The stroke disrupts all aspects of life, including the most intimate ones. Sexuality, physical affection, couple dynamics… Everything can be called into question. Yet, this subject often remains taboo, relegated to the background behind medical and functional concerns. In this article, we address
without hesitation these essential questions: how does a stroke affect intimate life and couple relationships? How to talk about it? How to adapt and regain a fulfilling emotional and sexual life? Because intimacy and love are integral parts of quality of life and recovery.
Why is intimate life often neglected after a stroke?
A taboo subject in the care pathway
After a stroke, attention focuses on vital and functional aspects: motor recovery, autonomy, returning home, resuming activities. Sexuality and intimacy often take a back seat.
The reasons for silence:
On the caregivers’ side:
- Embarrassment in addressing the subject
- Impression that it is not a priority
- Lack of time during consultations
- Lack of training on this specific subject
- Modesty in discussing these intimate questions
- Impression that it is not the right time to talk about it
- Fear of being judged or appearing “superficial”
- Not knowing that caregivers can help them on this subject
- Fear of hurting the other
- Modesty even after years of living together
- Fear of appearing selfish or insensitive
- Not knowing where to start
- Side position (spooning), partner behind
- Position where the valid partner is on top and controls movements
- Use of cushions to support weakened limbs
- Same adaptation in mirror
- The valid side provides support
- Positions where the tired person is passive (lying on their back or side)
- Favor morning or after a nap
- Shorter intercourse
- Less intense physical foreplay
- Favor caresses on the sensitive areas that remain
- Use varied textures (feather, silk, warmth, cold) to stimulate differently
- Oral stimulation can compensate for a loss of tactile sensitivity
- Empty the bladder just before
- Discreet protections if necessary
- Positions that limit pressure on the bladder
- Talk openly with your partner to de-dramatize
- Check with your cardiologist that they are compatible with your treatments
- Follow the dosages
- These medications do not create desire; they facilitate erection if desire is present
- Plan intimate moments (this is not less romantic, it is realistic)
- Choose moments when you are rested and stress-free
- Create a pleasant atmosphere (music, dim lighting, fragrance…)
- Adapted outings (cinema, restaurant, walk)
- Shared activities at home (watching a series, cooking together, games)
- Deep discussions about your dreams, fears, projects
- A kiss upon waking and going to bed
- Regularly saying “I love you”
- Small gestures (making coffee, a sweet note…)
- Holding hands, cuddling on the couch
- Having goals together (a trip, home improvement, a creative project)
- Projecting together into the future
- Maintain personal activities (hobbies, rehabilitation, friendships)
- Do not define oneself solely by the illness
- Continue making decisions, having choices
- Continue to have moments for oneself (hobbies, friends, rest)
- Do not forget oneself in the caregiver role
- Seek external help to lighten the load (home care, day care…)
- Restore communication
- Manage difficult emotions (anger, guilt, sadness)
- Redefine roles in the couple
- Regain intimacy
- Day care
- Temporary accommodation
- Home care
- Respite stays
- Understand the psychological and relational impacts of stroke
- Identify factors that affect couple life
- Discover adapted communication strategies
- Know the resources available for psychological support
- Managing the dual caregiver/partner role
- Preserving the romantic relationship
- Preventing caregiver burnout
- Resources for obtaining support
- Intimate difficulties after a stroke are common and normal
- It is possible and safe to resume a sexual life after the acute phase
- Open communication in the couple is key
- Professionals can help you: do not hesitate to consult
- Intimacy is rebuilt gradually, in stages
- Sexuality may be different from before, but still fulfilling
- The emotional bond and tenderness are as important as genital sexuality
- Preserving each person’s identity helps maintain the flame
On the patients’ side:
Result: a silence sets in. Patients do not dare to ask questions, caregivers do not spontaneously bring up the subject, and difficulties accumulate in the unspoken.
Yet, sexuality and intimacy are fundamental human needs. They contribute to self-esteem, the feeling of being “whole,” and the quality of the couple relationship. Neglecting them means neglecting an important part of well-being and recovery.
The multiple fears after a stroke
The stroke generates specific fears concerning intimate life.
On the side of the patient who had the stroke:
Fear of triggering another stroke: “Can the physical effort of sexuality cause another stroke?”
Fear of no longer being desirable: “My body has changed, can my partner still desire me?”
Fear of no longer being performant: “What if I can’t do it physically?”
