Sex after stroke

STROKE HELPLINE 0303 3033 100 FACTSHEET 31

Sexual difficulties after stroke can be the result of many factors, including
psychological changes (such as low mood) and physical problems (such as
weakness or paralysis). Often a little information and reassurance can help
overcome these issues, but specialist help is also available. This factsheet looks
at what can lead to sexual problems after stroke and what help is available.

Making love is an important part of many Psychological and emotional changes

relationships, whatever your age. It can be
an important way of expressing love for
each other, strengthening your relationship
and is also a good way of getting exercise.
However, sex can be a difficult or
embarrassing subject to talk about, and
problems may be overlooked by doctors.
All health professionals who work with
stroke should understand these issues and
discuss sex and relationships with you, if you
want to. You might also find it helps to talk to
someone who specialises in sexual and
emotional difficulties. Some GP surgeries
have their own counsellor or can refer you to
an expert in sexual issues. Some charities
offer sex therapy or advice on sexual issues
(see ‘Useful organisations’ on page 5).
What causes sexual
difficulties after stroke?
A number of reasons may lead to you having
dificulties with sex after a stroke, including
psychological and emotional changes,
relationship difficulties, and physical
problems. Often sexual problems are caused
by a combination of several factors.
Emotional and sexual difficulties are
closely interwoven. It’s not unusual to feel
low or depressed after a stroke and this
is often accompanied by a loss of interest
in sex. Strokes can change your life in
many ways, perhaps bringing a loss of
independence or changed relationships
with family and friends, and coping with
these changes can lead to depression.
In addition, the stroke may have damaged
centres in the brain which control how
you feel, leading to depression. For more
information about depression see our
factsheet F10 Psychological effects of stroke.
Anxiety is also common after stroke, and
a lack of information can add to your worries.
A common fear is that sex will raise blood
pressure and cause another stroke. While
it is true that blood pressure can rise at the
time of orgasm, you are no more likely to
have a stroke while making love than at
any other time. In fact, an active sex life can
help keep you healthy. One very rare
exception to this would be if you have had a
stroke due to bleeding from a weak point in an
artery (an ‘aneurysm’) and this had not been

