My husband became impotent after a stroke. How long does it take for potency to return after a stroke? ED in patients with encephalitis

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A stroke is a vascular disease, a sudden disruption of blood circulation in the brain. Its consequences can be partial or complete paralysis, loss of speech, memory, vision and hearing. Although impaired brain functions are restored as a result of medical rehabilitation, impotence after a stroke is a common occurrence.

A stroke is a test for a married couple. The psychological, physical and emotional aspects of relationships undergo profound changes. Yesterday, a healthy and cheerful person turns into a patient of a nurse, whose role is played by the spouse. A man often falls into depression and apathy, experiences bouts of severe irritation, can withdraw into himself, and stop being interested in his wife and the sexual part of married life. The wife, playing the role of nanny and nurse, dutifully enduring outbursts of anxiety and anger, also ceases to feel loved and needed. Nevertheless, despondency, fatigue and irritation must be hidden from the patient in order to hasten the moment of his recovery.

Often during an attack, the brain segments responsible for the sensitivity of erogenous zones are affected. The situation is aggravated by the presence of inflammation of the genitourinary organs - a common occurrence after an impact. The couple's intimate life suffers greatly. Impotence after a stroke ruins the lives of most men in this category.

However, in some cases, potency is restored quickly - before speech and coordination of movements. Cases have been recorded when making love stimulated the return of speaking function, and sexual satisfaction helped to rehabilitate in the shortest possible time. This phenomenon is typical for 10% of men who have had a stroke and is accompanied by a strong increase in libido. The spouses enter a positive stage in their sexual relationship.

If sexual activity is still contraindicated, the attending physician warns his patient about this. But when the pressure has been normalized, sex does not pose a danger, but on the contrary, it helps the rehabilitation process:

• improves the functioning of the nervous system,
• stimulates the production of “happiness hormones”,
• reduces thrombus formation,
• helps relieve depression,
• causes a rush of blood to all tissues and organs.

Provided that the doctor has not forbidden the man to have an intimate life, sex is a good help for speedy rehabilitation.

How to overcome impotence after a stroke

To restore a man’s sexual function, the moral support of a loved one is very important. It is necessary for the wife or girlfriend to show that despite the changes, he is loved. The physical component of the expression of love plays an important role: touching, stroking, hugging will make a person feel that he remains desired. Along with libido, the desire to enjoy life and return to the previous level of activity returns to the man.

In sex, it is better to use the “woman on top” position so that the recovering person does not become overtired and at the same time gets pleasure. This gentle version of lovemaking will improve your overall condition and will not cause harm. Many people fear that sex and orgasm can trigger another stroke, but this is not the case. On the contrary, positive libidinal relationships between spouses normalize physical and mental processes disturbed by the disease.

They understand the disorder, a persistent disorder of cerebral circulation, which is manifested by signs of neurological pathology.

The disease has the most undesirable effect on “male strength” - potency, since it almost always entails extremely life-threatening damage to the brain parenchyma and peripheral nervous system, which suffers due to the lack of proper control by the central nervous system.

How does a stroke affect potency?

A severe, widespread ischemic stroke can easily cause so-called spinal (also called corticospinal) impotence. Sexual (sexual) disorder implies cases of impotence or simply weakening of erection, sexual impotence, which are based on pathologies of the brain and spinal (spinal) genital centers. Disturbances of this nature are inherently associated with severe exhaustion, partial disappearance or complete loss of excitability. Spinal impotence is classified into several variants according to the type of course and pathogenetic mechanism:

1. Increased neurological excitability of centers that have a direct effect on erectile function and ejaculation.
2. Increased ejaculatory activity and decreased threshold of excitability of the erection center.
3. The disappearance of the excitability of the center responsible for ejaculation - in this case, it is customary to talk about spinal aspermatism.
4. Decreased physiological activity of both centers.

Accordingly, sex after a stroke is, in principle, allowed, but its quality, like the quality of life as a whole, is significantly reduced. Again, this statement is only true when a small area of ​​the brain parenchyma is affected. If this organ is extensively damaged, the patient will have no desire to make love.

In addition, this is simply dangerous for his health - activation of the sympathoadrenal system will lead to a significant crisis.

