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Evaluation of Sexual Changes After Stroke. [CME]

J Clin Psychiatry 2003;64:302-307

Background: Sexual difficulties may arise after stroke. This study was aimed at evaluating and quantifying sexual changes 1 year after stroke.

Method: Sixty-eight stroke patients, consecutively admitted to our rehabilitation unit, were enrolled in the study. Sixty-two patients were available for response after 1 year--46 men and 16 women with a mean age of 64 years (SD = 9.2). Time interval between stroke event and admission to rehabilitation unit was 15 days. None of the patients presented with lack of comprehension. Methods of data collection at admission were clinical examination, computed tomographic scan or magnetic resonance imaging, the Cumulative Illness Rating Scale, laboratory data, and data collection on sexual life from patients and, separately, from their partners. After 1 year, they were interviewed again to assess sexual performance; the Center for Epidemiologic Studies-Depression scale, Structured Clinical Interview for DSM-IV, and Functional Independence Measure were also performed. A questionnaire designed for this study was also administered for collecting data on patients' private lives.

Results: Sexual decline was common in the poststroke period. Age (p = .009) and disability (p = .0059) were significant variables. There was no correlation between sexual decline and gender, nor injured hemisphere. There was also no correlation to marriage duration, education duration, or depression. Evaluation and analysis of the questionnaires revealed, however, that patients' partners played a substantial role in the decline of sexual activity. Many partners experienced fear of relapse, anguish, lack of excitation, or even horror, which withheld them from encouraging sexual activities.

Conclusion: Data from this study demonstrated that sexual decline in the aftermath of stroke is pronounced. Patients suffer from their sexual impairment, but do not conceal that problem. Psychological, rather than medical, aspects account for discontinuity of sexual activity in stroke survivors, and proper counseling is clearly warranted.