|Year : 2018 | Volume
| Issue : 3 | Page : 127-129
Erectile dysfunction in cerebrovascular stroke patients
Emad E.K. Ali1, Tarek A Sayed Rageh2, Ahmed A. A Abdel Mageed3, Doaa A Sayed Mahdy4
1 Department of Andrology, Sexology STD, Faculty of Medicine, Assiut University, Asyut, Egypt
2 Department of Neuropsychiatry, Faculty of Medicine, Assiut University, Asyut, Egypt
3 Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Assiut University, Asyut, Egypt
4 Department of Dermatology and Andrology, El Biadya Central Hospital, Luxor, Egypt
|Date of Submission||25-Dec-2018|
|Date of Acceptance||10-Feb-2019|
|Date of Web Publication||14-Mar-2019|
Doaa A Sayed Mahdy
Department of Andrology, Sexology and STD, Faculty of Medicine, Assiut University, Asyut
Source of Support: None, Conflict of Interest: None
Erectile dysfunction is a common problem in cerebrovascular stroke patients. It may have a significant impact on the quality of life of sufferers and their partners. Consequential to stroke is often low self-esteem, depression, anxiety, rejection by a partner or spouse, impotence, problems communicating due to aphasia or unwillingness to communicate, and role changes. Mobility problems, fatigue, previous illnesses, and medication also have a negative effect on sexual activity. However, it is often neglected during rehabilitation along with the psychological issues that may affect sexual dysfunction.
Keywords: cerebrovascular stroke, erectile dysfunction, sexual dysfunction
|How to cite this article:|
Ali EE, Sayed Rageh TA, Abdel Mageed AA, Sayed Mahdy DA. Erectile dysfunction in cerebrovascular stroke patients. J Curr Med Res Pract 2018;3:127-9
|How to cite this URL:|
Ali EE, Sayed Rageh TA, Abdel Mageed AA, Sayed Mahdy DA. Erectile dysfunction in cerebrovascular stroke patients. J Curr Med Res Pract [serial online] 2018 [cited 2019 Mar 19];3:127-9. Available from: http://www.jcmrp.eg.net/text.asp?2018/3/3/127/254201
| Body|| |
Erectile dysfunction (ED) is the inability to attain and maintain an erection sufficient for satisfactory sexual performance. Although a benign disorder, it can have a significant impact on the quality of life of sufferers, partners, and their families. It is also important to consider the physical and psychosocial health of the person who has the condition. Patients should be properly assessed and investigated before embarking on a treatment.
ED is a male health problem of global dimensions and is a symptom of many clinical conditions and certain risk factors.
The prevalence of ED varies widely in studies from different countries. It was estimated to be 18.4% in men aged more than or equal to 20 years in the USA, 49.4% in Canada, and 63.6% in Hong Kong. In a study in Qatar the prevalence of ED among Qatari patients was 66.2% among hypertensive patients and 23.8% among nonhypertensive controls.
Aging, vascular insufficiency, psychogenic and neural disorders, systemic illness such as diabetes mellitus, hormonal derangement, and side-effects of medications may result in ED. ED has a profound negative impact on the quality of life and on a person's self-esteem.
The cerebral cortex influences sexual arousal and response and the limbic system and hypothalamus play an important role in the integration and control of reproductive and sexual functions.
Cerebrovascular stroke is a rapidly developing clinical sign of brain dysfunction due to focal or global disruption with symptoms that last for more than or equal to 24 h and can cause death, without any other cause other than vascular.
It occurs when part of the brain does not receive the needed blood flow for one of two reasons: either the blood supply to part of the brain is suddenly interrupted (ischemia), or because a blood vessel in the brain ruptures and blood invades the surrounding areas (hemorrhage). The brain is the central information-processing organ of the body responsible with the control of multiple complex functions.
In 2010, the worldwide prevalence of this disease was 33 million, with 16.9 million people having a first stroke. This condition kills nearly 129 000 people a year, it is considered the no. 5 cause of death and the leading cause of adult disability.
The sequelae of stroke include dysphasia, hemiparesis, changes in cognition, and changes in the ability to express emotions, all of which may impact the ability of a stroke survivor to perform activities of daily living, including sexual activity. In this sense, neurological disorders are frequently responsible for sexual disorders. Their impact can be major and could rank first in the concerns of patients with a neurological handicap. Consequently, impaired sexual activity is common after ischemic stroke. Therefore, ED is a common sequela after stroke.
