Different strokes... after a stroke
Do brain-attack survivors have to give up sex for the rest of their lives?
The idea of sex after surviving a stroke could strike some as silly, but it could be the best thing to help a patient on the road to recovery.
Even just holding hands can boost the [stroke patient's] self-esteem, which is the most important thing to remember," said psychiatrist Maria Rocio Valdes-Cabio of St. Luke's Medical Center (SLMC) and the National Center for Mental Health.
She defined sex as "not just the act itself, it should comprise of two willing adults (in our culture, of course, it is supposed to be with the spouse) who share intimacy and love." It is that intimacy that acts as the foundation of a stroke patient's well-being.
Even for spouses or partners of those who have not had a stroke, it is important to set the mood for love. For stroke patients, convincing them to be receptive to intimacy is vital.
"What activities you do prior to the act itself, like [setting up] a romantic room, [wearing] aromatic fragrances, [having] good food and music, [communicating through] body language--all play a role in the success of intimacy," Cabio said.
She said emotional well-being is a key ingredient to a good recovery after a stroke. "Without a positive outlook, a person will not have the willpower to help himself,"
Some stroke patients who feel despondent about the future often exhibit "poor compliance with medication [and] serious problems with cooperation [when they are undergoing rehabilitation]," Cabio said.
This behavior could lead to the patient starting fights with his or her caregivers--usually the immediate family--and causes "more stress, start of depression and feelings of helplessness and worthlessness, more somatic complaints, and an overall sense of despair in the immediate environment," she warned. "You know how hard it is for [a patient's] loved one to see the patient [waste away] after they have given them the best medical treatment just because the patient has major depression."
Finally, Cabio said, it is important for the people taking care of the patient "to be well-informed of the possible obstacles to recovery. The next is to know where to find help. Other people have gone through the experience and, with the help of professionals trained in poststroke management--like the whole team at SLMC's Acute Stroke Unit--a patient can find easier ways to deal with his individual problems after the stroke."
Not cut-and-dried
Cabio said doctors cannot have a cut-and-dried approach in treating stroke patients because each one, before the stroke, has a unique personality that "may or may not have changed during or after the stroke process so the little personality changes that may happen does not immediately constitute depression," which is nevertheless common in stroke survivors.
She said some patients may not go through depression, but their relatives could actually suffer from depression or anxiety and adjustment problems.
She recommends that patients and their relatives acknowledge that "there will be a mourning process because something was lost," referring to the physical disability that follows a stroke.
"Definitely, emotionally, there will be changes. The patient could be scared, and so could their relatives or spouse," Cabio said.
To lessen the feelings of guilt often felt by relatives of stroke patients, which can affect their recovery process, she said they should try to know more about stroke and what they can do once it happens.
"We have medications that really, really work specially if the patient is rushed to the hospital as soon as possible," she said.
Cabio also recommends that patients, their relatives, and caregivers attend the Life After Stroke (LAFS) seminar conducted by the Stroke Society of the Philippines (SSP). The three-day workshop covers all aspects of stroke from recovery, alternative foods for stroke patients, myths and misconceptions, intimacy, and other topics.
The society conducts the seminar at SLMC and the Philippine Heart Center and is trying to expand it to the provinces.
Life after stroke
Neurologist Cristina San Jose of SLMC, meanwhile, said the point emphasized by the SSP is that there is life--and love--after a stroke.
"We ask them to go back to as much normal life as possible. Sex is part of life," she said, adding that common questions from patients include whether they could still drive, resume work, and do other activities that are "part of daily living."
While many factors will determine a patient's recovery after a stroke, San Jose said it is possible for patients to resume their usual activities--including sex. However, she cautioned that "there might be some limitations …because of the disability that results from the stroke."
The patient and his or her partner may have to alter their sexual style, she said, since "there are some positions that might not be safe because of the disability or [might be] too strenuous," and they might also try having the patient's partner be the active one in bed.
She also cautioned that sex can be stressful on the heart, and recommends that a patient be guided by a physical therapist in determining if his or her body can withstand the rigors of sex.
As for the sensations a patient may feel during sex, San Jose said it depends on the severity and site of the stroke. She explained that after a stroke, a patient may suffer from "motor and sensory abnormalities," such as numbness and muscle weakness or both.
"It really depends on what part of the brain is affected," she added.
A stroke can also affect a patient's understanding of his or her surroundings, and even feelings toward something or someone can change. However, San Jose said even patients whose cognitive processes have been severely affected have "a chance for recovery" within six months. After this period, recovery continues but at a slower rate.
Having a stroke can also be a factor in erectile dysfunction because a male patient can have low self-esteem, feel that he is no longer physically attractive, or fear that he might have another stroke while having sex.
For San Jose, emotions are very important to a patient's recovery.
"Part of healing is accepting what happened. If you want to really recover, it's your responsibility and [that of] those around you," she said.
A team of health professionals is usually needed to help a patient recover from stroke. This team is usually composed of doctors (neurologist, psychiatrist) a nurse, a physical therapist, and a nutritionist who monitor the patient's progress from the first day of confinement onwards.
San Jose said doctors treating stroke patients also have to look at other conditions and risk factors their patients may have, which can be different depending on age and sex.
"Mortality [from stroke] is higher in females," she said, adding that doctors have yet to find out why. She speculates that the better care given male patients could be a factor.
Deanna Morales
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