The Stroke Association (June 2010) 1

FACTSHEET 31
repaired (‘clipped’). However, this will almost
always be operated on straight away. If you
are concerned, speak to your doctor. Almost
certainly they will be able to reassure you and
discuss your concerns.
In some rare cases, sexual desire can
increase after stroke and someone may
lose their inhibitions about inappropriate
sexual behaviour. This can be upsetting
and embarrassing for people around
them. This problem needs special medical
attention and partners should not try to
deal with it alone. Remember that the
person is not aware that there is anything
wrong with their behaviour and it is the
stroke that is causing them to act in this way.
Relationships
The effect of a stroke on you and your partner
can be life-changing, and this may put a
strain on your relationship. Not only do you
both have to adapt your lives to deal with any
disabilities, but if your partner is caring for
you physically, it may be more difficult for
either, or both of you to feel sexual. If you
need your partner’s help with personal care
and hygiene, you may see each other
differently, which can put you off physical
intimacy. Stroke can affect the way you see
yourself and it may take time before you can
view yourself as sexually attractive again.
Also, sexual problems can be a self-fulfilling
prophecy – if you expect them, they can
become more likely to happen.
Many people have difficulty controlling the
expression of emotion after stroke. You
may feel short-tempered or irritable and
this can be a strain on your relationship with
your partner which can affect your sex life.
2 The Stroke Association (June 2010)
Sex after stroke
Communication with your partner can
become difficult, leading to feelings of
frustration and anger, which can affect your
relationship and make you less interested in
making love. Tension and resentment can
build up between you, and get in the way
of your sexual feelings for each other.
It may be that one of you would like to
have sex but the other wouldn’t. This could
become a source of tension if not resolved.
If you are not in a relationship, you may
find it more difficult to deal with the issue
of sexual problems after stroke. Starting new
relationships is hard enough for anyone, but
especially so if a stroke has left you with
physical effects, such as mobility or
speech problems. Because a stroke
can affect your image of yourself, your
confidence and self-esteem, you may feel
unable to approach anyone. You may also
feel embarrassed about raising the issue
when you are first getting to know someone.
Physical problems
Physical difficulties caused by stroke such
as weakness or spasticity (muscle
stiffness), may restrict how you move and
how you can position yourself during sex.
You may be less sensitive if the stroke has
affected your sensation. You might also
experience pain after stroke and this can
make sex uncomfortable.
Feeling tired is a very common problem after
stroke. Although this initial tiredness will often
improve, physical limitations resulting from
your stroke can mean that simple daily
activities take much more out of you than
they used to. Consequently, you may feel too
FACTSHEET 31
tired for some of the activities you used
to enjoy – including sex.
Problems with continence may be a source
of fear or embarrassment after stroke and
may lead to avoiding sexual activity. Also,
if you need an indwelling catheter, this
may cause practical difficulties.
Sometimes, stroke can cause an imbalance
of hormones, leading to a wide range of
sexual difficulties including difficulty getting an
erection in men or low sexual desire in
women. This may happen when a stroke
affects parts of the brain which control your
hormones, called the pituitary gland and
hypothalamus.
Medications for high blood pressure,
depression and epilepsy are known to have
side effects that may affect your sex life,
including erectile dysfunction, decreased
desire and difficulty reaching orgasm.
Apart from the direct effect of stroke,
other underlying conditions that you
may have (such as diabetes, epilepsy
and cardiovascular disease) can also cause
problems such as decreased desire, difficulty
reaching orgasm, trouble getting an erection in
men, or reduced vaginal lubrication in women.
For more information about these issues, see
factsheets F33 Physical effects of stroke, F30
Pain after stroke, F18 Tiredness after stroke
and F12 Continence problems after stroke.
What help is available?
The first step in dealing with any sexual
problems is to talk about them. This isn’t
always easy and you may find it difficult or
embarrassing to talk about issues such as
lack of desire or arousal, or the inability to
The Stroke Association (June 2010)
Sex after stroke
reach orgasm or get an erection. However,
all these can affect anyone at any time –
not just people who have had a stroke.
Help with psychological
or emotional difficulties
If you are feeling low or depressed, talk to
your doctor. Depression can happen to
anyone and does not indicate that you are
weak or unable to deal with things. It may
help to speak to a professional such as a
counsellor. Alternatively, treatment with
antidepressant medication can be very
effective. However, some of the medications
themselves can cause problems with
sexual desire and performance. There
are many different drugs available so ask
your doctor to prescribe a different drug if
you experience this side effect.
Few people feel like sex when they are tense
and anxious, so it’s worth giving yourself
time to get in the mood beforehand. Choose
a time when you are both relaxed and can
be sure you won’t be interrupted Avoid large
meals or too much alcohol. This can affect a
man’s ability to get and maintain an erection
and can make you feel sleepy.
Above all, remember sex is not a
performance. You don’t have to ‘succeed’
or ‘fail’ – and it doesn’t always happen
perfectly every time. And remember there
are many ways to express your feelings
and be close to another person. You could
start by getting to know your partner
physically again without attempting to
reach orgasm. Penetration is not the only
way to have a satisfying sex life. All five
senses can be very sensual. Most people
get pleasure from touching, kissing,
cuddling and massage.
3
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Help with relationship problems
If sex is important in your relationship, try
sorting out with your partner where your
difficulties lie and what you might do to
begin to resolve them. It is important to talk
about any difficulties with your partner.
It takes time for both of you to recover
emotionally from the impact of a stroke.
Your stroke will have been a shock for you
both, and your partner may be frightened
that you’ll have another or be anxious
about what the consequences of your
stroke might mean in the future.
If you don’t feel comfortable going into
detail, you may still be able to talk in
more general terms about changes
in the way you feel about sex. It may
help to introduce talking about sex
gradually. Reading books about sex
together can be a good idea. Talking
about masturbation can help you be
more aware of yours and your partner’s
bodies and what you find pleasurable.
Tackling problems with emotional aspects
of your relationship is not always easy
and may require professional help. If
you find it difficult to talk about how you
both feel about sex – or find that it doesn’t
help – you might benefit from seeing a
counsellor or therapist. Relationship
therapists and counsellors work with
individuals – not just couples. They
can provide a supportive environment
to help you find a way through any
difficulties you may be facing. They may
suggest strategies that will help you
resolve issues affecting you, and help
you find ways of talking about any
difficulties with potential partners.
4 The Stroke Association (June 2010)
Sex after stroke
A speech and language therapist
should assess anyone experiencing
communication difficulties following their
stroke. The therapist will be able to help
you and your partner in finding suitable
ways that can help you communicate
your feelings and emotions for each other.
Many relationships flourish despite a lack
of sex. Companionship and emotional
intimacy may be more important to you
than physical lovemaking. You can find a list
of organisations that provide relationship and
sex counselling in the back of this factsheet.
Help with physical problems
Practical problems can almost certainly
be overcome. If you have weakness or
spasticity, finding sexual positions you
can use may be a case of trial and error.
Positions where you lie on your side can
be comfortable and don’t need much
physical exertion. If you have one weak
side, lying on this side will leave you active
arm free. Your physiotherapist or
occupational therapist should also be able
to give you practical advice.
Problems with sensation can improve
over time. Parts of your body may have
heightened sensation, which may even have
a positive effect sexually.
If you suffer from tiredness, try making love in
the morning when you may have more energy.
Talk to your doctor about any
medications you are taking or any
underlying medical conditions you have.
They may be able to change you to different
drugs which do not impair your sex life.
Never stop taking medication without
consulting your doctor.
FACTSHEET 31
If you are a man experiencing erectile
dysfunction, you may have questions about
sildenafil (Viagra). Although there is not
much evidence about whether it is safe
after stroke, the manufacturers do not
recommend its use in this situation. Talk to
your doctor about what it is appropriate for
you. Other methods could include an
injection into the penis which you can give
yourself before sex or aloprostadil which
contains a naturally-occurring substance
causing inflammation. This is inserted into the
urethra. If these methods are unsuccessful or
unsuitable it is possible to insert a device into
the penis which can be inflated. The first
step is to talk to your GP as there are many
different reasons someone may have difficulty
getting an erection.
Women who have had a stroke should
not use the combined oestrogen/
progesterone pill as this increases
your risk of stroke. Any other methods
of contraception can be used. Discuss with
your partner and GP what’s best for you.
If you have problems with continence
try emptying your bladder just before
you have sex and avoid drinking lots
beforehand. A plastic covering on the bed
may give you peace of mind. If you have a
catheter your continence advisor can tell
you how to remove and replace it. It may be
possible to tape your catheter to one side or
(for men) to the shaft of the penis. For men,
a condom can also help to keep the
catheter in place.
Pay attention to your lifestyle by eating a
healthy diet and taking some regular gentle
exercise, if possible. This can help improve
your overall health and your sexual well-being.
The Stroke Association (June 2010)
Sex after stroke
Useful organisations
All organisations listed are UK wide
unless otherwise stated
British Association for Sexual and
Relationship Therapy (BASRT)
BASRT PO Box 13686, London SW20 9ZH,
tel: 020 8543 2707, email: info@basrt.org.uk,
website: www.basrt.org.uk
Governing body for sexual and relationship
therapists. Provides a list of private therapists
and information about therapy and common
problems on their website.
Disability Now
www.disabilitynow.org.uk
Magazine and website for disabled people.
Includes a free personal ads section.
FPA (Family Planning Association)
Website: www.fpa.org.uk
Offers information, advice and support
on all aspects of sex and relationships.
England: 50 Featherstone Street, London
EC1Y 8QU, tel: 0845 122 8690
Northern Ireland: 3rd Floor, Ascot House,
24–31, Shaftesbury Square, Belfast
BT2 7DB, tel: 0845 122 8687
Scotland: Unit 10, Firhill Business Centre,
76 Firhill Road, Glasgow G20 7BA,
tel: 0845 122 8676
Wales: Suite D1 Canton House, 435–451,
Cowbridge Road East, Cardiff CF5 1JH,
tel: 029 20 644034
Outsiders
Dr. Tuppy Owens, BCM Box Lovely,
London WC1N 3XX, helpline: 0707 499
3527, email: sexdis@outsiders.org.uk,
website: www.outsiders.org.uk
Offers a sex and disability helpline plus
a network of meetings for people with
5
FACTSHEET 31 Sex after stroke

