A stroke, the condition that occurs when blood supply to the brain is interrupted, is a serious and frightening medical disorder, but it is usually not life threatening. According to Isadore Rosenfeld, M.D., an attending physician at New York Hospital and author of The Best Treatment and many other books, most stroke victims do improve, and some even make a full recovery. Still, the period after someone suffers a stroke (sometimes called a brain attack) requires a tremendous amount of adjustment, not only for the patient but for his or her spouse. "A stroke can be very debilitating, and the recovery period often lasts for months or longer," says Virginia Sadock, M.D., a clinical professor of psychiatry at New York University School of Medicine. Among numerous other concerns, many stroke patients and their partners worry about resuming their sex life. A stroke can interfere with sexual functioning and desire in any number of ways. Some men and women are hesitant to resume sexual activity after a stroke, for fear it will trigger another attack. Some people lose sexual desire after suffering a stroke. Still others may have the desire but experience problems with the "performance" aspects of sex: for men, erection, orgasm and ejaculation; for women, vaginal lubrication and orgasm. Sexual positions that were once comfortable may now prove difficult or impossible. Medications prescribed after a stroke may interfere with sexual drive and functioning. And as with any major illness, there are also psychological factors that can strain a couple’s relationship. Here is a look at some common concerns, along with suggestions on how to cope.

Is it risky to have sex after suffering a stroke? "Sexual activity has not been found to be a factor in causing a stroke," says Robert N. Butler, M.D., professor of geriatrics and adult development at Mt. Sinai School of Medicine in New York, and co-author with Myrna I. Lewis of The New Love and Sex After 60. "It also doesn’t cause more damage in those who have had a stroke." However, depending on the severity of the stroke, it may be awhile before the patient feels well enough to engage in sex, along with other activities that were once routine. If a patient doesn’t feel ready to resume intercourse, he or she can still give and receive sexual pleasure in other ways, like oral sex, mutual masturbation, kissing, and caressing. Why do some stroke victims experience loss of sexual desire? When someone undergoes loss of libido after a stroke, it’s difficult to determine whether the stroke is a direct cause (by affecting parts of the brain that generate messages for sexual response), or if other factors are involved. For example, a study of sexuality in female stroke patients found that more than half reported a decrease in sexual desire. But the researchers also observed that "almost all the women complaining about impaired desire" were being treated with anticoagulant medication, which could have been a factor: Certain medications can have a dampening effect on sexual desire or performance. Interestingly, most of the women reported little or no change in other aspects of their sexual functioning, such as vaginal lubrication and ability to reach orgasm. The researchers, who published their findings in the journal Sexuality and Disability, speculated that the women who experienced loss of libido may have been influenced by emotional factors as well as medication. "Even when sexual functioning is intact," said the researchers, "patients may show decreased desire (because of) anxiety, impaired self-image," depression, or other emotional concerns related to their condition.

How long does it take for sexual desire to return? One study, cited in The Kinsey Institute New Report on Sex, found that male stroke victims, on average, reported a return of sexual interest within six to seven weeks. But obviously, this can vary. A lot depends on the patient’s physical and psychological state during the recovery period. Men and women who continue to experience a loss of libido months after suffering a stroke should see a medical professional, ideally someone who specializes in sexual dysfunction, to determine the causes. If medication is found to be a factor, doctor and patient can work together to see if a different medicine, or dosage, reduces sexual side effects. If the problem is primarily emotional, the patient and his/her partner could benefit from seeing a sex or marriage therapist.

What are a couple’s options when stroke affects sexual functioning? According to Butler, in most cases stroke is more likely to affect sexual performance than desire, "especially in the early period following the stroke." Weakness, paralysis, changes in body awareness, and loss of sensation can all interfere with sexual functioning. So can medications and emotional factors, like depression. The partial paralysis or weakness that some stroke patients experience can make it impossible to engage in lovemaking positions a couple has previously enjoyed. If that is the case for you and your partner, this is the time to experiment with different positions to find the ones that work best for you. There are plenty of options beyond missionary style, and many allow for very gentle movements. Illustrated manuals such as Alex Comfort’s The New Joy of Sex depict a creative variety of positions; mainstream bookstores like Barnes and Noble generally offer a selection in their Relationships or Sexuality section. And of course, sex doesn’t necessarily equal intercourse. There is a whole range of other pleasures to be enjoyed. You and your partner may want to try things you haven’t done before, like slow massage with scented oils, or playing with sex toys. If changes in sexual function continue to present a problem, however, the stroke patient should see his or her physician to determine the cause and possible treatment.

What else can a couple do to cope? It is not uncommon for a stroke patient to be anxious and depressed during the recovery period. He or she may also feel inadequate - sexually and in other ways - and physically undesirable. For these reasons, psychological counseling during this time can be as important as physical care and rehabilitation. Psychotherapy can help the patient deal with sexual problems, but he or she should not neglect to express other concerns, such as fear of having another stroke or being a burden on one’s partner. The healthy partner, who is also faced with great emotional stress, can benefit from therapy as well, either individually or in marital therapy with his or her partner. And whether or not a couple has resumed their sexual life, affectionate touch between partners is extremely beneficial - for both partners. "Physical touch can help people heal," says Sadock. "Even just holding hands can be comforting and therapeutic. And the partner who is the caregiver needs this loving contact as much as the partner who is ill."