The Association of Depression, Anxiety, and Quality of Life with Sexual Function in Young-to-Middle-Aged Stroke Patients: A Case-Control Study

Background Despite its impact, sexual health remains a neglected component of rehabilitation for younger stroke patients. Aim To evaluate sexual dysfunction prevelance in stroke patients and examine its association with health-related quality of life and psychological distress. Methods This case-control study included 30 stroke patients and 30 matched controls. Data were collected using the Arizona Sexual Experience Scale (ASEX), Stroke-Specific Quality of Life Scale (SSQOL), and Hospital Anxiety and Depression Scale (HADS). Results Patients had significantly higher total ASEX scores (19.3 ± 6.6 vs. 13.0 ± 3.1, p < 0.001), and a higher prevalence of dysfunction than controls ( p = 0.004), reporting a significant decline in sexual satisfaction (7.5 to 4.1, p < 0.001). Sexual function was significantly associated with the SSQOL Energy, Thinking, and Language domains ( p < 0.05), and HADS-Depression ( r = 0.450, p = 0.013), but not with functional state. Strengths and Limitations Strengths include a matched control group. Limitations include a small sample and cross-sectional design, potential selection bias from a high refusal rate, and restricted psychological variance due to clinical exclusions. Conclusion Sexual dysfunction represents a multifaceted challenge for young-to-middle-aged stroke patients, appearing more closely linked to perceived quality of life domains (cognitive, energy, emotional well-being) than to motor deficits. Sexual health may be affected even in patients with low physical disability. Clinical Implications Rehabilitation should address holistic needs. Healthcare professionals could benefit from incorporating sexual health screenings into routine care, considering the management of fatigue and depressive symptoms to support long-term well-being.