Talking about sex can sometimes be a taboo topic, so I wanted to clarify why I decided to write about it. Sex is something that often gets overlooked in the rehab process and by the time you get home, you likely won’t reach out to a healthcare professional to ask questions. It can be embarrassing to ask about sex and intimacy.
Having sex after a stroke can be really intimidating and scary. A lot of survivors wonder, will this cause another stroke? Will I be able to function normally? Will I still feel attractive? How can I work around my impairments?
My goal is to answer these questions and give you some ideas to navigate these waters without feeling embarrassed. You may even want to read through this article with your partner. It can help them understand what you’re dealing with and open the lines of communication between you, which you’ll find is one of the most important pieces.
Will sex cause another stroke?
The good news here is that the chance of having a stroke during sex is low. I know it seems like you’re doing a lot of physical work during sex as your heart rate and breathing increase. However, you’re actually doing about the same amount of work as it takes to go up a flight or two of stairs, not running a marathon.
Although the risk is low, I still recommend that you ask your doctor when it’s safe for you to start having sex. Your doctor knows your medical history and can give you a personalized recommendation. I know it can be awkward to ask those questions, but it’s best to be safe.
Birth Control & Stroke Risk
Studies are mixed on whether certain types of birth control increase stroke risk. What is clear, is that having comorbidities (like smoking, obesity, and high blood pressure) along with the use of combination (progestin-estrogen) oral contraceptives puts an individual at a higher risk of stroke.
Physicians often discontinue combination (progestin-estrogen) birth control pills after someone has a stroke due to the potential for developing blood clots which are the cause of ischemic strokes. On a positive note, the data shows that combination oral contraceptives do not increase the risk of hemorrhagic strokes.
If you’re trying to avoid pregnancy there are options you can talk to your doctor about. Reversible options include progestin-only pills, implants, IUDs, or injections; copper non-hormonal IUDs; diaphragms; or condoms. A non-reversible option is sterilization which will prevent pregnancy over your lifetime.
Will I be able to function normally?
Typically, the stroke itself is not the cause of sexual dysfunction. If you’re having trouble keeping an erection or having an orgasm, it may be due to other issues.
Depression
Around 30% of stroke survivors have post-stroke depression. Depression and other mood disorders can make it hard to want to have sex in the first place. You may lose interest in sex or physical intimacy. It may take time for those feelings to come back. Share how you’re feeling with your partner.
It may be helpful to start with hugging, cuddling, and comforting touch without any expectations of having sex. This releases oxytocin which is a hormone that helps foster calm and feelings of connection. The more you cuddle, the more connected you feel.
Impairments
Having a stroke is traumatic and dealing with the impairments it leaves behind is tough. Normal functioning during sex may be stifled by feelings of embarrassment, frustration, or depression due to these new impairments. It’s so important to have open and honest communication with your partner.
Talk with them about how you’re feeling about your body. You may have to try some new things to see what works for you. Give it some time to become comfortable with your new normal.
Medications
If you find that you have a lower sex drive, difficulty maintaining an erection, or achieving orgasm, medication may be to blame. Talk to your doctor if you think that’s the case. Don’t stop taking any of your medications unless your doctor has given you the go-ahead. Certain medications are really important to reduce secondary stroke risk.
Will I still feel attractive?
Feeling attractive is inherently an internal process. By that I mean, feeling attractive is something that we all deal with inside ourselves. It’s something that I can’t answer for you, but something that will take work on your part.
It can be hard to rebuild confidence in yourself if you’re dealing with physical, cognitive, mental, or emotional changes after a stroke.
Although it can be difficult, it’s important to find ways to build confidence in yourself after a stroke to establish a new normal.
How can I build confidence?
Remember that you are not your disability. It’s not to say that your disability isn’t part of your identity, but it does not define everything about you.
Laugh a little. You may find that having a little humor around your disability helps you cope with changes. Humor also projects confidence.
