Physical Disability and Sexual Dysfunction among Stroke Survivors

Original Editor - Olufemi Oyewole.

Top Contributors - Olufemi Oyewole, Kim Jackson, Temitope Olowoyeye and Matt Huey  

Introduction

Stroke remains public health issue with attendance sequelae. Stroke is the one of major leading cause of disability1 and this impact stroke survivor’s quality of life2 including their sexual quality of life.

Definition

Physical Disability can be defined as impairment in body structures and functions, activities limitation and participation restrictions (ICF). International Classification of Functioning, Disability and Health (ICF)

Sexual Dysfunction can be defined as low sexual functioning as a result of “decline in libido and coital frequency for both genders, decline in vaginal lubrication and orgasm in females and in erection and ejaculation in males”3.

Physical Disability

Disability is commonly reported among stroke survivors2,4,5. A third of stroke survivors have moderate to severe disability and another third have mild disability5. About 95% of the stroke survivors had moderate/severe global disability4. This disability may lead to hamper community reintegration and participation restriction of community-dwelling stroke survivors6. Focusing on reducing disability during rehabilitation will not only improve quality of life and reduce burden of stroke but will as well enhance self-reliance and productivity1.

Assessment of Physical Disability There are many assessment tools in form of outcome measure to assess physical disability among stroke survivors. Some are regional, general and condition specific (see: Stroke Outcome Measures Overview).

Sexual Dysfunction

Sexuality is an important issue in post-stroke rehabilitation. Most stroke survivors reported low sexual functioning7,8. This dysfunction may be ‘‘a difficulty that occurs during the sexual response cycle that prevents the individual from experiencing satisfaction from sexual activity’’ 9 or dysfunction characterized by pain following sexual intercourse10.

Sexual dysfunctions among stroke survivors are multi-factorial in nature. The cause can be primary, secondary and tertiary in nature. The primary causes include: stroke directly affect sexual functioning e.g. “decline in libido and coital frequency for both genders, decline in vaginal lubrication and orgasm in females and in erection and ejaculation in males”; and medical related sexual problems such as medication and premorbid medical conditions. Secondary causes include: sensorimotor problems which unable the stroke survivors to position themselves during sexual activity. Cognitive, behavioural and psychosocial adjustment issues formed the tertiary causes3.

Assessment of Sexual Dysfunction There are numerous outcome measure tools to assess sexual dysfunction in stroke survivors. The list are not limited to these: International Index of Erectile Function (IIEF), Derogatis Interview for Sexual Functioning (DISF), Changes in Sexual Functioning Short-Form (CSFQ-14), Sexual Function Questionnaire (SFQ), Arizona Sexual Experience Scale (ASEX), Sexual Satisfaction Scale for Women (SSS-W), Sexual Self-Perception and Adjustment Questionnaire (SSPAQ), etc3,11.

Management

Management of physical disability

One of the goals of rehabilitation post stroke is to reduce disability to achieve maximum function and participation. There are several means of achieving this through physical therapy intervention. The role of physical activities cannot be over emphasised in improving function and reducing disability (Stroke: The Role of Physical Activity; Physical Activity in Individuals with Disabilities).

Management of sexual dysfunction3

• pharmacological interventions

• non-pharmacological interventions such as: mechanical devices (e.g. vacuum pumps, penile implants, penile prostheses and lubricating gels); psycho-educational interventions (e.g. counselling and psychotherapy); physical therapy (e.g physiotherapy for bed mobility)

• complementary medicine interventions

Resources

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