New attention on brain injuries in the NFL and military has shed a light on the lasting consequences concussions can have people’s overall health and mental well-being. But less attention has been paid to how these mental, cognitive, and physical changes can affect a person’s sexuality. Over half of brain injury patients say their head injuries cause sexual dysfunction, and this dysfunction can become a chronic problem if left untreated.
“Considering the role of the brain in sexual function, it is not surprising that sexuality can be influenced by neurological diseases,” explained psychologist and brain-injury expert John Alexander Moreno of the University of Montreal. “Brain injury can affect the processing of sexual stimuli, decrease or increase sexual desire, limit the expression and communication of affect, and interfere with intercourse.”
Moreno and colleagues recently performed a meta-analysis of the existing literature on brain injuries and sexuality.1 They describe how brain injuries can lead to a number of factors that impact sexuality including memory and attention deficits, reduced processing speed, communication disorders, and difficulties recognizing facial emotion.
Attention deficits can also reduce a person’s focus during sex and memory problems may mean that someone forgets a date or significant episode in a relationship. Personality changes after brain injury, as well as PTSD and psychosis, may lead to patients losing social contacts. Additionally, TBI patients may have difficulties interpreting social cues or exhibit a lack of initiation or indifference to sex, or become involved in unsafe sexual practices. Many TBI patients are also taking number of antidepressants, stimulants, and other medications that can decrease libido or arousal.
Since the symptoms of brain injuries can vary widely based on the individual and the severity of the injury, researchers in one study sought to determine what predicts sexual dysfunction after brain injury in study of 322 men and women with TBI.2
Compared to non-injured participants, men with TBI were more likely to report sexual dysfunction, arousal difficulties, trouble maintaining an erection, reduced energy for sex, and body image difficulties. Interestingly, women with TBI had similar levels of sexual activity compared to non-injured women, although they also had difficulties with arousal, vaginal lubrication, and reported more pain with sex. Predictors of sexual dysfunction after a head injury were depression, older age, milder injuries, and in women, endocrine disorders.
In another study involving heterosexual couples who were married before a brain injury, 47% said they were dissatisfied with the changes in their sexual activity after the injury.3
Moreno and colleagues also found that few studies have examined the role of sexuality in the treatment of traumatic brain injuries. In addition to recommending more research on the subject, they pointed out that sexuality should be addressed within the rehabilitation process to prevent TBI patients from developing sexual dysfunction. They recommended a holistic treatment approach to traumatic brain injuries which addresses sexuality along with the varied cognitive, psychological, and physical symptoms of the injury.
- Moreno JA, et al. Sexuality after traumatic brain injury: A critical review. NeuroRehabilitation 2013; 32: 69-85.
- Hibbard MR, et al. Sexual dysfunction after traumatic brain injury. NeuroRehabilitation 2000; 15(2), 107-120.
- Garden, F. H., Bontke, C., & Hoffman, M. Sexual functioning and marital adjustment after traumatic brain injury. Journal of Head Trauma Rehabilitation 1990; 5(2), 52-59.