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.2–4 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.