Stroke lesions may disturb central autonomic network structures and pathways that contribute to erection and physical impairment such as motor weakness, spasticity, bladder, or bowel dysfunction may constitute physical handicaps of sexual activity,.
Research into poststroke sexuality has found a high prevalence of sexual changes across a diverse range of countries, despite the potential for very different sexual attitudes and beliefs between these cultures. In a study involving Nigerian stroke survivors attending a physiotherapy clinic, Akinpelu et al. found that 94.8% of the participants reported dysfunction. Similar findings have been found in stroke survivors in Turkey and Korea.
Depression is common after stroke and anxiety, apathy, and emotional lability are also observed in some individuals. These mood difficulties sometimes appear to be related to the location of a stroke, and in others appear to be a reaction to the experience of having a stroke and its consequences. Stroke survivors who experience depression appear to be more likely to have sexual issues poststroke. Akinpelu et al. found depression had a significant impact of poststroke sexual functioning and depressed individuals were more likely to experience sexual dissatisfaction and ED.
Problems with sensation are other factors which affect sexual dysfunction. Fatigue may reduce autonomy and cause feelings of guilt and also the patient's outward appearance, in particular facial asymmetry and drooling, may cause problems and reluctance for physical contact with their spouse. Vander et al. suggest that there is a relationship between poststroke fatigue and depression.
New medications such as centrally acting antihypertensive agents, β-blockers and potassium sparing diuretics, or antidepressants may have side effects that deteriorate sexual function,.
β-Blockers and diuretics have the most negative effects on sexual performance with ED being associated with propranolol and thiazide diuretics.
Antidepressants, anticonvulsants, and antihypertensives have been shown in a few studies to affect sexual dysfunction following stroke.
Dysfunction increases with age, the common risk factors being general health, psychiatric and psychological disorders, and sociodemographic conditions.
Increased weight, diabetes, and cardiovascular disorders are also associated with impaired sexual functioning. Bener et al. found that the risk of poststroke ED increased with age, obesity, presence of hypercholesterolemia, diabetes and hypertension and use of associated medications.
Tamam et al. found that an inability to discuss sexuality with their partners was explanatory for the decline in coital frequency and sexual satisfaction, along with unwillingness for sexual activity. Cognitive impairments may impact negatively the sexual life of a couple and change how a partner views the stroke survivor.
Systemic disorders lead to decreased libido and ED by affecting the sexual function in men. Hormonal imbalances in systemic disorders are thought to arise from the testes or the hypothalamic–pituitary–testicular pathway.
Loss of sexual desire and function has been associated with decreased testosterone levels, which along with a decrease in libido and erectile function in men are also caused by aging. Sexual dysfunction can manifest as problems with physical performance (e.g. ED in men) or as problems with reduced sexual desire or arousal, inability to achieve orgasm, discomfort during sex, anxiety about performance, or sex not being pleasurable.
Early hospital admission may reduce the potential negative consequences of a stroke. The development of thrombolysis treatment has also increased the proportion of individuals who survive a stroke. Health professionals should provide opportunities for patients to express their emotions following a stroke and should initiate the topic of poststroke sexuality. In this way, it is important to use the assessment tools which can be easily used in practical configuration and can provide a starting point for sexual counseling; in addition, it may indicate a desire for additional information and advice from health professionals.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
San Martín C, Simonelli C, Sønksen J, Schnetzler G, Patel S. Perceptions and opinions of men and women on a man's sexual confidence and its relationship to ED: results of the European Sexual Confidence Survey. Int J Impot Res 2012; 24:234–241.
Williams P, Bandhoo S, McBain H, Mulligan K, Steggall MJ. Erectile dysfunction and its detection in the healthcare setting: 10 years on. Int J Clin Pract 2015; 69:910–911.
Selvin E, Burnett AL, Platz EA. Prevalence and risk factors for erectile dysfunction in the US. Am J Med 2007; 120:151–157.
Grover SA, Lowensteyn I, Kaouache M, Marchand S, Coupal L, DeCarolis E, et al
. The prevalence of erectile dysfunction in 5. the primary care setting. Arch Intern Med 2007; 166:213–219.
Siu SC, Lo SK, Wong KW, Ip KM, Wong YS. Prevalence of and risk factors for erectile dysfunction in Hong Kong diabetic patients. Diabet Med 2001; 18:732–738.