Fear of judgment: “What if my partner thinks I am selfish for thinking about this?”
On the partner’s side:
Fear of causing harm: “What if I trigger another stroke?”
Fear of imposing: “He/she already has so many worries, I don’t want to add to them.”
Transformation of the relationship: “I have become a caregiver, how do I become a lover again?”
Fear of rejection: “What if I propose and he/she refuses?”
These fears, if not expressed and addressed, create a gradual distance in the couple.
The impacts of a stroke on sexuality and intimacy
The direct physical impacts
The stroke can directly affect sexual function through several mechanisms.
Motor disorders:
A hemiparesis (partial paralysis on one side of the body) makes certain positions difficult or even impossible. Movements may be less fluid, coordination impaired.
Impact: Need to adapt positions, take more time, accept a certain “clumsiness.”
Sensory disorders:
A loss or decrease in sensitivity on one side of the body can diminish pleasure during caresses.
Impact: Need to prioritize areas of the body that remain sensitive.
Fatigue:
Post-stroke fatigue is often intense and can make sexual activity exhausting.
Impact: Favor moments of the day when energy is better (often in the morning), accept shorter or less frequent intercourse.
Erectile dysfunction (for men):
The stroke can cause erectile dysfunction through several mechanisms: brain lesions affecting nerve circuits, vascular disorders, side effects of certain medications (notably antihypertensives, antidepressants).
Frequency: About 50 to 75% of men report erectile dysfunction after a stroke.
Possible solutions: Medications (sildenafil, tadalafil…), erection pumps, intracavernous injections. To be discussed with a doctor.
Lubrication disorders (for women):
Decreased vaginal lubrication, either directly related to the stroke or secondary to stress, medications, or concurrent menopause.
Solutions: Water-based lubricants, longer foreplay, adapted stimulation.
Genito-urinary sensory disorders:
Some patients report hypo or hypersensitivity in genital areas, or urinary disorders that interfere with sexuality.
The psychological impacts
Beyond the direct physical impacts, the psychological consequences of the stroke deeply affect sexuality.
Post-stroke depression:
It affects 30 to 40% of patients and significantly decreases libido (sexual desire).
Impact: Decreased interest in sexuality, difficulties in feeling pleasure, emotional withdrawal.
Anxiety disorders:
Generalized anxiety, fear of recurrence, performance anxiety…
Impact: Avoidance of intimate situations, physical tension that prevents pleasure, inability to “let go.”
Alteration of body image:
Visible hemiparesis, changes in physical appearance, facial sequelae…
Impact: Feeling of no longer being desirable, avoidance of showing one’s body, refusal of intimacy due to shame.
Loss of self-confidence:
The stroke profoundly shakes confidence. One feels “diminished,” “less than before.”
Impact: Difficulties in allowing oneself to enjoy pleasure, hyper-control, fear of disappointing.
The relational impacts
The stroke transforms the couple’s dynamic, which inevitably affects intimacy.
The shift to a caregiver-care recipient relationship:
When one partner becomes a caregiver (helping with bathing, meals, mobility), it can be difficult to “switch” back to a lover relationship.
Impact: Feeling that it is “no longer like before,” difficulty in reconciling the two roles.
Disrupted communication:
If the stroke caused speech disorders (aphasia), expressing desires, fears, and wants becomes complicated.
Impact: Frustration, misunderstandings, unspoken issues accumulating.
Imbalance in the couple:
One has become dependent, the other feels responsible. This asymmetry alters the relationship.
Impact: Feeling guilty about expressing one’s needs, fear of “taking advantage” of the situation.
Medication impacts
Some medications prescribed after a stroke have side effects on sexuality.
Antihypertensives: Some (especially beta-blockers) can cause erectile dysfunction or decreased libido.
Antidepressants: Particularly SSRIs, can decrease desire and delay or prevent orgasm.
Anxiolytics: Can decrease libido.
Important: Never stop a treatment without medical advice. If you suspect that a medication is harming your sexuality, talk to your doctor. Alternatives or adjustments are often possible.
Dare to talk about it: to whom and how?
Breaking the silence in the couple
The first conversation is with your partner. It is the most difficult, but also the most important.
Why it is so difficult:
How to approach the subject:
Choose the right moment: A calm moment, without pressure, not after a difficult day or in a stressful situation.
Talk about your feelings, not accusations: “I feel…”, “I am afraid that…”, “I wonder if…” rather than “You don’t…” or “You have changed…”.
