Information about sex after stroke

Abstract

Background: Participating in sexual activities involves multifaceted and intricate physical, spiritual, biological, psychological, social and cultural connections. Stroke causes numerous problems which impact sexual activities and lowers the satisfaction with sex life for both the stroke survivor and their partner. The lack of information about sex and relationships during rehabilitation is thought to exacerbate the physical and psychosocial impacts caused by the stroke itself. The clinical guidelines for stroke management recommend that “stroke survivors and their partners should be offered: the opportunity to discuss issues relating to sexuality with an appropriate healthcare professional; and written information addressing issues relating to sexuality post stroke” (NSF, 2010, p. 29). In most stroke rehabilitation units, sex is not addressed as part of standard practice and the available written information addressing issues relating to sex after stroke have not been evaluated. More research on the need for information from the perspectives of stroke survivors and their partners’ on sex and relationships after stroke is warranted. Aims: The overall aim of this study was to uncover ways in which health professionals can improve the information available to stroke survivors about sexual activities after stroke. To achieve the above aim, three research questions were addressed. Each of these questions is the focus of the following three phases of this study. Phase 1: What is known about sex after stroke from existing research? Phase 2: What content is covered by existing educational material on sex after stroke? Phase 3: What information does a group of stroke survivors and their partners need about sex after stroke, and in what form? Method: A qualitative descriptive design was used for both Phase Two and Phase Three of the research. In Phase Two text data from nine existing educational materials about sex after stroke was analysed using content analysis. Textual data were collected from factsheets, booklets and brochures about sex after stroke which were produced from reputable sources, such as stroke organisations, and available online in English. In Phase Three nine stroke survivors aged between 48 and 62 from a metropolitan city in Australia participated in a semi-structured interview about their sexual concerns following stroke and their perspectives on the information needed to address their concerns. The interviews were transcribed verbatim and analysed using content analysis. Results: Phase Two analysis indicated that there was consistency in the content of the education materials which covered three main content areas: the problems experienced after stroke, suggested solutions for resuming sex after stroke and general reassurance. Content describing potential problems reflected published research, but solutions and reassurance were general, nonspecific, and often not supported by evidence. Phase Three analysis revealed that participants’ felt that their engagement in sex was negatively affected due to physical, emotional, and social changes experienced as a consequence of stroke. Most participants did not receive information about sex and they also had not sought out this type of information. The participants considered that information about sex ought to be available and that health care providers should have initiated conversations about sexual issues. They also expressed desire for the information to be delivered at a time when they felt ready to engage with it, in a variety of formats, and by a health professional with whom they had good rapport. Discussion: Some implicit messages within existing education material about sex after stroke appear to discourage recovery. Despite this, some information may still be useful to stroke survivors, their partners and health professionals. Some stroke survivors want information about sex after stroke to be available and accessible. Ideally, health care providers ought to be prepared with knowledge about sex after stroke and the ability to initiate and engage in conversations about sex. Resources need to be developed with a range of content and in various formats in order to meet the individual concerns of stroke survivors and their partners.