Bener A, Al-Ansari A, Al-Hamaq AO, Elbagi IE, Afifi M. Prevalence of erectile dysfunction among hypertensive and nonhypertensive Qatari men. Medicina (Kaunas) 2007; 43:870–878.
Lue TF. Erectile dysfunction. N Engl J Med 2000; 342:1802–1813.
Stein J, Hiillinger M, Harvey L, Clancy C, Bishop L Sexuality after stroke: patient counseling preferances. Disabil Rehabil 2013; 35:1842–1847.
Sacco RL, Kasner SE, Broderick JP, Caplan LR, Culebras A, Elkind M, et al
. An updated definition of stroke for the 21st
century. Stroke 2013; 44:2064–2089.
Adams H. Guidelines for the early management of adults with ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation 2007; 116:515.
Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al
. Heart disease and stroke statistics – 2012 update: a report from the American Heart Association. Circulation 2012; 125:2–220.
Steinke EE, Jaarsma T, Barnason SA, Byrne M, Doherty S, Dougherty CM, et al
. Sexual counselling for individuals with cardiovascular disease and their partners: a consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP). Eur Heart J 2013; 34:3217–3235.
Denys P, Soler JM, Giuliano F. Sexuality of men with neurologic disorders. Prog Urol 2013; 23:712–717.
Bugnicourt JM, Hamy O, Canaple S, Lamy C, Legrand C. Impaired sexual activity in young ischaemic stroke patients: an observational study. Eur J Neurol 2014; 21:140–146.
Tibaek S, Gard G, Dehlendorff C, Iversen HK, Erdal J, Biering-Sørensen F, et al
. The effect of pelvic floor muscle training on sexual function in men with lower urinary tract symptoms after stroke. Top Stroke Rehabil 2015; 22:185–193.
Pistoia F, Govoni S, Boselli C. Sex after stroke: a CNS only dysfunction ? Pharmacol Res 2006; 54:11–18.
McMahon CG. Erectile dysfunction. Intern Med J 2014; 44:18–26.
Akinpelu AO, Osose AA, Odole AC, Odunaiya NA. Sexual dysfunction in Nigerian stroke survivors. Afr Health Sci 2013; 13:639–645.
Tamam Y, Tamam L, Akil E, Yasan A, Tamam B. Post-stroke sexual functioning in first stroke patients. Eur J Neurol 2008; 15:660–666.
Jung JH, Kam SC, Choi SM, Jae SU, Lee SH, Hyun JS. Sexual dysfunction in male stroke patients: correlation between brain lesions and sexual function. Urology 2008; 71:99–103.
Kim JH, Kim O. Influence of mastery and sexual frequency on depression in Korean men after a stroke. J Psychosom Res 2008; 65:565–569.
Giaquinto S, Buzzelli S, Di Francesco L, Nolfe G. Evaluation of sexual changes after stroke. J Clin Psychiatry 2003; 64:302–307.
Van der Werf SP, van den Broek LPH, Anten WM, Bleijenberg G. Experience of severe fatigue long after stroke and its relation to depressive symptoms and disease characteristics. Eur Neurol 2001; 45:28–33.
Billups KL. Erectile dysfunction as an early sign of cardiovascular disease. Int J Impot Res 2005; 17 (Suppl 1):19–24.
Rees PM, Fowler CJ, Maas CP. Sexual function in men and women with neurological disorders. Lancet 2007; 369:512–525.
Bener A, Al-Hamaq AO, Kamran S, Al-Ansari A. Prevalence of erectile dysfunction in male stroke patients, and associated co-morbidities and risk factors. Int Urol Nephrol 2008; 40:701–708.
Wylie K, Kenney G. Sexual dysfunction and the ageing male. Maturitas 2010; 65:23–27.
Kautz DD, van Horn ER, Moore C. Sex after stroke: an integrative review and recommendations for clinical practice. Crit Rev Phys Rehabil Med 2009; 21:99-115.
Banks P, Pearson C. Parallel lives: younger stroke survivors and their partners coping with crisis. Sex Relationsh Ther 2004; 19:413–429.
Karadag F, Ozcan H, Karul AB, Yilmaz M, Cildag O. Sex hormone alterations and systemic inflammation in chronic obstructive pulmonary disease. Int J Clin Pract 2009; 63:275–281.
Collins EG, Halabi S, Langston M, Schnell T, Tobin MJ, Laghi F. Sexual dysfunction in men with COPD: impact on quality of life and survival. Lung 2012; 190:545–556.