Friday, Mar 16, 2012 12:00 AM UTC

Sex after a stroke

"Am I Normal?": A woman whose husband is recovering from a brain hemorrhage wants to reignite their love life

Am I normal?

 (Credit: Yuri Arcurs via Shutterstock)

Dear Tracy,

My husband had a stroke last summer (a brain hemorrhage) at 35 — coincidentally, I noticed something was wrong right after we had sex. He survived with some relatively minor mobility problems and some issues with aphasia (speech problems) and we’re attempting to get our lives back together after a week in the ICU, five weeks inpatient rehabilitation, and several months of outpatient rehabilitation.

I am certainly not blaming the stroke on sex (although the EMTs sure had a field day with the information!), but I am having trouble getting back into having a sex life. For so many weeks and months, I was solely in charge of everything: schedules, medication, work, food, finances — the whole deal. Being sick, particularly with neurological deficits, unfortunately tends to infantilize a person to a certain degree, and I’m having some trouble coming away from the role as Sole Adult in Charge of Everything.

In addition, since he still has little feeling and some mobility problems on his right side, sex seems more like therapy than, well, just sex (that is, I sometimes come away with bruises since he doesn’t realize he’s elbowed me in the ribs or whatever).

In short, in the past nine months I’ve had one orgasm.

What can I do to move away from the more parental role and back into the role of wife and sex partner? And how can I manage this while minimizing his overwhelming feelings of guilt (for “ruining” everything about our lives, including our sex life)?

Thanks for any advice on the matter.

Oh honey, I’m so sorry. What a thing you’ve gone through, and are continuing to go through. Most couples struggle with keeping passion alive in their relationship — and many women’s sex lives are cooled by caretaker feelings — but you’re facing these issues very early and in especially unfortunate circumstances.

What’s remarkable to me, standing here on the outside at a far remove, is that you not only have a sense of humor about what’s happened, but you’re also taking action to make sure that things improve. My guess is that, hard as it was, you did pretty damn well as the Sole Adult in Charge of Everything. I can picture you cringing at these words, but: It’s impressive. Pat yourself on the back, woman.

Luckily, I come bearing good news. There is a tremendous amount of resources out there that can help you, and I’ve rounded up a couple of experts to weigh in on your particular case.

William Finger, a clinical psychologist and president of the American Association of Sexuality Educators, Counselors and Therapists, says communication about sex is the most important issue here. Of course, your husband’s speech problems complicate what is already a challenge for most couples — but communication is essential to everything from preventing him from accidentally bruising you during sex to understanding the particular challenges, fears and insecurities each other are experiencing.

Donald D. Kautz, a registered nurse and professor of nursing who has written extensively on the topic of post-stroke sex, asks whether your husband is working or has somewhere to go during the day. “The more independent he can become, including activities on his own, often helps the ‘caregiving’ partner feel less like a caregiver and both feel more like lovers,” he says. “Many couples report that getting involved in outside activities makes them feel better about themselves, which transfers over into the bedroom.” (And, might I add, that’s often true, regardless of whether a stroke is involved.)

You might want to try scheduling sex, setting aside a time removed from your caretaking routine. I know, I know, the idea of scheduling nookie is routinely viewed as sad and unsexy, but Finger says, “Nobody has spontaneous sex, except many when they first meet.”

As for the nitty-gritty of your bedroom happenings, there are several positions that should be more comfortable and hopefully prevent bruising. Sex with you on top — cowgirl, reverse cowgirl, him in a chair, whatever you please — is the most obvious option. (Again, something that’s awesome, stroke or not.) Kautz sent me a guide to positions that are ideal for those dealing with a chronic illness or disability; while they might not apply directly to you, I wish I could link to it, because the illustrations were an inspiring testament to the way sex can remain fun through injury and old age. They show an elderly couple in various convenient coital arrangements, and it seems a reflection — a NSFW reflection, sure — of lasting love. You can find another, less tear-jerky guide here.

To the issue of his lack of sensation on the right side of his body: You’ll want to focus more attention on his left side — but, duh, you probably already figured that. Optimistically speaking, this does force you guys to slow down and discover anew which sensations feel best — and not just for him. The issue of your own pleasure is crucial here too. Kautz recommends asking for “more direct genital stimulation, through touch, cunnilingus, or a vibrator.” (Again, advice worthy of all women.) He adds, “Making sure that she has an orgasm first may make sex seem less like therapy — and much closer to what intimacy was like before he had the stroke.” (At least we can hope that’s what it was like!)

Finally, I know this is annoying advice, but you should check out both online and local resources for stroke survivors. Kautz points out that you might not have much in common with those who show up to a nearby “stroke club” meeting, seeing as most could be your grandparents, but the medical professionals who run the thing should be a great connection. There are countless respectable online resources about sex after a stroke — try this comprehensive guide, for starters — that cover far more ground than I can in this column.

Good luck to you both, and have fun.