It is normal to have questions around your sex life after a stroke, our expert helpline nurse Bernadette Bergin, addresses this by openly discussing sex and sexuality post stroke

A recent article in the Journal of Clinical Rehabilitation, concluded, “Stroke has a profound impact on how sexuality is experienced by both stroke survivors and partners of stroke survivors.” However, the article found that despite this, “post-stroke sexuality is rarely discussed openly.”

The study by researchers from the University of Sydney in Australia, also found that stroke survivors and their partners were not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke.

Irish Heart Foundation Helpline nurse, Bernadette Bergin said sex can be a sensitive subject for many people, and for some it can be difficult to discuss.

“While some people experience sexual difficulties after a stroke, the good news is that the physical function required to have sex is rarely damaged by a stroke, and there’s little evidence to indicate that having sex will cause another stroke.

“Getting back to a fulfilling sexual relationship may take time and may involve some changes; which may be determined by how severe your stroke was. If you have any medical concerns, discuss them with your doctor before resuming your sexual relationship,” she advised.

According to Bernadette, some of the reasons you may experience sexual difficulties post stroke can be physical, emotional or related to the medicines you need to take.

As Bernadette explained, “Problems with your circulation can reduce the amount of blood flow to your sex organs. Some men may develop erectile difficulties and some women can find the reduced blood flow has affected vaginal arousal and lubrication. Some medicines you’re taking can also cause a similar effect. Talk to your doctor about this and discuss what options are available for you.”

“You may worry for example, that your partner may not feel the same about you sexually because your appearance may have changed since your stroke, or you can no longer communicate verbally in the way you used to. Your partner may also be anxious about causing you pain and may even be overprotective. Try to talk about how you’re both feeling. Evidence would suggest that couples who discuss their concerns seem to cope better,” Bernadette added.

She also said that fatigue can be a problem for stroke survivors and their partners and you may both find that you need to rest more during the day.

“Having a rest together with your partner if possible, is also a good time to build a more intimate relationship. Some people find having sex after a rest is more comfortable,” Bernadette suggested.

Bernadette also pointed out that depression was quite common after a stroke and this may affect how you feel about being intimate with your partner. She suggested seeing your doctor as early as possible about this.

“Depression is not something to be embarrassed about. You’ve had a lot going on in your life since you had the stroke. It takes time to adjust to your new life,” Bernadette said.

From a physical point of view Bernadette explained that some stroke survivors may find sex challenging when their limbs are affected and may need to work with their partner to find new, safe and comfortable positions.

“Finding new positions can be a positive experience. It may be challenging, but it could be fun. You may find using pillows to support affected limbs helps. For some couples, oral or manual mutual stimulation can be a great alternative to intercourse,” Bernadette suggested.

Some stroke survivors may have a urinary catheter in place. Speak to your doctor about this in relation to sexual intimacy. Bernadette said that in some cases the catheter can be removed for the duration of sexual intercourse; then reinserted.

“If the urinary catheter cannot be removed, then men can fold the catheter back over the erect penis and apply a condom. If you use this method, use a lubricated condom to decrease any irritation. Women can tape the urinary catheter to the tummy or thigh, so it will not be accidentally moved, or be in the way.”

According to Bernadette, some people find that they are less interested in sex since their stroke and she advised trying not to put any pressure on yourself to perform.

“Try just laying close together. You may find that cuddling, kissing and caressing is a more comfortable way to start. The cuddling, kissing and caressing is also an excellent non-verbal form of intimate communication.

“On the other side of the coin, you may find you have developed a high sex drive and may feel unable to control your sexual urges. You may even find you’re talking or acting inappropriately, like saying sexually explicit things, or touching sexually, either yourself or others, at inappropriate times. These changes may be related to the area of your brain damaged in your stroke. You should seek advice from your doctor, who may suggest counselling to help you manage this issue,” Bernadette advised.

Finally, Bernadette said it was important not to put any pressure on yourself and to talk with your partner and your doctor if you have any concerns.

If you have any further questions you can contact the free Irish Heart Foundation’s National Heart and Stroke Nurse helpline for more information.

Sexuality and relationships after stroke are one of the many topics discussed on the Irish Heart Foundation’s A Life After Stroke; online forum on Facebook which connects working age stroke survivors. This forum aims to create an engaging private online network to enable working age survivors and their close family members to talk to others affected by stroke, share experiences and find information in confidence.