physical and social disabilities and a library
of videos and books including their own
book, Practical suggestions.
Relate
Premier House, Carolina Court, Lakeside,
Doncaster, DN4 5RA, tel: 0300 100 1234,
website: www.relate.org.uk
Offers sex and relationship counselling, in
centres, online and over the phone. Their
website has information and advice for
those with relationship difficulties.
Relate Northern Ireland
3rd & 4th Floors, 3 Glengall Street,
Belfast BT12 5AB, tel: 028 9032 3454,
website: www.relateni.org
Relationships Scotland
The Lesbian and Gay Foundation (LGF)
Princess House, 105–107 Princess Street,
Manchester, M1 6DD, tel: 0845 330 30 30,
email: info@lgf.org.uk, website:
www.lgf.org.uk Provides individual and
couples counselling and a helpline offering
information and support.
The Sexual Advice Association
Suite 301, Emblem House, London Bridge
Hospital, 27 Tooley Street, London, SE1
2PR, helpline: 020 7486 7262, email:
info@sexualadviceassociation.co.uk,
website: www.sda.uk.net
Produces information about sexual
problems and how to seek help for them.

F31 Sex after stroke © The Stroke Association 2010. The Stroke Association is registered as a Charity in England and Wales
Disclaimer: The Stroke Association provides

(No 211015) and in Scotland (SC037789). Also registered in Isle of Man (No 945) Jersey (NPO 369) and in Northern Ireland.
18 York Place, Edinburgh EH1 3EP, the details of other organisations for
tel: 0845 119 2020, website: information only. Inclusion in this factsheet
www.relationships-scotland.org.uk does not constitute a recommendation or
The Scottish branch of Relate. endorsement.
Spokz
PO Box 14004 Sutton Coldfield B73 9LJ,
tel: 0845 25 77 496, email: info@spokz.co.uk,
website: www.spokz.co.uk
Makes disability equipment to help with sex
if you have weakness or paralysis.

For further information, phone the Stroke Helpline on 0303 3033 100,
email info@stroke.org.uk or visit our website www.stroke.org.uk
If you are unhappy with The Stroke Association in any way,
please contact us immediately. We will happily discuss any
issues and how we can resolve them.
Produced by The Stroke Association’s Information Service.
For sources used, visit www.stroke.org.uk/
information/our_publications
Factsheet 31, version 01 published June
2010 (next revision due December 2012).

The Stroke Association (June 2010) 6