Interventions for sexual dysfunction following stroke.

Area of Science:

• Neurology
• Sexual Health
• Rehabilitation Medicine

Background:

• Sexual dysfunction is a prevalent and often under-managed issue following stroke.
• Growing awareness highlights the need for robust evidence to guide effective interventions.

Purpose of the Study:

• To systematically evaluate the effectiveness of interventions for sexual dysfunction in stroke survivors.
• To assess potential adverse events associated with these interventions.

Main Methods:

• Comprehensive literature search across multiple databases up to November 2019.
• Inclusion of randomized controlled trials (RCTs) comparing pharmacological, mechanical, complementary, or non-pharmacological interventions against placebo or usual care.
• Independent study selection, data extraction, quality assessment, and risk of bias evaluation using the GRADE approach.

Main Results:

• Analysis of three small, low-to-very-low quality RCTs involving 212 participants.
• Heterogeneity observed in interventions: one pharmacological (sertraline), one physiotherapy-based (pelvic floor muscle training), and one psycho-educational (sexual rehabilitation).
• Insufficient data to reliably indicate the benefit or risk of these interventions for clinical practice.

Conclusions:

• Further high-quality randomized controlled trials (RCTs) are required, particularly for sertraline in premature ejaculation.
• Absence of demonstrated benefit for sexual rehabilitation and pelvic floor physiotherapy does not confirm ineffectiveness.
• Need for well-designed, long-term, placebo-controlled trials, acknowledging potential challenges in blinding complex interventions.