national-clinical-guidelines-for-stroke-fourth-edition

further strokes. Despite its importance for quality of life it is an area that is frequently
neglected by clinicians when seeing patients after stroke.
Evidence to recommendations
There is little evidence of the risks and benefits of using sildenafil and similar drugs after
stroke. No patients within 6 months of stroke and ischaemic heart disease were included
in the original trials. There is no reason to suspect that people are at increased risk of side
effects after stroke but the consensus of the working party is to wait for 3 months after
stroke onset before prescribing, as long as blood pressure is controlled. A study of
cerebral blood flow after administering sildenafil to people with cerebrovascular risk
factors did not appear to cause any detrimental effects (Lorberboym et al 2010).
6.31.1 Recommendations
A Every patient should be asked, soon after discharge and at their 6-months and annual
reviews, whether they have any concerns about their sexual functioning. Partners
should additionally be given an opportunity to raise any problems they may have.
B Any patient who has a limitation on sexual functioning and who wants further help
should:
● be assessed for treatable causes
6.31.2 Sources
● be reassured that sexual activity is not contraindicated after stroke and is extremely
unlikely to precipitate a further stroke
● if suffering from erectile dysfunction, be assessed for the use of sildenafil or an
equivalent drug
● avoid the use of sildenafil or equivalent drug for 3 months after stroke and until
blood pressure is controlled
● be referred to a person with expertise in psychosexual problems if the problems
remain unresolved.
A Consensus; Schmitz and Finkelstein 2010; Thompson and Ryan 2009
B Consensus; Cheitlin et al 1999; Lorberboym et al 2010; Melnik et al 2007; Song et al
2011
6.32 Personal equipment and adaptations
6 Recovery phase from impairments and limited activities: rehabilitation
People with a disability may have specific difficulties in using objects or in moving
around their environment. Sometimes special equipment or adaptations may enable
them to have more autonomy, and/or to be safer. Often specialist equipment may become
more widely used (eg remote controls for televisions) and the distinction between healthrelated
equipment and normal choice is not always clear. This section refers to equipment
that is small and can move with the patient.
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