Suggested ways to combat

Restoring potency in patients who have suffered acute cerebrovascular insufficiency can begin only after discharge from the hospital. Please note that during the first months, active loads are strictly contraindicated for the patient, and this applies to both physical and psychological. After the activity of the damaged fibers is normalized, it is permissible to implement one of the proposed methods:

1. Performing sports exercises;
2. Increased resistance to stress;
3. Taking stimulant pills, drugs for sexual arousal.

It often happens that in order to restore sexual activity, the patient has to use all the methods listed above together.

The changes that occur in the human body after a stroke do not directly affect the functioning of the intimate organs, but damage to the central nervous system causes damage to the peripheral innervation and autonomic system. And this, in turn, has the most unfavorable effect on the functioning of the genitourinary system.

Be that as it may, in the first months after a stroke the patient should observe sexual rest. It is allowed to engage in sexual intercourse only with the permission of the supervising doctor.

No stress

Potency largely depends on a man's resistance to stress. Doctors strongly recommend avoiding negative emotions and psychological states that make you very nervous and worried. For complete rehabilitation of intimate function, you should learn to relax correctly and quickly. Relaxation should be combined with special procedures:

1. Meditation helps restore male power. It can be combined with relaxing music. It's also good to listen to the sounds of nature.
2. Short walks in the fresh air can help you relax and relieve stress, but you should avoid making rapid movements. A man's breathing should be calm, even and smooth. Thanks to this approach, it is possible to significantly speed up the processes of rehabilitation and renewal.
3. Useful for restoring potency and doing yoga. For this purpose, a whole complex of special asanas has been developed and put into practice. Their implementation helps to greatly increase blood circulation throughout the body. Moreover, after completing the course, there is an increase in sexual activity.

When a person has sexual intercourse for the first time after a stroke, his behavior will change significantly - he will become more confident and positive, but sex should not be harmful to health. You need to sensibly assess your strengths and follow the recommendations of experts.

Sports training

After acute cerebral circulatory failure has occurred, many doctors urgently recommend that patients perform special health and sports complexes that will help in the rehabilitation of male strength and will not in any way harm the functioning of the cardiovascular system. The entire program can be characterized as follows:

1. In the first month, all efforts must be devoted to restoring the sensitivity of peripheral nerve endings. The implementation of these intentions, according to the recommendations of leading experts in the field of neurology, should be carried out through the Su-Jok and. Manual influence is carried out manually, but not directly on peripheral organs - pressure is applied to certain points. It is thanks to this that it becomes possible to restore the movement of nerve impulses throughout the body.
2. After rehabilitation of adequate sensitivity, you should begin a set of exercises - but here you can’t do without special sports equipment. For example, you can easily restore blood circulation to the pelvic organs (actually, the genitourinary system) and limbs by rolling a special ball.
3. After working with the ball, they begin to sort out the beads, which are first laid out on the floor. The essence of the exercise is for the patient to bend down for each ball individually. The bending exercises significantly speed up blood circulation. In turn, increased blood flow causes acceleration of metabolic processes. During all these changes, the functioning of the pelvic organs is restored, and the man becomes capable of full sexual intercourse.

To have sex, simply restoring potency is completely insufficient. A man must subjectively assess the state of his cardiovascular system.

The question here is not to undergo numerous studies, the results of which allow us to assess the state of the circulatory system. A person must decide for himself how well he feels.

You need to be aware that intimacy is a significant burden on the body, which is accompanied by activation of the symptoadrenal system. The level of blood pressure rises, the pulse and breathing rate increase significantly. In fact, sexual intercourse is comparable to significant physical activity, which all stroke patients avoid. That is why it is worth asking yourself whether sexual contact will be harmful to health, since it usually has a fatal outcome.

Taking stimulants

Many men prefer to avoid performing a complex of sports exercises and psychological rehabilitation, and immediately begin medical recovery. Special medications that, according to the modern classification, are classified as PDE inhibitors - Viagra, Levitra and Cialis - help to rehabilitate sexual life.

