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Ask Kate: Let’s talk about sex!



Dr Kate Allatt is a stroke survivor, internationally published author, charity founder, GripAble ambassador and inspirational leadership speaker.

As we enter so-called ‘Divorce Month’ Kate asks: Should occupational therapists be doing more to address sex and intimacy after stroke? 

Intimacy in relationships is a basic human need and one that is all too often non-existent for young people after their stroke.

Imagine a lifetime of intimacy abstinence because you’ve lost your body confidence or self-worth. What if your partner is sex obsessed but you feel put off or your partner just can’t make the step change from carer back to lover?

Just imagine how utterly sad, worthless, invisible and lonely this can be for so many stroke survivors and their partners who suffer silently in the community.

One husband even commented that it ‘feels like it’s like having sex with a dead body’ after his wife’s stroke.

Others worry that they want to go for a wee when they orgasm because they’ve developed undiagnosed coital incontinence.

Some service users report no change to their sex lives after stroke on my closed Facebook groups, though this is unusual.

So it raises the question: do many occupational therapists actually start conversations with stroke survivors and their partners about the tricky subject of intimacy and sex after stroke?

I can answer that – no.

Why? Because it’s embarrassing and talking sex is taboo for many therapists and service users.

There appears to be a lack of training on the subject for occupational therapists. Indeed, perhaps there are some ownership issues over which therapist on the MDT should even be talking about sex.

Yet sex is at the core of our very evolution. We know that intimacy and sex are good for our physical and mental wellbeing. Sexual health is an essential part of patient-centred holistic care.

Dr Kate Allatt

Service users often expect the therapist to start the conversation on intimacy and sex issues after stroke, yet, in many cases, therapists expect patients to talk about the intimacy difficulties.

Perhaps occupational therapists assume there are no intimacy and sexual issues if they are not mentioned? I’m sure there must be health inequalities with non-heterosexual communities after stroke.

So what else gets in the way?  Is it embarrassment? Time? Pre-conceived judgments? A lack of training?

Maybe it’s not just that therapists lack the training to start these difficult conversations with patients and it’s something more?

Perhaps they don’t have the motivation and lack the emotionally intelligent behaviours to start these difficult but vital conversations?

Occupational therapists need to be as comfortable talking about sex after stroke as they are discussing where to put grab rails in homes.

That’s why I’ve developed a sex after stroke training course aimed at occupational therapists to help service users to develop skills, confidence and knowledge about intimacy and sex after stroke.

Together, we patients and occupational therapists can develop training to help young stroke survivors maintain or develop loving, intimate relationships so they may be happy and flourish after stroke at home.

Please reach out with any comments and ideas on Twitter @kateallatt

Dr Kate Allatt