Sex after having a stroke
Read about the author Samantha Evans
Having a healthy, fulfilling sex life is important in any relationship but having a stroke can have a huge impact on it, both physically and mentally. Often, many of the problems encountered after having a stroke can be alleviated and overcome but you may need to seek professional advice.
Research by University of Ulster (2009) by Dr Assumpta Ryan and Hilary Thompson found that suffering a stroke can have a profound effect upon relationships. They found that sexual relationships were significantly affected, gender roles become blurred and often feelings of anger and frustration arise due to a lack of independence and ongoing fatigue.
Having a stroke can be a life changing event and can affect anyone of any age. Coping with both the physical and emotional effects of the condition can be difficult. Many healthcare professionals overlook the impact it can have upon sexual health and it can be uncomfortable for the person who has had the stroke or their partner to raise the issues that it may pose to their sex life.
If sexual problems arise, it is important to either discuss it with your doctor, clinical nurse specialist or ask to be referred to a specialist in psychosexual problems.
What sexual problems may occur after having a stroke?
Some people find they do not have any sexual issues, other people may struggle to enjoy sex. Seeking medical advice is important, do not think you have to give up on your sex life or live with any sexual issues, help is available.
Erectile dysfunction, vaginal dryness, vaginal tightness, decreased sexual sensation and loss of libido can all impact upon sexual intimacy and pleasure after having a stroke. Some people may find they are unable to get or maintain their erection, their orgasms may feel less pleasurable or they are struggling to orgasm, sex may feel painful if they experience vaginal dryness or tightness. Talking to your partner is important so you can explore new ways to remain intmate and enjoy pleasure together.
The same goes if you meet a new partner, honesty is important to helping you both enjoy sex.
If you are single, enjoying regular orgasms is good for you and can help boost your libido so try using a simple sex toy if you find you are struggling to orgasm or your orgasm feel less pleasurable
Reduced libido
A reduction in libido is commonly reported by stroke patients, caused by a hormone imbalance which can lead to erectile dysfunction and low sexual desire. Having a stroke can affect the pituitary glands and hypothalamus, both responsible for controlling the secretion of sex hormones. Erectile problems can be overcome by taking medication or using a penis pump or cock ring.
Muscle stiffness or weakness
Following a stroke, many people find that they are unable to have sex in certain positions due to weakness or muscle stiffness. Experiment with different sexual positions you both find comfortable and pleasurable. Discuss how to vary positions with your physiotherapist or occupational therapist: they should be able to give you ideas on how to alleviate any problems you may have.
Use cushions or pillows to help prop you up, stay in position or to rest or cushion your limbs, sex furniture is also available, designed to allow easier access
Loss of sensation
Some people experience a loss of sensation following a stroke, depending on which side of their body is affected and the extent of the stroke. Sensation does normally return but may be diminished. If your genital region has been affected, using a sex toy with strong vibrations may help, such as a Doxy body massager, Satisfyer Pro 2 or vibrating male penis sheath or cock ring. Many sex toys have varying levels of vibrations so you should be able to find something to improve your feeling of sensation.
You may find that you really enjoy nipple play if you experience decreased sexual sensation in the genital area. Experiement with sex toys, lubricants and try stimulating other erogneous zones on your body too.
Fatigue
This is a common problem after having a stroke because the effort of doing anything can be tiring. Consider having sex at a different time of day if you find yourself feeling tired at the end of the day. Take any medication at least 30 minutes before having sex to help ease pain or sensation problems. Many people enjoy sexual pleasure in so many different ways where the focus is not on penetration but sexual stimulation with fingers, sex toys, lips, tongues and gentle touch, there are many other ways to enjoy a healthy sex life without penetration.
Sexual Function
A good sex life at any age isn’t just about the physical act of sex: it is also about intimacy and touch, both of which can benefit anyone. If you enjoy penetrative sex but are no longer able to, consider exploring alternative ways such as touching, kissing and other intimate sexual contact such as masturbation and oral sex which can be just as pleasurable , if not even more so because they often bring a closer level of intimacy.
