual life post stroke, open communication is the key
  element.
• Being able to share/discuss your feelings openly and listening to each other are essential for the couple to build a sustaining and positive relationship.
• Talk to your partner and work out things that are comfortable for both of you

Learn to adapt physical changes

• If you have problem with muscle stiffness/weakness, and/or spasm finding the right position to have sex may be a case of trial and error. Talk to your rehabilitation therapist and seek their advice.
• If you often feel tired, try to have sex in the morning when you have more energy.
• If you have problem getting or maintaining an erection, talk to your doctor for prescription of medication or procedure to help you.
• If you have continence problems, empty your bladder and bowel just before sex and avoid drinking too much beforehand.

Where can I find out more?

Sexual Counselling after Disability

Hotline: +65 6256 6011
Email: rehab_enquiry@ttsh.com.sg
Address: Department of Rehabilitation Therapy Services
Tan Tock Seng Rehabilitation Centre, 1 Tan Tock Seng Link Singapore 307382

Article available in Chinese, Malay and Tamil. 

For more information on how to better manage your stroke recovery journey, visit Stroke E-Resources.