Start with the emotional connection before sexuality: “I miss you,” “I would like us to reconnect,” “Our relationship is important to me.”
Use supports if verbal communication is difficult: Write a letter, use images, gestures.
Examples of opening phrases:
“I would like us to talk about us, about our relationship. I know that many things have changed, but you mean a lot to me.”
“I feel a bit lost in our relationship since the stroke. I would like us to find together how to regain our complicity.”
“I want to touch you, to be close to you, but I am afraid I won’t be able to or that I will disappoint you. Can we talk about it?”
Talking to healthcare professionals
You are not alone. Professionals can help you.
Who to turn to?
Your rehabilitation doctor or neurologist: Can assess the physical impacts of the stroke on sexuality and reassure you about the risks of recurrence.
Your general practitioner: More accustomed to discussing sexuality, can prescribe treatments if necessary.
A sexologist: A professional specialized in sexual disorders. They can see you alone or as a couple.
A psychologist or couple therapist: To work on relational and emotional aspects.
An urologist (men) or gynecologist (women): For specifically genital disorders.
How to approach the subject in consultation:
If the doctor does not spontaneously ask the question, dare to bring it up.
Possible phrases:
“Doctor, I would like to ask you a somewhat delicate question… Can a stroke have consequences for sexuality?”
“I have difficulties in my intimate life since the stroke. Is this common? What can I do?”
“My partner and I are struggling to regain an intimate life. Who can we turn to?”
Most doctors will be relieved that you asked the question and will be able to help or guide you.
Questions to ask
Questions about risks:
“Can sexual activity trigger another stroke?”
Reassuring answer: No. The moderate physical effort of sexual activity does not pose a particular risk once the acute phase has passed (generally after 2-4 weeks). It is equivalent to climbing 2 flights of stairs.
“Are there any particular precautions to take?”
Answer: Avoid overly physical positions at first, favor moments when you are rested, do not combine with substances like alcohol or certain drugs.
Questions about solutions:
“Are there treatments for erectile dysfunction after a stroke?”
Answer: Yes, several options exist (medications, mechanical aids…). To be discussed with a doctor.
“Can my medications affect my libido?”
Answer: Some medications can have this effect. An adjustment is sometimes possible.
“Are there aids or advice to adapt our intercourse?”
Answer: Yes, a sexologist or couple therapist can assist you.
Adapting concretely
Redefining intimacy
Intimacy is not limited to penetration or orgasm. It is a continuum of affectionate gestures, closeness, shared pleasure.
Steps to reconstruct intimacy:
Step 1: Non-sexual tenderness
Before thinking about sexuality, rediscover tenderness: holding hands, hugging, tender kisses, gentle caresses. These gestures reactivate the emotional bond without performance pressure.
Step 2: Sensuality
Explore sensory pleasure without the goal of complete intercourse: massages, shared baths, caresses all over the body. Rediscover your body and your partner’s body.
Step 3: Adapted sexuality
When you feel ready, gradually reintroduce genital sexuality, but with a different approach, adapted to your new capabilities.
Key concept: “sensate focus”
This is a technique developed by sexologists Masters and Johnson. It consists of focusing on bodily sensations, without performance pressure.
How to practice:
1. Phase 1 (several sessions): Caresses all over the body except genital areas and breasts. Each takes turns. No goal of arousal, just feeling.
2. Phase 2: Integration of erogenous zones, still without the goal of orgasm or penetration.
3. Phase 3: Gradually, integration of genital stimulation, then if desired, penetration.
This approach removes pressure and allows rediscovery of pleasure without performance anxiety.
Adapting sexual practices
Positions adapted according to sequelae:
For right hemiparesis:
For left hemiparesis:
In case of significant fatigue:
In case of sensory disorders:
Possible technical aids:
Positioning cushions: To support the body, compensate for a lack of strength.
Grab bars or handles: Installed near the bed for support, changing positions.
Adapted vibrators: With ergonomic handles for people with grip difficulties.
Lubricants: Essential in case of vaginal dryness.
Working on communication during intimacy
Expressing limits:
“I’m getting tired, can we take a break?”
“This position hurts me, let’s try another way.”
Expressing desires:
“I like it when you touch me like that.”
“I would like us to try this…”
Reassuring:
“You are not hurting me, keep going.”
“Take your time, there is no rush.”