Their mechanism of action is to expand the vascular lumen. In turn, an increase in the diameter of the vessel is associated with an increase in the volume of blood arriving at the genitals. Accordingly, strong sexual arousal occurs. The effect of taking such drugs is one-time. If the patient stops drinking them, potency decreases accordingly.

It is important to focus attention on contraindications:

1. The presence of cardiovascular insufficiency, even the most insignificant. Otherwise, there is a risk of manifesting a new stroke.
2. These drugs can further aggravate the situation if used too often - so-called resistance is formed.
3. If a man has already decided to normalize sexual intercourse by using these drugs, then you should not give up all other methods. Only their combined use can provide the truly desired result and return a person to a full life without harm to health. After all, it is not suitable to rehabilitate male strength at the expense of the cardiovascular system. Moreover, techniques have been developed that help to successfully get rid of problems. You just need to show a little patience and willpower. Believe me, the result will not keep you waiting!

Conclusion

A patient who has suffered a stroke will need to first take care of the health of his cardiovascular system. No other problems should worry him more than the consequences of the accident of a cardio-neurological nature.

Yes, the loss of male power is, without a doubt, a very serious problem, but it is not worth risking your health and even your life over it.

It is very difficult for a man to realize the loss of his strength - especially if acute cerebral circulatory failure has occurred (unfortunately, disappointing statistics are now being noted - strokes have begun to occur in 40-year-olds with alarming prevalence).

Erectile dysfunction, or impotence (from the Latin impotens - impotent) is an integral part of the problem of sexual dysfunction, the continued inability to achieve and maintain an erection at the level necessary to ensure full sexual intercourse.

Erection (from Latin erectio - straighten) is a neurovascular process that is directly related to the amount of blood pressure inside the cavernous (cavernous) bodies of the penis. During sexual stimulation, biologically active substances (mainly nitric oxide) are released from the nerve endings, which relax the smooth muscles of the cavernous bodies of the penis, as well as the muscles of the arteries. This leads to vasodilation, increased blood flow in the penis, expansion and filling of the cavernous spaces with blood. At the same time, the veins that perforate the tunica albuginea of ​​the corpora cavernosa of the penis narrow, and passive venous outflow becomes difficult.

Squats are considered the most effective exercise for strengthening an erection; it is recommended to perform 50–100 squats per day.

Filling of the cavernous bodies of the penis with blood and veno-occlusion lead to an erection. During sexual intercourse, this state of the vessels is maintained, the inflow and outflow of blood stops, and intracavernous pressure increases. There is an increase in the volume of the penis and further strengthening of the erection.

Problems with erections over a long period (3-6 months) are grounds to suspect erectile dysfunction.

According to WHO, about 160 million men in the world suffer from erectile dysfunction. Every tenth man over 21 years of age suffers from erectile dysfunction, about 50% of men over 40 years of age experience various difficulties associated with erectile dysfunction, every third man over 60 years of age is unable to perform sexual intercourse.

Forms

According to the etiological factor, the following types of erectile dysfunction are distinguished:

• psychogenic;
• organic;
• mixed.

Among psychogenic erectile dysfunctions, primary and secondary forms are also distinguished:

• the primary (congenital) form is rare and is characterized by a complete absence of normal sexual function throughout life;
• Secondary erectile dysfunction is characterized by a gradual decline in the previously existing ability to have erections.

Causes of erectile dysfunction and risk factors

The causes of erectile dysfunction are divided depending on the pathophysiological mechanisms underlying its occurrence.

When treating the organic form, eliminating the disease that led to erectile dysfunction is of paramount importance.

Organic causes are associated with disruptions in the functioning of internal organs or systems. These include:

