Montalvan V, Ulrich A K, Tirschwell D L, Zunt J R
ICTUS Program. University of Washington, Seattle, WA, USA; Department of Neurology, Texas Tech University Health Science Center, Lubbock, TX, USA; Department of Neurology. Guillermo Almenara National Hospital, Lima, Peru.
Division of Epidemiology and Community Health(Ulrich), University of Minnesota, USA.
Clin Neurol Neurosurg. 2021 Apr 20;205:106642. doi: 10.1016/j.clineuro.2021.106642.
Sexual dysfunction affects at least one half of patients after a stroke. Problems related to sexual function are rarely assessed or addressed by physicians.
To determine the frequency and factors associated with sexual dysfunction among stroke survivors and self-reported barriers of physicians to discuss sexual dysfunction during regular consultation.
We administered a questionnaire to a cross-sectional sample of stroke survivors to assess the frequency and factors associated with sexual dysfunction and the aspects of sexuality most commonly affected by stroke in a reference hospital in Peru. A qualitative approach was used to determine the willingness to address sexual issues and related barriers among neurology physicians participating in the study.
Among 150 patients, sexual dysfunction was identified in 89 (59%). Only 10% self-reported their sexual function as optimal. Markedly decreased frequency of sexual encounters (49%) and markedly decreased sexual desire (33%) were the aspects of sexual function most commonly reported by patients after a stroke. Fear of having a new stroke [OR:3.2, 95% CI (1.5-6.3)], depression [OR:2.1, 95% CI (1.0-4.3)], and self-perception of having impaired motor function [OR:2.5, 95% CI (1.2-5.0)] were significantly associated with sexual dysfunction. In the qualitative assessment of physicians (N = 15), when asked how often they addressed sexual aspects during regular consultation with a stroke survivor, none answered "very often", and only 8 (51%) answered "sometimes". At the end of the study, 10 (66%) physicians verbalized the perception that addressing this issue encouraged their patents to be more open to personal concerns and prompted a stronger doctor-patient relationship.
Sexual dysfunction affected more than a half of stroke survivors, and was significantly associated with depression, fear of having a new stroke, and with the self-perception of impaired motor function. Addressing sexual issues during the regular consult by physicians was infrequent. Barriers reported by physicians included limited time during regular consultation and the belief that this issue should be addressed under the scope of other specialties.
性功能障碍影响至少一半的中风患者。医生很少评估或解决与性功能相关的问题。
确定中风幸存者中性功能障碍的发生率及相关因素，以及医生在常规会诊中自我报告的讨论性功能障碍的障碍。
我们对秘鲁一家参考医院的中风幸存者横断面样本进行问卷调查，以评估性功能障碍的发生率及相关因素，以及中风最常影响的性方面。采用定性方法确定参与研究的神经科医生解决性问题的意愿及相关障碍。
在150名患者中，89名（59%）被确定存在性功能障碍。只有10%的患者自我报告性功能最佳。中风后患者最常报告的性功能方面是性接触频率显著降低（49%）和性欲显著降低（33%）。害怕再次中风[比值比（OR）：3.2，95%置信区间（CI）（1.5 - 6.3）]、抑郁[OR：2.1，95%CI（1.0 - 4.3）]和自我感觉运动功能受损[OR：2.5，95%CI（1.2 - 5.0）]与性功能障碍显著相关。在对医生的定性评估中（N = 15），当被问及在与中风幸存者的常规会诊中多久讨论一次性方面问题时，没有人回答“经常”，只有8名（51%）回答“有时”。在研究结束时，10名（66%）医生表示认为解决这个问题会促使他们的患者更愿意坦诚个人问题，并促进更牢固的医患关系。
性功能障碍影响超过一半的中风幸存者，且与抑郁、害怕再次中风以及自我感觉运动功能受损显著相关。医生在常规会诊中很少解决性问题。医生报告的障碍包括常规会诊时间有限以及认为这个问题应由其他专科解决。
