Poststroke Sexual Function
To the Editor:
We read with great interest the recent article by Korpelainen et al.1 Despite the fact that the majority of their patients reported a marked decline in all the measured sexual functioning, there was increased libido in 19 of their 192 patients. These patients did not differ from other patients as to the site of the lesion, as reported before.2 3 4 However, no information was presented about intercourse frequency, deviant sexual behavior, or spousal satisfaction.
We have recently seen a 69-year-old right-handed man, who presented with acute left hemiplegia. His medical history was significant for coronary artery disease diagnosed 6 years before this admission. He had stopped smoking and drinking alcohol since that time. His examination showed dense left hemiplegia, and CT showed massive infarction involving the entire right middle cerebral artery territory.
Three months after the ictus, he was walking with a cane; his arm, however, showed no improvement. His wife complained that he became hypersexual and wanted to have sexual intercourse daily. She denied any deviated sexual behavior; socially, his behavior was appropriate. She stated that before ictus they had intercourse every 2 weeks and she is now unsatisfied with her husband’s behavior.
The patient at that time was not on any drugs reported to increase sexuality.5 Seven months later, the patient developed poststroke seizures, and 3 years later he died of acute myocardial infarction.
This case is different from the other reported cases in that the hypersexuality developed before the seizures, and the involvement of the frontal, temporal, and basal ganglia regions occurred at the same time.
As Korpelainen et al1 stated, sexual counseling after stroke is needed for the patients and their spouses. Direct questioning is usually needed, as most of the patients will not disclose their sexual problems spontaneously.
- Copyright © 1999 by American Heart Association
Korpaelainen JT, Nieminen P, Myllyla VV. Sexual functioning among stroke patients and their spouses. Stroke. 1999;30:715–719.
Libman RB, Wirkowski EJ. Hypersexuality and stroke: a role for the basal ganglia. Cerebrovasc Dis. 1996;6:111–113.
Miller B, Cummings J, McIntyre H, Ebers G, Grode M. Hypersexuality or altered sexual preference following brain injury. J Neurol Neurosurg Psychiatry. 1986;49:867–873.
We thank Hamed et al for their interesting comments regarding our article.R1 Hypersexualism related to cerebral lesions is an interesting phenomenon that has been associated particularly with temporal lobe lesions and temporal lobe seizures. Its pathophysiology is not yet clearly known, however. In their classic study, Klüver and BucyR2 described behavioral changes resulting from bilateral temporal lobectomies in rhesus monkeys. These changes included increased sexual activity, marked changes in dietary habits, and antisocial behavior. Terzian and OreR3 reported that bilateral removal of human temporal lobes may result in symptoms similar to Klüver and Bucy’s syndrome.
It also seems that stroke may sometimes increase libido and sexual activity leading rarely to hypersexuality, as Hamad et al and other authors have previously reported.R4 R5 R6 It is still unclear whether this is related to epileptic activity or to the cerebral lesion itself.
In our study, all the patients and their spouses independently completed a questionnaire that included their prestroke and poststroke sexual functions and habits. Interviews were not used. Nineteen of our 192 stroke patients reported increased libido after the stroke in comparison with the prestroke libido, but as far as we know, none of these patients suffered from a real hypersexuality. Interestingly, many of these patients and their spouses also reported increased satisfaction with their sexual life, in contrast to the majority of other patients and spouses reporting dissatisfaction with their poststroke sexual life. Therefore, it seems that increased libido after the stroke may sometimes improve the quality of sexual life. We suggest that this may be caused by improved relations between the patient and the spouse or by other positive changes in psychosocial elements.
In future, the phenomenon of poststroke hypersexuality should be studied using qualitative (ie, interviews) instead of quantitative studying methods to obtain more information about its psychological and social significance. In addition, modern functional brain imaging techniques could be used to study its pathophysiology.
Korpelainen JT, Nieminen P, Myllylä VV. Sexual functioning among stroke patients and their spouses. Stroke.. 1999;30:715–719.
Terzian H, Ore GD. Syndrome of Klüver and Bucy reproduced in man by bilateral removal of temporal lobes. Neurology (Minn.). 1955;5:373–380.
Miller BL, Cummings JL, McIntyre H, Ebers G, Grode M. Hypersexuality or altered sexual preference following brain injury. J Neurol Neurosurg Psychiatry.. 1986;49:867–873.