Background: Although poststroke depression has been shown to be related to decreased sexual activity (SA), the relationship between poststroke emotional incontinence (EI) and SA has not been properly investigated. Methods: We examined 70 nondepressed, sexually active patients with first-ever stroke approximately 3 months after stroke and conducted a follow-up interview approximately 2 years after stroke in 55 of them. EI (excessive/inappropriate laughing/crying) and SA (libido, coital frequency, erectile function) were assessed with the use of a standardized questionnaire. Results: Of these 70 patients, 24 (34%) had EI 3 months after stroke, which had resolved 2 years after stroke. Libido, coital frequency and erectile function were reported to have declined in 49, 65 and 26% of the patients, respectively, 3 months after stroke, and in 44, 49 and 20% of the patients 2 years after stroke. Multivariate analyses showed that low coital frequency before stroke (CFBS) was significantly (p < 0.05) related to decreased poststroke coital frequency, while the presence of EI (p < 0.05) and low CFBS (p < 0.05) was significantly associated with decreased erectile function 3 months after stroke. Two years after stroke, the presence of EI 3 months after stroke was significantly related to decreased libido, coital frequency and erectile function (p < 0.05 each). Age, gender, laterality of stroke, Barthel Index score, motor dysfunction and the presence of hypertension and diabetes mellitus were not independently related to SA 3 months and 2 years after stroke. Conclusion: The presence of EI is a factor related to decreased poststroke SA, more so in chronic than in subacute stages.

1.
de Haan RJ, Limburg M, Van der Muelen JHP, Jacobs HM, Aaronson NK: Quality of life after stroke: Impact of stroke type and lesion location. Stroke 1995;26:403–408.
2.
King RB: Quality of life after stroke. Stroke 1996;27:1467–1472.
3.
Bray GP, deFrank RS, Wolfe TL: Sexual functioning in stroke survivors. Arch Phys Med Rehabil 1981;62:286–288.
4.
Monga TN, Lawson JS, Inglis J: Sexual dysfunction in stroke patients. Arch Phys Med Rehabil 1986;67:19–22.
5.
Coslett HB, Heilman KM: Male sexual function. Impairment after right hemisphere stroke. Arch Neurol 1986;43:1036–1039.
6.
Korpelainen JT, Nieminen P, Myllyla VV: Sexual functioning among stroke patients and their spouses. Stroke 1999:30:715–719.
7.
Fugl-Meyer AR, Jaasko L: Post-stroke hemiplegia and sexual intercourse. Scand J Rehabil Med Suppl 1980;7:158–166.
8.
Malone PE: A preliminary investigation of changes in sexual relations following strokes; in Brookshire R (ed): Clinical Aphasiology: Collected Proceedings. Minneapolis, BRK, 1975.
9.
Sjogren K: Sexuality after stroke with hemiplegia. II. With special regard to partnership adjustment and to fulfilment. Scan J Rehabil Med 1983;15:63–69.
10.
Boldrini P, Basaglia N, Calanca MC: Sexual changes in hemiparetic patients. Arch Phys Med Rehabil 1991;72:202–207.
11.
Morris PLP, Robinson RG, Raphael B: Emotional lability after stroke. Aust NZ J Psychiatry 1993;27:601–605.
12.
Ceccaldi M, Poncet M, Milandre L, Rouyer C: Temporary forced laughter after unilateral strokes. Eur Neurol 1994;34:36–39.
13.
Kim JS: Pathologic laughter after unilateral stroke. J Neurol Sci 1997;148:121–125.
14.
Kim JS, Choi-Kwon S: Poststroke depression and emotional incontinence: Correlation with lesion location. Neurology 2000;54:1805–1810.
15.
Robinson RG, Parikh RM, Lipsey JR, Starkstein SE, Price TR: Pathological laughing and crying following stroke: Validation of a measurement scale and a double-blind treatment study. Am J Psychiatry 1993;150:286–293.
16.
Gainotti G, Azzoni A, Razzano C, Lanzillotta M, Marra C, Gasparini F: The Post-Stroke Depression Rating Scale: A test specifically devised to investigate affective disorders of stroke patients. J Clin Exp Neuropsychol 1997;19:340–356.
17.
Goddess ED, Wagner NN, Silverman DR: Poststroke sexual activity of CVA patients. Med Aspects Hum Sex 1979;13:16–30.
18.
Sjogren K, Fugl-Meyer AR: Sexual problems in hemiplegia. Int Rehabil Med 1981;3:26–31.
19.
Sjogren K, Damber JE, Liliequist B: Sexuality after stroke with hemiplegia. I. Aspects of sexual function. Scand J Rehabil Med 1983;15:55–61.
20.
Ford AB, Orfirer AP: Sexual behavior and chronically ill patient. Med Aspects Hum Sex 1967;1:51–61.
21.
Andersen G, Ingeman-Nielsen M, Vestergaard K, Riis JO: Pathoanatomic correlation between poststroke pathological crying and damage to brain areas involved in serotonergic neurotransmission. Stroke 1994;25:1050–1052.
22.
Derex L, Ostrowsy K, Nighoghossian N, Trouillas P: Severe pathological crying after left anterior choroidal artery infarct. Reversibility with paroxetine treatment. Stroke 1997;28:1464–1466.
