Sex and intimate relationships after stroke

What can cause problems with sex after stroke?

It’s very common to feel that a stroke has changed your relationship and sex life with a partner. If you’re single it could change how you feel about dating. Sex and relationship problems can happen to anyone of any sexual orientation or gender.

There are several reasons why you may have difficulties with sex after a stroke, including emotional changes, relationship problems and physical disabilities. But remember that help is available. Whether your difficulties are physical or emotional, you may find it helpful to speak to someone about them.

Many of us aren’t used to talking about our intimate relationships, but it can take away some of the worries you may have and can let you get any help and support you need.

Emotional changes

Many people feel low or anxious after a stroke, and this can make you feel as if you have lost interest in sex. If you’re having difficulties with sex and relationships, this may lead to emotional problems. Stroke can change your life in many ways. Perhaps you feel that you’ve lost your independence or that your relationships with the people you’re close to are not the same as before. If your partner is caring for you, this can affect the way you see each other. You might also feel differently about yourself and your body after a stroke.

Relationship problems

Your stroke is likely to be just as life-changing for your partner as it is for you, which can put your relationship under a lot of strain. Your roles may change, which can take some time to get used to. If your partner is helping to care for you, it could affect the balance of your relationship. Other things can affect intimacy, like communication difficulties and low mood or anxiety. Having a stroke can affect your confidence and self-image.

You may both find it difficult to talk about how you feel, because you think you should ‘stay strong’ for your partner. But if you don’t discuss your feelings, tension and resentment can build up between you both. It may be that one of you would like to have sex, while the other has lost interest in it. This could become a source of tension if it is not resolved. Openly discussing your feelings, listening to each other, and recognising how you both feel is the first step in sustaining a positive, healthy relationship.

If you are single, a stroke can sometimes pose difficulties if you are looking for a new relationship. For example, it can be tough if you have problems with mobility or communication difficulties. A stroke can
affect your confidence and self-esteem, which can also make it harder to talk to people. However, many people establish happy, healthy relationships after a stroke.

Physical problems

• 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 very common problems after stroke. If your stroke has affected your mobility, simple daily tasks can be more tiring than they used to. Fatigue means tiredness that does not get better with rest, and is a common condition for stroke survivors. Tiredness and fatigue can make it harder for you to do many of the activities you used to enjoy, including sex.

• Continence problems may be a source of worry or embarrassment, and you may avoid sex because of it. Catheters can cause practical difficulties when having sex as well.

• 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 make it difficult for men to get an erection or reach orgasm, and can also lower sexual desire and reduce vaginal lubrication in women.

Can sex cause a stroke?

Some people avoid sex because of a fear that it will cause another stroke. While it is true that your blood pressure can rise when you orgasm, you’re no more likely to have a stroke during sex than at any other time. If you had a haemorrhagic stroke (bleeding on the brain) due to a burst aneurysm, and you
feel worried that sex could trigger another bleed, contact your GP or stroke specialist nurse for advice. If an aneurysm and any other risk factors like high blood pressure have been treated, this risk should be very small. Whatever the cause of your stroke, you can visit your GP to ask for help with reducing your risk of another stroke.

Behaviour changes

A stroke can damage parts of the brain that are linked to the emotions, leading to problems with controlling emotions. Some people have difficulty controlling their mood, and seem angry or irritable, which can put a strain on relationships. Some people find that they become more sexual, or lose inhibitions. They might behave and talk differently, such as talking to someone about sex when it’s not appropriate. If people close to you say they are worried about your behaviour, try to be open to what they say, and remember that they care about you. It could be difficult to talk about for both of you, but it can help to discuss ways of dealing with it. For instance, if you agree that you sometimes act inappropriately, you could make an agreement with your loved ones about what to do when it happens.
For example, you could agree on a signal to make you aware, and let you take a minute to think.

What can help sexual problems?

This guide can only give general information. You should always get individual advice about your own health and any treatment you may need from a medical professional such as a GP, pharmacist or nurse. You can access emotional support through your GP, or by contacting a psychology professional such as a counsellor.

The first step in dealing with any problem is to talk about it. This isn’t always easy, and you may find it difficult or embarrassing to talk about things like a lack of desire or not being able to get an erection.

However, these kinds of problems can affect anyone at any time, not only people who have had a stroke. Talking and being open about your feelings can help your relationships, and might also help in dealing with sexual problems. Many people want guidance about sex and relationships after a stroke, and there is help and information available. It’s also important to look after yourself.

Try to have an active, healthy lifestyle, including eating a healthy diet and being as active as possible for you. This can help improve your overall health, as well as your sexual and emotional wellbeing.

Help with relationship problems

Talk about your feelings

You may feel awkward about bringing up the subject of sex, but having an honest conversation about what you are finding difficult is the first step to making changes. Set aside a time to talk when you won’t be interrupted, and choose a place where you both feel comfortable. Sometimes it’s easier to talk about sex away from the bedroom, so neither of you feels under pressure. Take it in turns to talk and listen carefully to each other.

Professional help with relationships

Talking about your feelings is difficult, even with someone close to you, so it can often help to get professional support. Relationship counselling can give you a safe space to find a way through the difficulties you’re facing.

Single people can also go to relationship counsellors. If you’re in a couple, you can choose to go alone or with your partner. Usually, a counsellor will ask you questions so that you, and your partner if you have one, can talk about what’s going on and how you feel.

Information guide

• Download Sex and intimate relationships after stroke (PDF)

Where to get help and information from the Stroke Association

Helpline
Call us on 0303 3033 100,from a textphone 1800 0303 3033 100
Email: helpline@stroke.org.uk
Our Helpline offers information and support for anyone affected by stroke, including family, friends and carers.

Read our information
Call the Helpline to ask for printed copies of our guides.

Other sources of help and information

College of Sexual and Relationship Therapists (COSRT)
Tel: 020 8543 2707
The professional body for sexual and relationship therapists. Find qualified private therapists and information about therapy and common problems on their website.

Disability Horizons online magazine
Information and practical tips on all aspects of living with a disability including a section on relationships and sex.

Sexwise
The Sexwise advice and information website is run by the sexual health charity Family Planning Association (FPA). It gives information about sexual wellbeing, sexual problems as well as contraception and pregnancy.

LGBT Foundation
Tel: 0345 330 3030
LGBT Foundation is a national charity delivering a wide range of services to lesbian, gay and bisexual and transgender (LGBT) people. It provides counselling for individuals and couples and a helpline offering information and support.

NHS One You Sexual Health
National Sexual Health Helpline: 0300 123 7123
Website and helpline offering support with sexual health and wellbeing.

Outsiders
Helpline: 07770 884 985
A free club for people with disabilities. The Outsiders Trust also offer support on relationships, sexuality and dating.

Relate (England and Wales)
Tel: 0300 0030 0396

Relate Northern Ireland
Tel: 0289 032 3454
Offers relationship and sex counselling (face-to-face, online and via telephone).

Relationships Scotland
Tel: 0345 119 2020
Provides relationship counselling, family mediation, child contact centres and other family support services.

Spokz
Tel: 015 4389 9317
Makes disability equipment including equipment to help with sex if you have weakness or paralysis.

Books

The ultimate guide to sex and disability: for all of us who live with disabilities, chronic pain, and illness. Miriam Kaufman, Cleis Press, 2020, a book about sex and disability including advice on sexual positions. Available in print and as an e-book.

Disclaimer: The Stroke Association provides the details of other organisations for information only. Inclusion on My Stroke Guide does not constitute a recommendation or endorsement.