• vascular. Insufficient blood pressure in the vessels of the arterial bed leads to an inadequate supply of blood to the cavernous bodies, and contraction of smooth muscles opens up the paths of passive venous outflow. Weakening or absence of erections may be a manifestation arterial hypertension , obliterating endarteritis , hyperlipidemia , atherosclerosis, arterial damage caused by irradiation of the pelvic area, as well as heart failure , coronary heart disease and transferred myocardial infarction ;
• neurological. Diseases of the parasympathetic pelvic visceral nerves and pathologies of the nerve pathways can lead to impaired redistribution of blood flow, insufficient pressure in the cavernous bodies, and impaired ability to have erections. Potency is affected by neurological disorders when Alzheimer's disease , Parkinson's disease, polyneuropathy, multiple sclerosis , hemorrhagic or ischemic stroke, injuries to the spinal cord, pelvis and perineum, degeneration of intervertebral discs, cerebral insufficiency, etc.;
• endocrine. The causes of impotence of endocrine origin include increased levels of prolactin, endogenous estrogens and decreased androgen levels, diseases associated with dysfunction of the pituitary gland and adrenal glands;
• Iatrogenic. They are explained by the side effects of a number of drugs (neuroleptics, tranquilizers, antihypertensives, anticonvulsants, cytostatics, antidepressants, first generation antihistamines, corticosteroids, etc.) on sexual function;
• toxic. Caused by the toxic effects of alcohol, drugs, nicotine.

The consequence of erectile dysfunction is an unsatisfactory sex life, which leads to further disorders.

Psychogenic causes are associated with central suppression of the erection mechanism. These include increased anxiety, lack of sexual arousal, neuroses, mental illness ( depression , schizophrenia). It has been proven that the psychological causes of erectile dysfunction are based on organic diseases. Most patients suffering from erectile dysfunction exhibit a combination of psychogenic and organic components.

An independent risk factor for erectile dysfunction is aging. The leading causes of erectile dysfunction during aging are an age-dependent decrease in the level of testosterone, vascular pathologies and chronic infectious diseases of the urogenital area. Sexual disorders progressively increase with aging: in the age group of 50–60 years, the number of patients is 10%, and after 80 years – already 80%.

Symptoms

Symptoms of erectile dysfunction include:

• insufficient quality of morning erections or their absence;
• inability to insert the penis due to insufficient tension;
• premature ejaculation;
• increasing the time interval between sexual stimulation and erection;
• incomplete erections or complete absence of erections during stimulation;
• inability to introject and maintain an erection until ejaculation;
• reduction in ejaculate volume;
• increasing the recovery period between erections.

Psychogenic and organic erectile dysfunctions have their own characteristics.

Psychogenic erectile dysfunction begins suddenly. Characterized by the presence of problems in relationships, the presence of spontaneous erections at night. As a rule, problems with erection are episodic. Once the external problem is resolved, normal erection is usually restored.

Massage and self-massage of the pelvic area and pubic bone are effective, as it has a beneficial effect on vascular tone in the genital area.

Erectile dysfunction of organic origin is accompanied by systematic erectile dysfunction. This form of the disease begins gradually and is rarely accompanied by spontaneous nocturnal erections.

Diagnosis of erectile dysfunction

Diagnosis of erectile dysfunction begins with collecting a general history, identifying etiological factors, and assessing sexual life. A number of questionnaires have been developed to identify the pathophysiological basis of impotence.

Physical examination often reveals signs of vascular, neurological or hormonal disorders, confirming the pathophysiological hypothesis based on the history: the presence of signs hypogonadism, fibrotic changes, gynecomastia , phimosis, detection of La Peyronie's plaques, disturbances of perineal sensitivity, decreased tone of the anal sphincter, atrophy of the muscles of the lower extremities, changes in peripheral pulsations.

Diagnosis should include screening for major vascular, metabolic and endocrine diseases, and determination of testosterone levels.

Source: umedp.ru

To objectively assess the state of the physiological mechanisms that control the erection process, a number of techniques are used:

• assessment of the state of the vascular system– determination of the level of blood flow in the pelvic arteries using vascular Dopplerography of the arteries of the penis, plethysmography and radioisotope studies;
• assessment of neurological status– determination of the sensitivity threshold of the penis to vibration using a biothesiometer (helps to detect early manifestations of peripheral sensory neuropathy), electromyography of the perineal muscles, study of the refractoriness of the sacral nerves, registration of brain potentials during irritation of the external genitalia (helps to determine erectile dysfunction of neurogenic origin). If screening tests reveal a neurological pathology in a patient, electroencephalography, computed tomography of the brain or myelography;
• endocrine system assessment– measurement of plasma concentrations of testosterone, prolactin, luteinizing hormone ;
• assessment of the patient's mental state– identification of psychological, causal relationships (situational impotence), mental disorders (anxiety, depression, feelings of shame, guilt).

