Bringing up the topic of sex after a stroke with your patient can be an intimidating prospect for many clinicians. At what point after this traumatic event is it appropriate to bring up something as sensitive as intimacy?
Although stroke is a serious medical event that requires extensive recovery, it is possible – and probable! – to return to sexual activity post-stroke.
Of course – individuals should discuss any physical, cognitive, and emotional changes with their doctor and rehab clinicians in order to get an accurate overview of any restrictions or limitations, and risk factors that may need to be observed.
It is important to take precautions when returning to sex post-stroke to ensure that there are no additional complications.
The medical team can provide guidance about appropriate physiologic changes, frequency of sexual activity, and risk for pregnancy or sexually transmitted infections.
However, when our patients in rehab present post stroke, it falls into our role as a rehab clinician to make a safe space for sex and intimacy to be brought up!
What is my role as a rehab clinician in addressing return to intimacy post stroke?
The main role of the rehab clinician is to create a safe space and area of discussion for our patients.
Read our article about examining the rehab clinician’s role in addressing sexuality here!
Rehab for intimacy post stroke may address:
Physical changes
After experiencing a stroke, individuals may experience a variety of changes to their physical abilities- such as weakness, numbness, or unilateral paralysis. These physical changes affect the ability to perform sexual activities, such as kissing and intercourse. Additionally, it may be difficult to move or position oneself comfortably, which can make sexual experiences less enjoyable.
There are many ways to incorporate intimacy into a relationship even when physical sensation and desire may have changed after a stroke.
While physical intimacy may not be feasible for all couples, it is important to recognize that intimacy can be fostered in many different ways. Participating in activities together, such as taking a walk in the park, going out for dinner, or even just cuddling can increase connection. It is also helpful to understand that different people have different boundaries, and it is important to respect them. Everyone should feel comfortable expressing their desires and boundaries to each other.
Encourage your patients to experiment with new positions and techniques that are comfortable and enjoyable.
Communication
When it comes to bringing intimacy back into a relationship post stroke, communication is key. Partners should take the time to talk about the changes in sensation and desire, as well as any difficulties with positioning or movement. One way to start is by discussing past experiences in the relationship and finding ways to recreate those fond memories. In addition, focusing on activities that don’t involve physical contact can be helpful, such as playing board games or watching a movie together.
Acknowledging the difficulty of the situation, being thoughtful and honest with each other, and reaching out for help from professionals are all important steps to take. Additionally, activities such as massage, cuddling, talking, and other forms of physical contact can be beneficial. It is important to remember that both partners should be able to express their needs in order to find solutions that work for the relationship.
Compensation
Compensatory techniques can be used to minimize the impact of stroke-related disability and facilitate a return to sexual activity. These techniques include adapting the environment, using assisted devices, and positional aids.
Assistive devices can play a crucial role in helping stroke survivors resume sexual activity. Devices like sexual aids, lubricants, and inflatable cushions can help address physical limitations by enabling individuals to maintain comfortable positions while engaging in sexual activity. Some assistive devices can also help with communication, such as visual aids that depict body parts or assistive apps that allow partners to communicate desires and needs.
Healthcare providers can educate patients and their partners about the available options and help them choose the devices that best fit their needs and preferences.
Resources for your patient
Fortunately, there are a variety of resources available to individuals who are looking to get back into a sexual relationship after a stroke. Websites such as the American Stroke Association provide tips and advice on how to handle such conversations and activities with respect to physical abilities and comfort levels.
Additionally, therapists specializing in couples and family therapy can assist in creating a safe space to discuss communication hurdles and help build intimacy – outside of physical activity. With support, couples can work together to find ways to expand passion, sex and intimacy post stroke.
Resources for the healthcare provider
There are also resources to you, as a rehab clinician, to develop your skills in addressing this area! CE courses, such as this course from Sex, Intimacy, OT (https://www.sexintimacyot.com/). If you would like to become more versant in this field, seeking out further training is a great idea.
Even without further certification, however – your role is always to be open and a safe space for your patients post-stroke. As rehab clinicians, we may find ourselves making the first indelible impression on the person as to whether they are returning to a full life after a stroke, which includes sex and intimacy. Therefore, we should display compassion and empathy for this conversation – despite our level of comfort with this sensitive area.
Want to level up your approach to Stroke Rehab? Have a look at our course, ‘In-Patient Stroke Rehab: 14 strategies to get your patient home!” for an in-depth, highly practical approach to stroke care and rehab.
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Emily Cahalan OTR/L, CLT, CBIS: Emily is an OT with almost fifteen years experience in the field, having graduated from National University of Ireland, Galway in 2010. Emily is passionate about inpatient rehabilitation and specifically lymphedema therapy in this space. In her (limited) spare time, Emily has started accepting OTD Capstone students to do her part in further promoting the advancement of OT in the rehab world.