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Poststroke Sexual Dysfunction and Quality of Life

1999; Lippincott Williams & Wilkins; Volume: 30; Issue: 10 Linguagem: Inglês

10.1161/01.str.30.10.2238d

1524-4628

Javier Carod, J. Egido, José Luis González, E. Varela de Seijas,

Sexual function and dysfunction studies

HomeStrokeVol. 30, No. 10Poststroke Sexual Dysfunction and Quality of Life Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBPoststroke Sexual Dysfunction and Quality of Life Javier Carod, José Egido, José Luis González and E. Varela de Seijas Javier CarodJavier Carod Stroke Unit, Department of Neurology, San Carlos University Hospital, Madrid, Spain , José EgidoJosé Egido Stroke Unit, Department of Neurology, San Carlos University Hospital, Madrid, Spain , José Luis GonzálezJosé Luis González Stroke Unit, Department of Neurology, San Carlos University Hospital, Madrid, Spain and E. Varela de SeijasE. Varela de Seijas Stroke Unit, Department of Neurology, San Carlos University Hospital, Madrid, Spain Originally published1 Oct 1999https://doi.org/10.1161/01.STR.30.10.2238dStroke. 1999;30:2238–2248To the Editor:We read with great interest the article recently published in Stroke by Korpelainen et al,1 who reported an increasing sexual dysfunction and dissatisfaction with sexual life in stroke patients and their spouses. In that study, poststroke sexual dysfunction in patients was also closely related to the degree of depression as measured by the Geriatric Depression Scale. The authors recognize that a limitation in their study was using only the Rankin scale to score the degree of patients disability.We developed a study to measure the variables (depression, disability, or psychological) that could interfere in the sexual life of stroke survivors and their spouses. During 1997, we followed up for 1 year a cohort of 118 patients consecutively admitted to our Stroke Unit at San Carlos University Hospital in Madrid, Spain. The final series consisted of 90 survivors (41 women and 49 men; mean age 68 years, range 32 to 90 years), of whom 70 had experienced an active sexual life before stroke and had been recruited to participate in our study. They completed a questionnaire that included questions on their prestroke and poststroke sexual function, in addition to the Hamilton Depression Scale,2 the Sickness Impact Profile (SIP),3 the Short Form 36 (SF-36),4 the Barthel Index,5 the Rankin scale,6 the Scandinavian Stroke Scale,7 and the Bamford stroke classification.8 We developed an ANOVA model for statistical analysis.The main outcomes measures were libido, impotence, sexual satisfaction, and disability, measured by Rankin Scale and Barthel Index; depression, measured by Hamilton Scale; Psychosocial Dimension of SIP; SF-36 Vitality; and SF-36 Mental Health. A marked decline in sexual function was reported by 71.5% of the stroke patients at 1 year after stroke (72.7% of women and 70.8% of men who were sexually active before stroke); 48.5% of the stroke patients experienced diminished libido. These data are similar to those in the study conducted by Monga et al,9 who reported diminished libido and erection disorders in 79% and 62% of male stroke patients, respectively.In our study, impotence was diagnosed in 48% of men 1 year after stroke and was correlated with Physical Dimension of the Sickness Impact Profile. Mean value of Physical Dimension was 17.1 in patients with impotence and 8.8 in normal sexually functioning patients (P=0.001).Libido decline was not correlated with stroke etiology, laterality (right/left) of brain lesions, disability measured by Barthel Index, or age. Libido decline was statistically correlated with the Hamilton Depression Scale (mean value scale 17 versus 9.4 in patients without libido decline; P=0.001) and the Psychosocial Dimension of the SIP (mean value 43.7 versus 22.2 in patients without libido decline; P=0.009). SF-36 Vitality and SF-36 Mental Health were statistically significantly diminished in stroke patients with reduced libido.We found no statistically significant differences in the Barthel Index and Rankin scale scores in stroke patients with and without sexual dysfunction (mean score value of 95 versus 90, respectively) 1 year after stroke. Thus, psychological factors seem to exert a strong impact on libido decline in stroke patients 1 year after stroke. Disability and physical functioning exert only a specific impact on impotence, not on sexual dysfunction related to libido decline. Quality of life instruments are useful instruments for studying physical and psychological factors related to poststroke sexual dysfunction. References 1 Korpelainen JT, Nieminen P, Myllylä VV. Sexual functioning among stroke patients and their spouses. Stroke.1999; 30:715–719.CrossrefMedlineGoogle Scholar2 Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry.1960; 23:56–62.CrossrefMedlineGoogle Scholar3 Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Med Care.1981; 19:787–805.CrossrefMedlineGoogle Scholar4 Ware Jr JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36), I: conceptual framework and item selection. Med Care.1992; 30:473–483.CrossrefMedlineGoogle Scholar5 Mahoney PL, Barthel DW. Functional evaluation: the Barthel index. Md St Med J.1965; 14:61–65.MedlineGoogle Scholar6 