Introduce new elements to your sex life such as massage, a good lubricant and a sex toy.
Many partners enjoy either watching their partner using sex toys, whatever their sexuality. Even if your partner is unable to have penetrative sex, be that vaginally or anally with you, they can still arouse you sexually using a sex toy. Masturbating using a clitoral sex toy is no different to masturbating using your fingers and poses no risk to having another stroke. Anal sex toys offer intense sexual pleasure and can mimic anal penetration and create differents sexual sensations, especially anal vibrators.
Sex should never be painful, unless you are enjoying consentual BDSM so if you experience vaginal tightness, using a slim sex toy or silicone dilators can help to stretch the tissues and make pentrative sex feel more pleasurable.
Even if your partner is unable to get or maintain an erection, they can try wearing a strap on using a dildo, helping them and you to enjoy penetrative sex together.
Try a light weight product if you find that your motor skills are weakened. Many sex toys have easy to use controls and some are even remote controlled! We even have a product you can sit on. You can prop your sex toy on a cushion or pillow or even buy sex furniture that will hold certain sex toys in place whilst in use.
For those who experience erectile dysfunction, the Pulse III Duo is an ideal sex toy to use when penetrative sex isn’t possible as it offer sexual stimulation to both partners.
Constriction rings can help if you are able to get an erection but unable to sustain it. Some rings vibrate , offering different sexual stimulation and the Atom Plus is put on when flaccid and can really help promote an erection.
If you are uncomfortable about buying a product, many do not even look like sex toys.
Choose products that are made from skin safe materials, such as silicone, glass or metal. Avoid latex, rubber or jelly products which contain unpleasant chemicals, harmful to health and which are difficult to clean due to the porous nature of the materials they are made from.
We are knowledgeable about the products we sell, having tested many of them and are always happy to advise you about the most appropriate product for your needs.
Body image
Altered body image can pose a problem, making you feel less attractive to your partner. You may feel self conscious about the way you look due to muscle weakness or the way in which you speak, if your speech has been affected. Many of these symptoms will eventually disappear over time but be reassured, many people don’t notice these changes but accept you and love you for who you are. Talk to your partner about how you feel about the way you look. You will be surprised that this is not an issue for them.
Medication
If you think that your medication may be having a negative effect upon your sexual function, discuss it with your doctor who can prescribe different drug therapy with less side effects. Never stop taking your medication without consulting your doctor.
Incontinence
If you have problems with incontinence, try emptying your bladder and avoid drinking too much before having sex. A protective sheet on the bed may help. If you have a catheter, try taping it to your leg or wear a condom (men) to keep it in place and avoid it getting in the way. Your continence advisor may be able to show you how to remove it and replace it when you wish to have sex.
You can also buy sex sheets that protect the bed and are machine washable.
Contraception
If you are concerned about what contraception to use, discuss this with your doctor or practice nurse. Women who have had a stroke are often advised not to use the contraceptive pill, patch, implant or intrauterine system. Your GP will be able to suggest the best and safest type of contraception for you.
Vaginal dryness
Following a stroke, many women complain of vaginal dryness due to the imbalance of hormones in their body. This can be easily remedied by using a skin safe pH balanced sexual lubricant.
We only recommend skin safe products as many sexual lubricants both commercial and on prescription contain ingredients which can cause thrush, bacterial vaginoisis and vaginal and vulval irritation.
KY jelly exacerbates vaginal dryness as it is hyperosmotic which means it draws water out of the walls of the vagina rather than hydrating it. It also contain glycerin and parabens, neither of which have any place in the vagina.
Avoid store cupboard ingredients or products in your bathroom cabinet as many are not designed for internal use, especially inside your vagina.
Alway check the label or ask your GP what the ingredients are in any product they want to prescribe for you.
Choosing organic lubricants, such as YES organic lubricant. Skin safe, odourless and tasteless, YES organic lubricants provide you with the right amount of lubrication with minimal risk or mess. What’s more, they are quite possibly the closest thing you will find to the body’s natural lubricant, ensuring silky-smooth and pleasurable play.
