Stroke can cause erectile dysfunction due to brain lesions that affect motor skills and speech, in addition to psychological factors such as anxiety and depression. Discover what science says and the treatment options for men after a stroke.
A stroke can cause erectile dysfunction because brain damage hampers activation of the nervous system that boosts the blood flow required for an erection. Emotional and psychological factors such as anxiety, depression and low self-esteem also interfere with male sexual function. Learn more.
What is a stroke and what are its main consequences for male sexual health?
A cerebrovascular accident is an alteration of blood flow in the brain and can be hemorrhagic or ischemic. See the differences:
- Hemorrhagic stroke: rupture of a blood vessel causing bleeding within brain tissue or on the surface between the brain and meninges. According to Brazil’s Ministry of Health, about 15 % of strokes are hemorrhagic;
- Ischemic stroke: blockage of an artery that prevents oxygen from reaching brain cells, which then die. Roughly 85 % of strokes are ischemic.
Regarding the sequelae of stroke on sexual life, neurological injuries can disturb phases of the sexual response. Hence many men report low libido, erection problems or ejaculation difficulties.
Stroke can cause erectile dysfunction? Understand the connection
Yes, a stroke can cause erectile dysfunction and this article shows that the impact on erectile function is greater in patients with multiple brain lesions than in those with a single lesion.
The reason stroke undermines erection capacity is that it can affect structures related to sexual function. See which ones and why they matter.
Middle and posterior cerebral arteries
The middle cerebral artery supplies parts of the frontal and parietal lobes—areas for motor control and stimulus processing, including sexual stimuli.
The posterior cerebral artery feeds brain regions connected to the limbic system, which regulates emotions and sexual desire.
Basal ganglia
Large deep nuclei that coordinate movements and behaviours such as sexual reflexes.
Brainstem
Connects the brain to the spinal cord and controls automatic functions like breathing and heartbeat, also playing a role in erection.
Which stroke mechanisms affect sexual function?
Sexual sequelae of stroke stem from physical and psychological factors. Key mechanisms:
1. Neurological lesions
Stroke may damage areas linked to sexual response—the hypothalamus, limbic system, basal ganglia and brainstem. They govern sexual desire, arousal and reflexes for erection and ejaculation.
2. Brain–body communication interference
Signals travel via spinal cord and peripheral nerves; brain injury can disrupt messages needed for erection and orgasm even when libido is present.
3. Vascular problems
An erection relies on increased penile blood flow. Stroke affecting the hypothalamus or spinal pathways can impair this regulation.
4. Hormonal changes
Stroke may hit the hypothalamus—key for hormone release, including testosterone. Physical/emotional stress and common post-stroke drugs (antidepressants, anticoagulants) may also lower testosterone and libido.
Emotional and psychological impacts of stroke on sexual life
Emotional disorders are frequent after stroke and influence sexuality:
Post-stroke depression
Daily-life changes, motor or speech deficits raise depression risk, reducing motivation, relationships and libido.
Low self-esteem
Body changes or motor impairment harm self-esteem, lowering sexual confidence.
Relationship dynamics
One partner may become caregiver, shifting intimacy.
Social isolation
Aphasia hampers communication, causing insecurity and loneliness.
Performance anxiety
Fear of never regaining sexual potency can trigger avoidance of intimacy.
Is it possible to regain erectile function after a stroke?
Penile rehabilitation may be considered depending on lesion site/extent, overall health and emotional impact.
Treatments for post-stroke erectile dysfunction
In some cases, management of erectile dysfunction may include PDE5 inhibitors, always under individualized medical prescription.
Psychotherapy may also form part of an integrated approach to address anxiety, self-esteem and relationship issues.
When to seek medical help for sexual difficulties after stroke?
Men should seek medical advice when sexual dysfunction affects self-esteem or relationships.
Stroke is a serious neurological event that can impact sexual life. In some cases, specialist follow-up can help restore intimacy quality. For personalized guidance, complete a pre-assessment.
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- 10 Tips for Penis Care to Maintain Health and Prevent Infections and Diseases
- See What Causes Erectile Dysfunction and Available Treatments
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