Sex after stroke - what do we need to know? Jo Stevens Sex after stroke - what do we need to know? Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester

Do we talk about sex after stroke? And if we do, do we do it well? Do we feel well equipped to discuss it? Have we had any training? Where do we refer if there’s a problem? Whose job is it anyway? Do people even want to talk about sex?

What does the research say? Mellor et al. (2013)- Healthcare professionals views of discussing sexual wellbeing with patients Not in the policy or pathway to ask Not within the HCP’s role Inappropriate topic to discuss with some people Talking about it may have a psychological effect on the patient Bugicourt et al (2013) found that over a third of people in their study (aged under 60 after stroke or TIA) had impaired sexual function. Kautz (2007) It is not viewed as a rehab goal many HCPs can express or have the language to discuss.

3 questions Do you talk to your patients about sex after stroke? Everyone? If not, how do you decide? Do you ask about sex or just relationships? What professions should bring it up? Is it in your initial assessments? Or anywhere on your pathway? What are the barriers to discussing sex with patients? Embarrassment? Not enough knowledge? Not the right time in the journey? Knowing what to do if there is a problem? What would help you to discuss sex after stroke?

What do the guidelines say? The working party found no new evidence that could form a recommendation. A narrative literature review (Rosenbaum et al, 2014) identified the need for staff training and a structured approach to assessment. New RCP Guidelines 4.14.1 Sex - Recommendations A People with stroke should be asked, soon after discharge and at their 6-months and annual reviews, whether they have any concerns about sex. Partners should also have an opportunity to raise any problems.

Guideline recommendations B People with sexual dysfunction after stroke who want further help should be: ‒ assessed for treatable causes including a medication review; ‒ reassured that sexual activity is not contraindicated after stroke and is extremely unlikely to precipitate a further stroke; ‒ assessed for erectile dysfunction and the use of a phosphodiesterase type 5 inhibitor (e.g. sildenafil); ‒ advised against the use of a phosphodiesterase type 5 inhibitor for 3 months after stroke and/or until blood pressure is controlled; ‒ referred to a professional with expertise in psychosexual problems if sexual dysfunction persists.

What’s missing? What’s missing from the guideline? What other issues might come up? What question do you DREAD?

Resources to help Stroke association leaflet ‘sex after stroke’ www.stroke.org.uk Different strokes leaflet ‘sex after stroke’ www.differentstrokes.co.uk GM SAT easy access toolkit http://clahrc-gm.nihr.ac.uk/wp-content/uploads/GM-SAT_Easy-Access-Toolkit.pdf

What next? Look at it from stroke survivor perspective Gather good resources Find out your local support networks Look at documentation

Comments, questions? Contact: Joanna.Stevens@nihr.ac.uk Thanks Anything else? Comments, questions? Contact: Joanna.Stevens@nihr.ac.uk Thanks