9.2 My husband has had a stroke. We are being creative in terms of our love making but will sex hurt him?

There a two main types of stroke: hemorrhagic and the more common, ischemic one. Stroke is associated with high blood pressure so the major concern is: “Does sex increase blood pressures enough to increase the risk of another stroke?” There is
no good research that shows that sex causes strokes. Furthermore, there is no good research that shows that sex after a stroke can worsen the disease. However, stroke can affect sexual functioning both directly and indirectly. The sexual organs may lack normal sensation and may not function adequately for intercourse. It is fairly common for women to have vaginal dryness after a stroke and for male to have erectile problems. This means that certain sexual activities may be diffi cult or impossible after a portion of the brain has been damaged. Partners may also be afraid of hurting or worsening a stroke victim leading to dysfunction.
Stroke victims may be very self-conscious about the way their body looks or responds. A common example is the drooping of half of the face or when a body part will just lay there; immobile. It may directly interfere with love making. Imagine trying to hug someone one armed or kiss someone who is constantly drooling. Problems with positioning can occur and must be accommodated. There are even couples who require a third person to physically arrange their bodies so that love making can occur. If you can’t actually have intercourse, consider sensual massage, hugging and kissing. Some people fi nd that they can enjoy their partner sexually even when they have no physical feeling in their genitals.
Fatigue is frequently seen which limits interest in having sexual relations. Not only can the tiredness affect the act of interacting with another human, it can also extend to the point that personal hygiene can be neglected. Exhaustion can be part of the disease process or it can be the result of medications that are taken as a result of the stroke. Please see the section on medications to see if your husband’s medications are on the list. Because fine motor skills may be diffi cult, we may fi nd that people don’t get out of their pajamas, that they don’t shave or put on makeup. This can turn off partners. Try to schedule sex when you both have more energy.
Psychologically, sexual closeness may involve shifting mental gears. There can be role reversals when one partner has a stroke. And think about the diffi culty that some people would have in the following example: you just finished changing someone’s diaper and now they want you to perform oral sex on them.
Another reason why people don’t take care of themselves may because of depression. I address this in many sections of this
book since it is a common medical problem and it often interferes with sexuality. Having a stroke is associated with depression. It is important to look for it when someone is having sexual issues.
Remember that stroke can affect the ability to speak so consider non-verbal communication. Many families have “secret” hand signals or codes that signal interest in doing things sexual. It is no different in couples who deal with stoke. Also, guiding someone’s hand, for example, where you want contact can bypass speech. Emotional cues can be lost with strokes so communication may be tricky.
Another important point deals with informed consent. There may be loss of speech or competency. Therefore, it may be difficult to assess if someone can give permission to someone else to have sex with them. How do we know if they can say no to sexual advances? This is a big ethical issue that is still being intensively debated. Twenty years ago when I was working with mentally handicapped and emotionally disturbed individuals who lived in group homes, we didn’t know if it was OK for them to have sex with each other. I still don’t have the right answers for you at this time so stay tuned.
If there are incontinence issues, go to the bathroom before attempting sex. Put waterproof covers on the bed, have cleanup
supplies immediately available. Women can tape up a catheter to their upper thigh and men have put a condom over a folded over catheter.
When dealing with stroke, I recommend that both partners discuss things honestly amongst themselves. You can still be
affectionate but the methods may be different. Stop or change things if there is pain. Remain creative and enjoy!

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