Stroke can cause various physical effects which could impact sex and relationships. But there is help available. Find out about the different problems and what you can do about them.

Physical problems may include:

• Muscle weakness or spasticity (muscle stiffness) may restrict how you move and how you can position yourself during sex. Spasticity can cause pain which could affect your enjoyment of sex.
• Changes to sensation, like numbness, can make you less sensitive to touch, or you might experience painful sensations like pins and needles.
• Tiredness and fatigue are common after stroke. Fatigue means tiredness that does not get better with rest. It can leave you exhausted and lacking in energy. It can make it harder for you to do activities you used to enjoy, including sex.
• Continence problems (bladder or bowel problems) may be a source of worry or embarrassment. You may avoid sex because of them. Catheters can cause practical difficulties when having sex as well. You should have your continence assessed before you’re discharged from the stroke unit, and reassessed if there are still problems after two weeks.
• Hormone imbalances can sometimes be due to a stroke, leading to a wide range of problems, including difficulty getting an erection in men or low sexual desire in women. This can happen when a stroke affects the parts of your brain that are important for controlling hormones.
• Other medical conditions (such as diabetes, epilepsy or heart disease), and the medication you take for them, can sometimes make it difficult to get an erection or reach orgasm. They can also lower sexual desire and reduce vaginal lubrication.

Help with physical problems

Muscle weakness or spasticity

Some physical problems might make sex a bit less spontaneous, but there are often practical solutions to whatever problem you’re having. If you have weakness down one side or muscle stiffness, finding the right position for sex may be a case of trial and error. That does not have to be a bad thing. Think of it as an opportunity to experiment and explore what you can do in bed, including different ways of doing oral sex and masturbation.

You may find that lying on your side is more comfortable. If one side of your body is weaker than the other, lying on your weak side will leave your stronger arm free. Using lubricants during sex can reduce pain and improve your enjoyment. Talk to your physiotherapist or occupational therapist, who can give you practical advice.

See 'sources of help and information' for links to resources with suggestions for sexual positions for people with muscle weakness and disabilities.

If you are using pain medication for spasticity, you could think about intimacy at the times of day when the medication is most effective for you.

Tiredness and fatigue

If you often feel very tired, try having sex in the morning or at the times of day when you have more energy.

Continence problems and catheters

If you have continence problems, try going to the toilet just before sex. Protect the bedding with a waterproof sheet and have towels and tissues ready to mop up any leaks.

If you have a catheter, your doctor or nurse can show you how to remove and replace it. They can give you a valve that allows you to remove the drainage bag during sex. If you’re a woman, you may find it helpful to tape your catheter forwards and to one side using surgical tape. Men can bend the catheter back along their penis and hold it in place with either surgical tape or a condom.

Side effects of medication

If you suspect a medication is affecting your sex life, ask your GP if they can review your prescription. Never stop taking any medication without talking to a doctor or pharmacist first.

Erection problems

If you’re having problems getting or maintaining an erection, it’s important to tell your GP. Erection problems can be a sign of health problems like heart disease, high blood pressure and diabetes. Your GP can treat any underlying health conditions that may be causing your problems. Although it can feel embarrassing to talk about, it could be vital for your health.

If an erection problem is due to the effects of a stroke, some practical solutions and treatments may be available. Again, speak to your doctor first for individual advice.

• Lifestyle changes. Some practical steps like losing weight if you need to, stopping smoking and cutting back on alcohol can help with erection problems. Becoming more physically active if you can, reducing stress and treating symptoms of anxiety and depression may also benefit you.
• Drugs to improve an erection. Drugs called phosphodiesterase-5 (PDE-5) inhibitors work by temporarily increasing the blood flow to your penis. The most well-known of these is Viagra, and others include Cialis, Vardenafil and Spedra. However, these should be avoided for the first three months after stroke and until your blood pressure is under control, and you should seek guidance from your doctor before taking them. You may not be able to take them if you have heart disease, low blood pressure, or are taking some types of medication for high blood pressure. You may not be able to use these drugs if you are at risk of priapism, a painful, long-lasting erection which can happen to men with sickle cell disease. Some side effects of these drugs may include headaches, flushed skin and nausea.
• Vacuum pumps. These are clear plastic tubes you place over your penis. The tube is connected to a pump, which removes the air. This creates a vacuum around your penis, which causes blood to flow into it, making it erect. If you’re taking blood-thinning medication (for example, warfarin or apixaban), speak to your doctor first as a vacuum pump may not be suitable for you.
• Alprostadil is a drug that increases blood flow. It can be applied as a cream or injected into the penis to produce an erection. Speak to your doctor first as not everyone who has had a stroke may be able to use this medicine.

Vaginal dryness

When a woman becomes aroused, the vagina should become naturally moist and lubricated. If this does not happen, sex can be uncomfortable or sore. Treatments include:

• Lubricants you can apply during sex. These are usually liquids or gels available without a prescription. A pharmacist can give you advice on them.
• Vaginal moisturisers are gels or creams you can use regularly, to keep the vagina moist. A pharmacist can give you advice on them.
• Vaginal oestrogen is a hormone replacement therapy (HRT) medicine used in the vagina. It may help with vaginal dryness linked to the menopause. Some women will be advised not to take oral HRT tablets due to their other risk factors, but may be able to use other forms of HRT. Talk to your GP for individual advice on whether vaginal oestrogen is suitable for you.

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