Problems with erections over a long period (3-6 months) are grounds to suspect erectile dysfunction.

For differential diagnosis of forms of erectile dysfunction, a procedure for assessing nocturnal erections (NEE) using a plethysmographic sensor is used. The differentiation is based on the fact that patients with psychogenic erectile dysfunction have normal erections during sleep, while patients with organic erectile dysfunction have defective nighttime erections.

Treatment of erectile dysfunction

The goal of treatment is to achieve satisfactory erections with minimal side effects.

Psychotherapy plays an important role in the treatment of the psychogenic form of erectile dysfunction. It should be aimed at eliminating the causes that led to sexual maladjustment, resolving intrapersonal and interpersonal problems, and forming adequate ideas about intimate relationships. Marital therapy techniques, training partners in effective interaction, and cognitive behavioral therapy methods are used.

When treating the organic form, eliminating the disease that led to erectile dysfunction is of paramount importance. If impotence has endocrine causes, hormone replacement therapy is prescribed.

Pharmacological agents are widely used to strengthen and prolong erections. First-line drugs are oral PDE type 5 inhibitors. PDE 5 is an enzyme contained in cavernous tissue. Blocking its work leads to relaxation of the smooth muscles of the cavernous bodies and the occurrence of an erection in response to sexual stimulation.

It has been proven that the psychological causes of erectile dysfunction are based on organic diseases.

It is also possible to inject drugs directly into the corpus cavernosum. In this case, a very thin needle is used, with which the patient can independently inject a vasodilator drug selected by the doctor. A unilateral injection is sufficient for bilateral penile enlargement due to cross-flow of blood. 15 minutes after this, an erection occurs that lasts up to two hours. The method has disadvantages - inconvenience of use and rare side effects, such as priapism and fibrosis of the penis (2%).

Another method that increases blood flow to the penis is vacuum constrictor therapy. In this case, the use of a vacuum device increases blood flow into the cavernous bodies of the penis, and the constrictive ring prevents venous outflow.

Question. Good afternoon I am 55 years old. My name is Nikolai. I recently suffered a stroke and am very worried that now for the rest of my life I will remain impotent, a person who will never again experience the joy of sex and will not bring it to his wife. Please tell me, is it possible to restore potency after a stroke? And what should be done for this?

Answer. Good afternoon, Nikolay! A stroke is not a death sentence for a man. Of course, this condition always negatively affects potency and knocks him out of his usual way of life for several months. But over time, you can partially or even completely restore potency and return persistent erections and vivid orgasms. Only in rare cases, after a stroke, irreversible changes occur in the tissues, which lead to impotence that cannot be treated.

Erectile dysfunction after a stroke develops due to the use of specific medications, disruption of the transmission of nerve impulses and blood flow, as well as due to emotional depression. An important role in restoring potency is played by the actions of the person himself and his compliance with the recommendations of a specialist.

In the first six months after the disease, doctors advise completely abstaining from sex. At this time, it is better to start restoring the body and change your usual lifestyle to a healthier one. Walking in the fresh air, moderate physical activity, a balanced diet, giving up bad habits and other measures will help you feel better. It is also recommended to protect yourself after a stroke from stress and anxiety, mental and physical fatigue. If necessary, for this they even advise giving up your usual place of work, changing it to a less stressful and responsible one.

To restore potency, massage and therapeutic exercises, the use of alternative medicine, yoga and meditation are suitable. In some cases, it is necessary to take special medications, but only after consulting a doctor. Dietary supplements and homeopathy are usually prescribed, and six months after a stroke, in some cases it is possible to use Viagra, Cialis and other drugs similar in action to them.

After a man’s body recovers from a stroke, it may take quite a long time before good potency returns. Sex in this case brings only benefits: it normalizes metabolic processes and blood circulation, improves overall well-being and increases self-confidence.

But if there are serious problems with blood vessels or there is a high risk of recurrent stroke, then sexual activity is contraindicated. Don't ignore this advice. And in the case of sexual activity in the first time after recovery, give the initiative and active activity in bed to the hands of your partner.