Know that you have every right to love, be loved, and enjoy sex. Take your time getting to know your body as it is now. Then take your time by allowing your partner to get to know it.
How do I work around impairments?
This is the BIG question but luckily comes with uncomplicated answers.
Sensory Issues
After a stroke, you may find that you’re highly sensitive to noises or touch. On the opposite side of the sensory spectrum, you may have difficulty feeling pressure or light touch.
First, you’ll need to figure out where you sit on this spectrum. If you’re highly sensitive, communicate this with your partner. Show them the level of noise or touch that is comfortable or pleasurable for you. If you have difficulty feeling touch in certain areas, show your partner where you can feel and what feels best.
One-Sided Weakness
This is one of the most common symptoms after having a stroke. You may need to try new positions to accommodate weakness or immobility. Be mindful of the healing side when trying new positions so as not to cause injury, especially if you also have sensory issues.
If you have numbness, you may not realize if your hand or arm gets stuck underneath you or be able to move it independently to get back to a safe position. Make sure your partner also helps to keep an eye on your healing side during sex to avoid injury.
Aphasia
If you have difficulty with communication through speech, sex after stroke can be uncomfortable. Like anything else, it takes finding new ways to do things. You can establish certain gestures or touches with your partner when something feels good or bad. You can incorporate certain noises to indicate the same things. It may take more time and a little extra effort to create these new forms of communication, but it’s important to be heard and understood.
Fatigue
Neuro-fatigue is something that so many stroke survivors deal with. As unsexy as it sounds, planning a time for sex can be super helpful if you’re dealing with fatigue. If you carve out a time for sex, you can make sure you’ve had an appropriate amount of rest and sleep beforehand.
Plan to not do anything strenuous before, so you have enough energy to take part. You can also plan to rest afterward to give yourself time to reboot.
Incontinence
Trouble with urinary or bowel incontinence can be embarrassing. Just like you might cut back the amount of liquid you consume before going to bed, do the same thing a couple of hours before having sex.
You can also go to the bathroom just before sex to decrease the likelihood of having an accident. Of course, communicate your issue and how you’re feeling about it to your partner. They’ll more than likely understand and help you feel more comfortable about it.
Mood Disorders
I mentioned earlier that depression affects around 30% of survivors. Dealing with mood disorders like depression and anxiety can affect your sex drive and put sex last on the list of things you want to do. Know that that’s okay. Explain to your partner how you’re feeling and ask them to be patient with you.
In addition to the hugging and cuddling recommendations I made, talk to your doctor about medication options if that’s something you feel comfortable with. If you have the opportunity, you and your partner could talk with a couples’ counselor to problem-solve some strategies.
Pseudobulbar Affect
Although not completely clear why Pseudobulbar Affect happens, research shows that it’s likely due to a disruption in the neural pathways that allow us to express our emotions. This may cause excessive laughter or crying or inappropriate reactions (like laughing at something sad). This can be really frustrating and embarrassing to deal with, especially in the context of sex.
Sharing this information with your partner will help them understand if you have an episode during sex. They’ll know that you’re not necessarily overreacting to the situation but that it’s part of a neurological issue from the stroke. With your partner on board, it can make having episodes during sex more comfortable.
Cognition
Short-term memory issues, difficulty with sequencing (ability to know what actions come first and last), and problems with planning and organizing, can all disrupt your sex life. Again, as unsexy as it may be, schedule a time for sex and set a reminder on your phone. If you have difficulty with sequencing or organizing, communicate that with your partner.
If you’re the partner of someone with cognitive changes, it’s crucial to obtain consent before sex. Always make sure that they are ready, even if they agreed at an earlier time.
Take your time.
It may take some time to feel safe, comfortable, and confident having sex again after a stroke. Take the time you need to reacquaint yourself with your body. Keep an open line of communication with your partner. If possible, keep a sense of humor to help overcome any embarrassment you may feel. Establishing a new normal is not easy, but it is achievable.
