Sexual dysfunction after stroke—A biopsychosocial perspective

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Abstract
Objectives Post‐stroke sexual dysfunction (PSSD) is widespread and under‐recognized, affecting over half of stroke patients with significant effects on a patients’ quality of life. We reviewed the postulated factors contributing to PSSD and explore the under‐recognition by presenting a questionnaire study as well as examining existing literature. Methods A literature search between January 1980 and December 2019 in electronic databases such as EMBASE, MEDLINE and PubMed was conducted. The questionnaire study involved all adult stroke patients attending the outpatient clinic over a 6 months period, containing multiple choice and open questions relating to prevalence, impact and provision provided for patients with PSSD. Findings PSSD is unlikely attributed solely to the physical effects of stroke. We present a biopsychosocial model summarizing the wide range of factors which can contribute to PSSD. Less than 10% of patients receive any advice despite 90% of patients hoping for advice relating to sexual dysfunction in stroke. Interpretation and Implications A multidisciplinary, proactive involvement in screening and managing PSSD is required to successfully manage a commonly forgotten complication of stroke. As part of the wider theme of managing lifestyle factors post stroke (e.g. smoking, driving advice dietary advice, alcohol), the ‘sexual function aspect’ of patients’ lives must not be ignored.

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