Introduction

Sexuality and the ability to form and sustain an intimate relationship is a fundamental aspect of human life. It results from a complex interplay of physical, psychological, and emotional functioning within a social and cultural context. This chapter reviews the prevalence of sexual problems in the general population, the population with neurological disability, and those specifically with stroke. Sexual development and the physiology of sexual responsiveness are discussed followed by a discussion of relationship functioning. Finally, approaches to dealing with sex and relationship problems are discussed.

Prevalence of sexual dysfunction

In the general population

Dunn et al., (1998, 1999) carried out an anonymous postal questionnaire survey to examine the prevalence of sexual problems. From 4000 questionnaires, replies were received from 789 men and 979 women. The median age of the responders was 50 years, of whom 34% of the men and 41% of women reported a current sexual problem. The most common problems were erectile dysfunction and premature ejaculation in men and vaginal dryness and infrequent orgasm in women. Frequency of problems increased with age for men, but not women. Over half the responders reporting a sexual problem indicated they would like to receive professional help, but only 10% of these had received help.

Erectile dysfunction was most strongly associated with prostatic problems, but also with hypertension and diabetes mellitus. The most common associated factor with premature ejaculation was anxiety. In women, the most prominent association with arousal, orgasmic, and enjoyment problems was relationship difficulties, but anxiety and depression were also associated. The authors summarized that sexual problems clustered with self-reported physical problems in men whereas, in women, the association was with psychological and social problems.

A similar study in the USA amongst 1749 women and 1410 men, aged between 18 and 59 years, found sexual dysfunction amongst 43% of the female respondents and 31% of the male respondents. They described sexual dysfunction as being highly associated with negative experiences within sexual relationships and with overall well-being (Laumann et al., 1999).

In neurological disability

Detailed studies of sexual functioning among various groups with neurological disability have disclosed a high prevalence of sexual dysfunction. For example in multiple sclerosis, almost two-thirds of men and over one-third of women described unsatisfactory sex lives (Lilius et al., 1976).