Available in water based or oil based solutions, they nourish and lubricate the delicate tissues of the clitoris and vagina, making it more flexible and less dry.
Oil based lubricants are not condom compatible.
You may prefer to use a silicone lubricant which feels more slippery than an oil based or water based product and can be used with condoms but not silicone sex toys.
We recommend very few feminine hygiene products as the majority of products can and do impact upon your intimate health and sexual pleasure because they contain irritating ingredients that exacerbate vagina health issues. No one needs a scented condom or perfumed menstural pad!
Emotional problems after having a stroke
Depression
Following a stroke, many people can feel depressed or low which has an impact upon their sex life. It is extremely important to talk to family and friends as well as healthcare professionals. Sometimes the effects of a stroke can damage part of the brain responsible for controlling emotion, which can lead to depression. Your doctor may be able to prescribe medication or refer you for counselling.
Raised anxiety levels
People often feel anxious after having a stroke, worried that they may have another one. A common fear is that they will have another stroke if they have sex. This is unfounded as you are no more likely to have a stroke when making love as at any other time. Love making can raise your blood pressure but in a pleasurable, not stressful way. Having a fit, active sex life can aid your recovery and make you feel normal again.
If you are concerned, seek help from your GP. Having sex doesn’t mean you can only have sexual intercourse, you just need to be a little more creative!
Loss of inhibitions
In rare cases, some people lose their sexual inhibitions after having a stroke and may act inappropriately. They may not realise that they are behaving in this way which can cause embarrassment for their family and friends. This problem needs to be treated with specialist medical help and not by partners or family alone.
Changes in emotions
Having a stroke can put a strain upon your relationships, not just with your partner but with family, friends and work colleagues. Having to care for your partner’s basic needs such as washing and toileting can make you view the way in which you see them and your relationship differently and can impact upon your sex life.
One woman from the above mentioned research who had a stroke at the age of 35 summed her relationship up as “it’s not a husband and wife role anymore, it’s a carer and and a patient which isn’t very pleasant or fair”
They may be feeling angry or irritable and take it out on you, putting your relationship under strain. Try communicating with each other about your fears. Often when someone has had a stroke, they feel frightened and not in control of their body and mental state. They may feel that if they cannot perform sexually, you will seek sex elsewhere. If you find it difficult to talk about sex, talking to a counsellor or therapist may help.
Communication
A stroke can have an impact upon speech and communication may be difficult. A speech and language therapist will be able to help you and your partner find suitable ways in which to communicate your feelings if speech is affected.
Don’t give up on your sex life
At Jo Divine we believe that sexual health and sexual pleasure go hand in hand and have created a health brochure with suitable products to help people with vaginas and vulvas with sexual issues and one for people who have a penis and experience erectile difficulties. Working with medical professionals, we hope to encourage patients and HCPs alike in talking more freely about sexual problems, especially those that happen after having a stroke.
Experiment with sex toys and bondage, explore your own and your partner’s bodies to find out what turns you on and discover different ways in which to enjoy sex.
Don’t give up on your sex life, just because you have had a stroke as there are so many ways to enjoy sexual pleasure and intimacy, you just need to find one or more that work for you.
Many relationships flourish without sexual intercourse and by being supportive of each other and supported by the relevant organisations, your relationship can survive. If sex is an important part of your life, try introducing some of the suggestions above – you never know, you may discover a whole new way of having a happy, healthy and thoroughly satisfying sex life. Don’t give up if some of the suggestions don’t work for you, keep trying until you find something that satisfies both of you.
Useful Websites
Stroke Association : www.stroke.org.uk
Different Strokes : www.differentstrokes.co.uk a charity for younger people who have had a stroke
Headway : www.headway.org.uk
Royal College of Occupational Therapists : www.rcotss-ip.org.uk
Association of British Neurologists : www.theabn.org
British Neuroscience Association : www.bna.org.uk
British Association of Neuroscience Nurses : www.bann.org.uk
Association of Chartered Womens Health Physiotherapists :www.csp.org.uk
College Of Sex and Relationship Therapists : www.cosrt.org.uk