The Association of Depression, Anxiety, and Quality of Life with Sexual Function in Young-to-Middle-Aged Stroke Patients: A Case-Control Study.
A Ozakgul, Z Tulek, K Kılıçaslan and 2 others
72% of young-to-middle-aged stroke patients had sexual dysfunction, and it tracked more closely with perceived energy, thinking, and communication than with physical mobility.
Depression was the strongest psychological correlate.
Key findings
172% of stroke patients met criteria for sexual dysfunction compared with 28% of matched controls, and mean ASEX total scores were significantly higher in patients (19.3 ± 6.6 vs. 13.0 ± 3.1, p < 0.001).
2Sexual dysfunction was more closely associated with perceived energy, thinking, and communication than with physical mobility. Energy correlated with arousal (r = −0.566, p = 0.001) and total ASEX (r = −0.499, p = 0.005); the Thinking subscale was linked to drive, arousal, orgasm, and satisfaction (p < 0.05); language impairment was associated with lower arousal (r = −0.573, p = 0.001); and physical domains showed no significant correlation (p > 0.05).
3Self-reported sexual satisfaction dropped from a pre-stroke mean of 7.5 to 4.1 on a 0–10 scale (p < 0.001), and depressive symptoms were the strongest psychological correlate of sexual dysfunction (r = 0.450, p = 0.013 with total ASEX).
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What it does not show
Only 30 patients and 30 controls from a single hospital; 20 additional eligible people (mostly women) declined to participate because the topic felt too sensitive, which may bias the sample toward those more comfortable discussing sexuality. Cross-sectional design: all correlations are associations, not evidence that treating depression or improving energy will fix sexual function. No pre-stroke baseline sexual function was measured; the pre-stroke satisfaction score (7.5) is a retrospective recall, introducing recall bias. Participants with clinical-level anxiety or depression were excluded, so the findings apply only to sub-clinical psychological symptoms and cannot be generalised to stroke patients with major depression. The control group was slightly younger (44.6 vs. 48.9 years, p = 0.057), and the stroke group had a low disability profile (86.7% with mRS < 3), limiting generalisability to more severely affected patients. The ASEX scale does not capture intimacy, partner engagement, or the relational dimension of sexual health.
Declared interests
The authors state they received no financial support for the research, authorship, or publication of this article.
The easy way to misread this
Do not read the 72% prevalence or the depression–sexual function correlation as evidence that treating depression will resolve sexual dysfunction — this is a cross-sectional association in 30 patients with no treatment arm, and the authors explicitly state the design precludes causal inference. Likewise, the finding that physical mobility did not correlate with sexual function does not mean physical rehabilitation is irrelevant; it means motor recovery alone does not guarantee sexual function recovery, and fatigue, mood, and communication need to be addressed alongside it.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →