(Stroke. 1999;30:2238-2248.)
© 1999 American Heart Association, Inc.
Letters to the Editor |
Poststroke Sexual Dysfunction and Quality of Life
Stroke Unit, Department of Neurology, San Carlos University Hospital, Madrid, Spain
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To 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.
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1. Korpelainen JT, Nieminen P, Myllylä VV. Sexual functioning among stroke patients and their spouses. Stroke. 1999;30:715–719.
2. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.
3. 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.[Medline] [Order article via Infotrieve]
4. 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.[Medline] [Order article via Infotrieve]
5. Mahoney PL, Barthel DW. Functional evaluation: the Barthel index. Md St Med J. 1965;14:61–65.
6. Rankin J. Cerebral vascular accidents in patients over the age of 60, II: prognosis. Scott Med J. 1957;2:200–215.[Medline] [Order article via Infotrieve]
7. Boysen G. The Scandinavian Stroke Scale. Cerebrovasc Dis. 1992;2:239–427.
8. 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.[Medline] [Order article via Infotrieve]
9. Monga TN, Lawson JS, Inglis J. Sexual dysfunction in stroke patients. Arch Phys Med Rehabil. 1986;67:19–22.[Medline] [Order article via Infotrieve]
Response
Department of Neurology, University of Oulu, Oulu, Finland
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We thank the authors for their comments on our recent article, "Sexual Functioning Among Stroke Patients and Their Spouses."1 The results of their unpublished data are interesting, with many similarities to our results as well as to those of Monga et al,2 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,3 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 study1 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.
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References |
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TopIntroductionReferencesIntroduction References |
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1. Korpelainen JT, Nieminen P, Myllylä VV. Sexual functioning among stroke patients and their spouses. Stroke. 1999;30:715–719.
2. Monga TN, Lawson JS, Inglis J. Sexual dysfunction in stroke patients. Arch Phys Med Rehabil. 1986;67:19–22.
3. Korpelainen JT, Kauhanen M-L, Kemola H, Malinen U, Myllylä VV. Sexual dysfunction in stroke patients. Acta Neurol Scand. 1998;98;400–405.
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