- This is aimed at solving the patient’s individual, specific problems
- Not all health professionals would be expected to engage with this stage of the model
- Any health professional who is able to address this stage needs to have a full history of problems and influencing factors
- Suggestions would include problem solving, education, compensating strategies, referral for help to e.g. GP, Urology, Sexual Dysfunction Nurse, Couples Counselling, Psychology
For a reminder about the ‘Specific Suggestions’ part of the PLISSIT model, see the Additional Information Box below.
Fear of rejection
Specific Suggestion: This may be part of broader anxieties following stroke and related to complex factors such as loss of role and status, self identity and relationship changes. Referral to a specialist such as relationship counselling for further assessment may be helpful if this persists.
Altered body image
Specific suggestion:This may be seen as part of the broader adjustment process. Referral to psychology may be helpful if difficulties with body image persist.
Medication
Specific Suggestion: Reiterate the Limited Information already given such as antihypertensives can cause erectile problems, statins can reduce libido, antidepressants can cause loss of libido and increase fatigue, women using HRT will have to stop doing so and face the return of menopausal symptoms, someone who has used the combined pill for contraception will need to discuss an alternative method. Suggest discussing with their prescribing health professional.
Fear of inadequate performance
Specific Suggestion: Discuss with couple focusing on taking things a step at a time for example start with kissing, cuddling etc. Discuss effects of medication. Look at the environment – suggest a romantic setting. This fear may contribute in its own right to inadequate performance so some adjustments that increase relaxation may make it a different experience but just as good as before.
Fear of another stroke
Specific Suggestion: It is very rare for a stroke to happen during sexual activity. Sex only affects blood pressure (BP) in the same way as exercise does e.g. BP will only increase as much as climbing a flight of stairs and comes down again very quickly.
Tiredness
Specific Suggestion: There is little more that would be regarded as Limited Information i.e. discuss timing of sexual activity (AM or PM when less tired, beginning/end of week). May need to consider changing position normally used to allow the person who has had a stroke to conserve energy. Discuss intimacy without intercourse.
Communication
Specific Suggestion: if this continues to be a problem consider referral of couple to a psychologist or counsellor.
Loss of libido
Specific Suggestion: Discuss tiredness/fatigue; effects of medication; fluctuations of mood as detailed in Limited Information but in a more individualised way, for example may require referral to GP for discussion about medication.
Page last reviewed: 10 Feb 2021
