Intimacy and sexual activity

March 27, 2013
Communication, difficult issues & adapting lives

When a condition is first diagnosed, there are so many things to work through that sex is often low on the list of concerns. Eventually, the urge to return to intimacy and a sexual life is likely to be important for most people — of all ages.

Then the questions begin. Is it possible? Is it safe? Am I being selfish even considering it? Will he or she still find me attractive? Can I be a good lover? Will my erection last? Can I have an orgasm? What if I lose bladder control during sex? How can I have a sex life when I’m always tired? Will my partner continue to love me? How do I get interested in sex when I’m dealing with everything else?

Keeping channels of communication open and discovering appropriate avenues for sexual expression can have significant benefits to your overall feelings of happiness and wellbeing. If you are having problems, do ask your doctor or condition-specific supportorganisation for advice or more information.

Many types of Acquired Brain Injury (ABI) and neurological conditions can affect a person’s sexual response directly. Some progressive conditions only affect sexual abilities as time goes on.

A common worry for people after stroke is whether sexual activity will cause another stroke. The concern here is blood pressure. We all experience a sudden rise in blood pressure as excitement increases, but if it is already high this can cause problems. Check with your doctor. It also helps to make having sex more effortless, and your partner may need to take the more active part. A partner with high blood pressure is also likely to be on tablets to control it. These may affect the ability to have intercourse. If this is a problem, talk to your doctor. There are tablets that do not have this side-effect.

How chronic conditions affect sexual activity

Difficulties often arise as chronic neurological conditions progress, such as:
• physical changes
•cognitive changes
•emotional responses
•personality changes
•self-esteem and self-image.

Physical changes

For example, symptoms such as paralysis, weakness, spasticity, poor balance, muscle wasting or pain may require couples to adjust
their positioning or types of sexual activity.

Cognitive changes

Brain damage can affect cognitive (thinking) abilities that have an impact on a person’s sex life. For example, emotional instability (often part of ABI) and poor communication due to speech difficulties can be disruptive.


Fatigue can have a significant impact but if you know when it is most likely to occur, you can plan time together around it. Medications can also increase or decrease tiredness or change muscle function, which you may need to take into account as well.


The fear of bladder or bowel accidents makes some people uneasy but there are ways to minimise the likelihood: go to the toilet immediately before love-making, adopt positions that minimise the chance of reflex emptying of the bladder and having towels and a
sense of humour on hand, just in case.

Emotional responses

Depression, anxiety and stress that occur, either as a result of changes in the brain or in reaction to brain injury, can also reduce sexual desire. If depression is an issue, treatment can make a huge difference. Talk to your doctor. Strategies for reducing stress can also help.

Personality change

When brain injury affects aspects of someone’s personality, it can feel like you are living with a stranger. Occasionally, demanding or inappropriate sexual advances are an issue. A neuropsychologist can help with strategies that minimise difficult new behaviours.

Self-esteem and self-image

Sexual response is also tied up with our self-image and self-esteem. Both depend on our ability to accept ourselves and to not be influenced negatively by the perceptions of others, but both are challenged when someone becomes chronically ill. Self-image can take a battering when a person’s physical appearance changes. Self-esteem can falter if the person is less physically able to engage in sexual activities. If these are serious issues for you, consider seeing a sex counsellor or joining a support group. Your doctor or stroke support group can help with referrals.

For more on relationships after stroke click here.

This story was first seen in the Synapse bridge magazine