Sexuality and Intimacy after Stroke


Sexual difficulties after Stroke can develop for many different reasons. The emotional impact of Stroke can be huge, while the physical and psychological effects can create new difficulties. These issues can be short-term and relatively easy to overcome, but for some they are more serious and longer lasting.

Resuming your sex life may be as important a part of your recovery from Stroke as relearning everyday skills, such as walking and talking. Many healthcare professionals are not always open or comfortable discussing sex, or may feel reluctant or ill prepared to do so. This can make it even more difficult for you to broach the subject. However, it is worth persevering and finding someone who is adept at handling these issues.

Some GP surgeries have their own counsellor or they may refer you to one who specialises in sexual or emotional problems. Some practice nurses may also be trained in aspects of sexual health.

There are a number of reasons why you may find you have difficulties with sex after a Stroke, including:

  • Fear that sex will raise blood pressure and cause another Stroke. While it’s true that sexual excitement does cause blood pressure to rise, it does not raise blood pressure to levels that can cause a Stroke. If you are concerned, have a word with your doctor. Almost certainly they will be able to reassure you that there is no need for concern.
  • Physical difficulties caused by the Stroke. Disabilities, such as weakness or paralysis, may cause problems, as can other underlying illnesses that you may have, such as diabetes. Pain that may result from Stroke can also make sex uncomfortable or difficult.
  • Emotional problems resulting from the Stroke. One common effect of Stroke, depression, can result in lack of interest in sex. Having a Stroke can also affect the way you see yourself, resulting in a loss of self-confidence and lowered self-esteem.
  • Side effects of prescribed medication. Many medications taken to lower blood pressure are known to affect sexual desire and performance.
  • Communication difficulties with your partner may lead to feelings of frustration and anger, which can affect your relationship and make you less interested in making love.

Sharing your feelings

The first step in dealing with any sexual problems is to talk about them – not only with your partner, if you have one, but also with your doctor or counsellor. 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 reach orgasm or get an erection.

However, all these can affect anyone at any time – not just people who have had a Stroke. Discussing the matter with a close friend or relative may also help you take the first step in sharing any difficult feelings.

If you were admitted to hospital following your Stroke, there may be a member of the medical team assigned to your care with whom you feel comfortable talking over problems of this nature.

You and your partner

If sex is important in your relationship, it really is worth trying to sort out with your partner where your difficulties lie and what you might do to begin to resolve them. It is important to share your feelings as much as you can.

It takes time for both of you to recover emotionally from the impact of a Stroke and, while you want your partner to understand what you are experiencing, you also need to appreciate his or her feelings. 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.

It may be that one of you would like to have sex but thinks the other wouldn’t. Bringing concerns into the open can help reduce stress and tension and resolve misunderstandings.

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. For example, you may want to explain that while you would welcome kisses and caresses and other ways of showing affection, you feel too tired for anything more at present, or that you need time to come to terms with your changed situation. Those who are less reserved may find it helps to be quite specific.

It may also be helpful to keep in mind that there are a variety of ways of enjoying closeness with your partner, which you both find satisfying.

Relationship problems

Emotional and sexual difficulties are closely interwoven. The effect of a Stroke on you and your partner can be life-changing, which, in turn, can put a strain on your relationship. Not only do you both have to adapt your lives to deal with any remaining disabilities, but if your partner is involved in caring for you physically because of the limitations imposed by your Stroke, it may be more difficult for either – or both – of you to feel sexual. For example, 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.

If you aren’t able to talk about how you both feel about this – or find that it doesn’t help – you might benefit from seeing a counsellor or therapist. Tackling problems with emotional aspects of your relationship is not always easy and may require professional help.

If you are having physical difficulties following your Stroke, such as paralysis, pain or weakness, you may end up avoiding sex altogether. With help from your doctor, steps can be taken to help resolve any physical difficulties that you have as a result of the Stroke.

Emotional problems

It’s not unusual to feel low or depressed after a Stroke. Recovering from a serious illness, as well as spending time in hospital and having to adapt to any lasting disabilities, is likely to give rise to feelings of anxiety and depression.

Damage to the brain as a result of Stroke can also cause psychological effects, including depression. It’s hard to summon interest in sex if you are feeling depressed. In fact, a lack of interest in sex can itself be a symptom of depression.

Other emotional changes, especially mood swings, are sometimes linked to damage to particular areas of the brain. In the early months after your Stroke, you might feel too emotionally overwhelmed to summon an interest in sex. Try to accept the way you are feeling and don’t dwell on changing emotions. However,
it is worth speaking to your doctor about your feelings, as depression should be diagnosed and treated as soon as possible. Although treatment with antidepressant medication can be very effective, some of the medications themselves can cause problems with sexual desire and performance.

Stroke can also affect the way you see yourself and it may take time before you can view yourself as sexually attractive again. Looking after yourself and paying attention to your physical appearance and hygiene can help boost your selfesteem.

However, if your self-confidence shows no sign of returning, you may want to consider asking your doctor to refer you for counselling.

Physical difficulties

Medications for high blood pressure are known to have side effects that may affect your sex life, including impotence, lack of desire, and difficulty becoming aroused or reaching orgasm. If you are concerned, discuss this with your doctor, who may be able to prescribe a different drug, which doesn’t have these side effects. Never stop taking medication without consulting your doctor.

Feeling tired all the time is another common problem in the weeks and months after a Stroke. Although this initial tiredness may wear off, 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 tired for some of the activities you used to enjoy – including sex. Apart from the direct effect of Stroke, other underlying illnesses that you may have – such as diabetes – can also cause problems, so it is worth bearing this in mind when discussing possible causes with your doctor.

Communication problems

When a Stroke has affected your ability to communicate in words, it is difficult not to become frustrated and angry at times – both with yourself and with those who are having trouble understanding you.

Tension and resentment can build up between you and your partner, and get in the way of your sexual feelings for each other. What’s more, the struggle to get your meaning across may be exhausting for all concerned, leaving you with no energy to spare for sex.

A speech and language therapist should assess anyone experiencing communication difficulties following their Stroke. If you were not seen by one while in hospital or were not admitted to hospital in the first place, your GP can refer you. The therapist will be able to assist you and your partner in finding suitable ways that can help you communicate your feelings and emotions for each other.

New relationships

If you are not in a relationship, you may find it more difficult to deal with the issue of sexual problems after Stroke. Embarking on a relationship is hard enough for anyone, and this can be especially so if a Stroke has left you with physical effects, such as mobility and/or speech problems.

Because a Stroke can affect your image of yourself, your confidence and your self-esteem, you may feel unable to approach anyone as a result. You may also feel embarrassed about raising the issue when you are first getting to know someone.

Relationship therapists and counsellors work with individuals – not just couples. They may be able to help you work out strategies to come to terms with some of the issues affecting you, and also help you find ways of discussing any difficulties with potential partners.

Resuming your sex life

When you are ready to resume your sex life, a bit of preparation can help. Planning for sex is not ‘unromantic’, it is simply a matter of making the environment for sex as relaxing as possible.

  • 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 wellbeing.
  • Pick a time of day when you both feel rested and relaxed. Bear in mind, too, that sex isn’t an activity that has to take place only in bed at night.
  • Few people feel like sex when they are tense and anxious, so it’s worth taking the time to get in the mood beforehand. Do something pleasant together to help you relax such as having a meal, listening to music or watching a favourite television programme. However, avoid large meals or too much alcohol, which can make you feel sleepy, and allow time for digestion to take place.
  • 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 other ways to express your feelings and be close to another person.

Factsheet 31:  The Stroke Association

© Stroke Recovery Association NSW 2023 

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