Category: Advancing Modules

• The nurse visits for the third time and asks if it is OK with Les and Jean to enquire how they are both now feeling about their sex life.
• Jean replied ‘it was really helpful to have your advice and although it was different from before Les’ stroke it was good to feel close in this way again.’
• Les added ‘I agree with Jean but would like to ask you about some of the difficulties I had, in particular with my arm, it kept tightening up and getting in the way and also I did have some difficulty getting an erection.’

• During the conversation with the nurse it transpires that Jean thinks that Les’ loss of libido indicates that he is not as interested in her as he was before, and that Les thinks Jean no longer finds him desirable because of his physical limitations.
• After discussion with the nurse they realise that their fears are unfounded. They are reassured that sexual activity is unlikely to cause another stroke.
• On reviewing Les’ medication the nurse discusses the benefits of taking a statin but also mentions that it can also lower libido. She recommends alternative ways of increasing libido for example, timing of sex, and setting the mood, prior to considering medication changes.
• Les and Jean are happy with this information and both feel that discussing these issues with the specialist stroke nurse has been helpful.

The stroke nurse visits for a second time. Again, both Les and Jean are present.

• Les says that he and Jean have talked about wanting to have a closer relationship again. ‘It’s a bit embarrassing but you had said we could discuss this with you.’
• Les and Jean take it in turns to describe the current situation.
• They say that Les does not have the same sexual desires and Jean has noticed this. Although they know that the nurse said it was OK to have sex, they are still worried Les might have another stroke. They are both aware things are not the same.

Two weeks post discharge, the Specialist Stroke Nurse visits Les for the first time. Both Les and Jean are present.

• The nurse brings up the subject (i.e. gives ‘Permission’) of sex by saying that she was aware that Les had had some concerns regarding sexuality whilst in hospital. She offers to discuss this with them just now.
• Les replies that he has been trying to get settled in back at home and that they haven’t really had time to think about sex yet. He is also finding that he is very tired.
• The nurse reiterates the Limited Information that Les was given in hospital; that it is generally OK to resume sex after stroke. She reassures Les and Jean that matters relating to sexuality can be discussed with her at any time.

Les and Jean talked about whether to have further discussions with the hospital team, but Jean suggested they should wait until Les got settled back at home as everything might be fine by then.

The therapist reported back to the MDT meeting, where it was decided that further interventions would be within the domain of the community team. The nurses reported that Les seemed more like his usual self again.