Using non-verbal signals if verbal communication is difficult:
Signal system with hands, sounds, facial expressions…
Managing practical aspects
Urinary incontinence:
If you have urinary disorders, they can create discomfort during intercourse.
Solutions:
Medications for erection:
If you are taking sildenafil (Viagra), tadalafil (Cialis), or similar:
Organization:
The couple relationship beyond sexuality
Maintaining complicity
Intimacy is not limited to sexual intercourse. The couple’s complicity is nourished by many other elements.
Quality moments together:
Daily signs of affection:
Shared projects:
Preserving each person’s identity
The stroke may have created dependence, but it is essential that each person maintains their own identity.
For the person who had the stroke:
For the caregiving partner:
The danger of total sacrifice:
When the partner completely forgets themselves for the benefit of the care recipient, the relationship becomes unbalanced. Resentment, exhaustion, loss of desire can set in.
It is healthy and necessary for each to preserve their own secret garden and personal spaces.
Seeking external help
Support groups for couples:
Some associations (France Stroke in particular) organize support groups for couples affected by stroke. Sharing with other couples in the same situation can be liberating and reassuring.
Couple therapy:
A couple therapist can help you:
Respite for the caregiver:
Solutions exist to allow the caregiving partner to take a break:
A rested caregiver is a better caregiver and a better partner.
Testimonials from couples
Claire and Didier, 58 and 62 years old
“After Didier’s stroke, our sexual life came to a complete halt. For 6 months, we didn’t try anything. Neither of us dared to talk about it. It was the rehabilitation doctor who brought up the subject. He reassured us: no risk. He advised us to see a sexologist. We were embarrassed at first, but what a relief! She helped us gradually rediscover intimacy. Today, our sexual life is different from before, but it exists again. We have learned to communicate, to dare to say what we like, what we can or cannot do.”
Marc, 51 years old
“My stroke caused erectile dysfunction. I was devastated. For me, it was the end of my manhood. My wife was incredible. She said to me: ‘We will find solutions.’ We consulted a urologist. He prescribed Cialis. It worked. But beyond the medication, the most important thing was knowing that she did not judge me, that she still loved me. We also discovered that there are many ways to please each other without penetration. Our sexuality has become more creative, more complicit.”
Sophie and Julien, 45 and 48 years old
“I became Sophie’s caregiver after her stroke. I helped her with everything: bathing, dressing, meals. After a few months, I realized that I no longer saw her as my wife but as a patient. Our intimate life had disappeared. We talked about it, together and with a psychologist. We decided to delegate some care to a home aide, especially for bathing. It changed our dynamic. I am no longer just the caregiver. We reconnect as a couple. It’s not perfect yet, but we are making progress.”
Training and support
Understanding to live better
The more you understand the impacts of a stroke on intimate and relational life, the better you can anticipate difficulties and find solutions.
DYNSEO offers a comprehensive training on stroke that covers all aspects of daily life after a stroke, including relational dimensions.
This training helps you to:
A guide for caregivers
The partner of a person who has had a stroke also goes through a difficult ordeal. They need information and support.
The guide for supporting people after a stroke is a valuable resource for caregiving partners.
This guide addresses:
Working on oneself
Self-confidence, self-esteem, and stress management are essential elements for regaining a fulfilling intimate life.
CLINT, your brain coach, can help you work on your cognitive abilities, which strengthens your self-confidence and sense of competence.
By progressing cognitively, you feel more “whole,” more capable, and this confidence reflects on all aspects of your life, including intimacy.
Conclusion: Love and intimacy, engines of recovery
The stroke changes everything, but it should not kill love and intimacy. These dimensions are too important to be abandoned or set aside.
What to remember:
Regaining a fulfilling intimate life after a stroke takes time, patience, creativity, and a lot of communication. But it is possible. And it is important.
Your couple relationship, your emotional and sexual life are integral parts of your quality of life and recovery. Do not neglect them. Talk about it. Ask for help. Experiment. Adapt.
Love does not have a single manual. After the stroke, you may have to reinvent your way of loving and being loved. It is a challenge, but it is also an opportunity to rediscover your couple differently, perhaps even more deeply.
Resources exist to support you: the DYNSEO training to understand, the CLINT program to strengthen your confidence, the support guide to support your partner.
You have the right to pleasure, tenderness, intimacy, and love. Never forget that.
Take care of yourself, and take care of your couple.