Rankin J. Cerebral vascular accidents in patients over the age of 60, II: prognosis. Scott Med J.1957; 2:200–215.CrossrefMedlineGoogle Scholar7 Boysen G. The Scandinavian Stroke Scale. Cerebrovasc Dis.1992; 2:239–427.CrossrefGoogle Scholar8 Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet.1991; 337:1521–1526.CrossrefMedlineGoogle Scholar9 Monga TN, Lawson JS, Inglis J. Sexual dysfunction in stroke patients. Arch Phys Med Rehabil.1986; 67:19–22.MedlineGoogle ScholarstrokeahaStrokeStrokeStroke0039-24991524-4628Lippincott Williams & WilkinsResponseKorpelainen Juha T., MD, PhD101999We thank the authors for their comments on our recent article, "Sexual Functioning Among Stroke Patients and Their Spouses."R1 The results of their unpublished data are interesting, with many similarities to our results as well as to those of Monga et al,R2 pointing out the value of psychosocial factors in determining the quality of sexual life after stroke.The SF-36 is a reliable and valid measure of the quality of life of stroke patients, but it is rather long and not easy to use, especially in patients with cognitive deficits. We also used the SF-36 in our previous 6-month prospective study,R3 which describes sexual dysfunction and abnormalities of nocturnal penile erections in 50 acute stroke patients, but found no correlations between sexual dysfunction and the scores on the SF-36. Our experience was that without assistance, cognitively deteriorated stroke patients had difficulty in reliably completing the SF-36 questionnaire. Therefore, we decided not to use the SF-36 in the present studyR1 and focused instead on other aspects of psychosocial functioning. Second, the Finnish version of the SF-36 was not validated until this year.Our impression is that sexual functioning and satisfaction may significantly affect the quality of poststroke life, but further study is still needed to clarify this association. eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Auger L, Aubertin M, Grondin M, Auger C, Filiatrault J and Rochette A (2021) Assessment methods in sexual rehabilitation after stroke: a scoping review for rehabilitation professionals, Disability and Rehabilitation, 10.1080/09638288.2021.1889047, 44:15, (4126-4148), Online publication date: 17-Jul-2022. Singh N and Sandhu I (2019) Absence of Nocturnal Penile Tumescence: An Earlier Sign of Erectile Dysfunction and Its Linked Comorbid Conditions, AMEI's Current Trends in Diagnosis & Treatment, 10.5005/jp-journals-10055-0074, 3:2, (72-76), Online publication date: 18-Jul-2020. Lever S and Pryor J (2016) The impact of stroke on female sexuality, Disability and Rehabilitation, 10.1080/09638288.2016.1213897, 39:20, (2011-2020), Online publication date: 25-Sep-2017. Tibaek S, Gard G, Dehlendorff C, Iversen H, Biering-Soerensen F and Jensen R (2017) Lower Urinary Tract Symptoms, Erectile Dysfunction, and Quality of Life in Poststroke Men: A Controlled Cross-Sectional Study, American Journal of Men's Health, 10.1177/1557988317690283, 11:3, (748-756), Online publication date: 1-May-2017. Greenberg J, Smith K, Kim T, Naghdechi L and IsHak W (2017) Sex and Quality of Life The Textbook of Clinical Sexual Medicine, 10.1007/978-3-319-52539-6_34, (539-572), . Pinedo S, Sanmartín V, Zaldibar B, Erazo P, Miranda M, Tejada P, Lizarraga N, Aycart J, Gamio A, Gómez I and Bilbao A (2016) Calidad de vida a los 6 meses tras un ictus, Rehabilitación, 10.1016/j.rh.2015.08.002, 50:1, (5-12), Online publication date: 1-Jan-2016. Schenk T and Noble A (2014) Better Dead than Alive? Quality of Life After Stroke The Behavioral Consequences of Stroke, 10.1007/978-1-4614-7672-6_13, (241-255), . Hamam N, McCluskey A and Robbins S (2012) Sex after Stroke: A Content Analysis of Printable Educational Materials Available Online, International Journal of Stroke, 10.1111/j.1747-4949.2011.00758.x, 8:7, (518-528), Online publication date: 1-Oct-2013. Soriano Guillén A, Coarasa Lirón de Robles A, Reigada Pérez de Santa Cruz P and Solano Bernad V (2013) Empleo de la escala de calidad de vida para el ictus (ECVI-38) para cuantificar y medir las consecuencias de un ictus. Relación con variables demográficas y clínicas, Rehabilitación, 10.1016/j.rh.2013.06.001, 47:4, (213-222), Online publication date: 1-Oct-2013. Bener A, Al-Hamaq A, Kamran S and Al-Ansari A (2008) Prevalence of erectile dysfunction in male stroke patients, and associated co-morbidities and risk factors, International Urology and Nephrology, 10.1007/s11255-008-9334-y, 40:3, (701-708), Online publication date: 1-Sep-2008. Kim J (2008) Relationship among Sexual Knowledge, Frequency, Satisfaction, Marital Intimacy and Levels of Depression in Stroke Survivors and Their Spouses, Journal of Korean Academy of Nursing, 10.4040/jkan.2008.38.3.483, 38:3, (483), . Black-Schaffer R (2008) Stroke in Young Adults Essentials of Physical Medicine and Rehabilitation, 10.1016/B978-1-4160-4007-1.50152-8, (893-900), . Palmer S and Glass T (2003) Family Function and Stroke Recovery: A Review., Rehabilitation Psychology, 10.1037/0090-5550.48.4.255, 48:4, (255-265) October 1999Vol 30, Issue 10 Advertisement Article InformationMetrics Copyright © 1999 by American Heart Associationhttps://doi.org/10.1161/01.STR.30.10.2238d Originally publishedOctober 1, 1999 PDF download Advertisement