23.
Jeret JS: Treatment of poststroke pathological crying (letter). Stroke 1997;28:2321–2322.
24.
Nahas Z, Arlinghaus KA, Kotrla KJ, Clearman RR, George MS: Rapid response of emotional incontinence to selective serotonin reuptake inhibitors. J Neuropsychiatry Clin Neurosci 1998;10:543–545.
25.
Bishop GA, Ho RH: The distribution and origin of serotonin immunoreactivity in the rat cerebellum. Brain Res 1985;331:195–207.
26.
Lavoie B, Parent A: Immunohistochemical study of the serotoninergic innervation of the basal ganglia in the squirrel monkey. J Comp Neurol 1990;299:1–16.
27.
Palacios JM, Waeber C, Bruinvels AT, Hoyer D: Direct visualization of serotonin 1D receptors in the human brain using a new iodinated radioligand. Brain Res Mol Brain Res 1992;13:175–178.
28.
Luine VN: Serotonin, catecholamines and metabolites in discrete brain areas in relation to lordotic responding on proestrus. Neuroendocrinology 1993;57:946–954.
29.
Gorzalka BB, Mendelson SD, Watson NV: Serotonin receptor subtypes and sexual behavior. Ann NY Acad Sci 1990;60:435–446.
30.
Meston CM, Gorzalka BB: Psychoactive drugs and human sexual behavior. The role of serotonergic activity. J Psychoactive Drugs 1992;24:1–40.
31.
Musher JS: Anorgasmia with the use of fluoxetine (letter). Am J Psychiatry 1990;147:948.
32.
Herman JB, Brotman AW, Pollack MH, Falk WE, Biederman J, Rosenbaum JF: Fluoxetine-induced sexual dysfunction. J Clin Psychiatry 1990;51:25–27.
33.
Chandler BJ, Brown S: Sex and relationship dysfunction in neurological disability. J Neurol Neurosurg Psychiatry 1998;65:877–880.
34.
Fernandez-Guasti A, Rodriguez-Manzo G: Further evidence showing that the inhibitory action of serotonin on rat masculine sexual behavior is mediated after the stimulation of 5-HT1B receptors. Pharmacol Biochem Behav 1992;42:529–533.
35.
Vega Matuszcyk J, Larsson K, Eriksson E: The selective serotonin reuptake inhibitor fluoxetine reduces sexual motivation in male rats. Pharmacol Biochem Behav 1998;60:527–532.
36.
Rodriguez M, Castro R, Hernandez G, Mas M: Different roles of catecholaminergic and serotoninergic neurons of the medial forebrain bundle on male rat sexual behavior. Physiol Behav 1984;33:5–11.
37.
Svensson L, Hansen S: Spinal monoaminergic modulation of masculine copulatory behavior in the rat. Brain Res 1984;302:315–321.
38.
Burvill PW, Johnson GA, Chakera TMH, Stewart-Wynne EG, Anderson CS, Jamrozik KD: The place of site of lesion in the aetiology of post-stroke depression. Cerebrovasc Dis 1996;6:208–215.
39.
Ghika-Schmid F, Bogousslavsky J: Affective disorders following stroke. Eur Neurol 1997;38:75–81.
40.
MacHale SM, O’Rourke SJ, Wardlaw JM, Dennis MS: Depression and its relation to lesion location after stroke. J Neurol Neurosurg Psychiatry 1998;64:371–374.
41.
Starkstein SE: Mood disorders after stroke; in Ginsberg H, Bogousslavsky J (eds): Cerebrovascular Disease. Cambridge, Blackwell Science, 1998, pp 1168–1181.
42.
Andersen G, Vestergaard K, Ingemann-Nielsen M, Lauritzen L: Risk factors for post-stroke depression. Acta Psychiatr Scand 1995;92:193–198.
43.
Herrmann N, Black SE, Lawrence J, Szekely C, Szalai JP: The Sunnybrook Stroke Study: A prospective study of depressive symptoms and functional outcome. Stroke 1998;29:618–624.
44.
Åström M, Adolfsson R, Asplund K: Major depression in stroke patients. A 3-year longitudinal study. Stroke 1993;24:976–982.
45.
Zajecka J, Fawcett J, Schaff M, Jeffriess H, Guy C: The role of serotonin in sexual dysfunction: Fluoxetine-associated orgasm dysfunction. J Clin Psychiatry 1991;52:66–68.
46.
Buffum J: Pharmacosexology: The effects of drugs on sexual function, a review. J Psychoactive Drugs 1982;14:5–44.
47.
Balon R, Yeragani VK, Pohl R, Ramesh C: Sexual dysfunction during antidepressant treatment. J Clin Psychiatry 1993;54:209–212.
48.
Monga TN, Ostermann HJ: Sexuality and sexual adjustment in stroke patients. Phys Med Rehabil State Art Rev 1995;9:345–359.
49.
Hayes V, Morris J, Wolfe C, Morgan M: The SF-36 health survey questionnaire: Is it suitable for use with older adults? Age Ageing 1995;24:120–125.
50.
McHorney CA, Ware JE Jr, Lu R, Sherbourne CD: The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 1994;32:40–66.
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