Keywords: TBI, sexual functioning
TBI incidence and causes
Before finding out the correlation between TBI and sexual functioning let’s find out what is TBI. Traumatic brain injury (TBI) represents an important pathology caused by a physiological disruption of the brain, and its frequency increases every year with an incidence of approximately 506 per 100,000 people. Find out why is TBI a global burden.
The most prevalent causes of TBI based on age are:
● motor vehicle accidents – especially among the young people
● falls – especially in the elderly [Fig.1].
The number of sequelae that can result from head injuries is varied [1].
TBI and sexual function
Sexual functioning problems may arise after a traumatic brain injury. Therefore, it is essential that patients recognize these problems, know that they can be improved and seek help from their doctor [2].
Human sexuality represents a vast conglomerate that confines biological, physical, psychosocial, and cultural dimensions of personality and behavior. All of these dimensions can be affected by a head injury. For example, research shows that 50% of TBI patients manifest different sexual changes up to 5 years post-injury, with the majority complaining of a decrease in sexual activity after the injury. Patients attribute these changes to a number of different physical and psychological factors that interact in a complex way and are always going to be difficult to distinguish [3].
TBIs are predominantly encountered in young persons ages 15-25 years, especially men. Unfortunately, sexuality after TBI has received limited attention from researchers compared to other aspects of brain injury, despite the fact that these impairments can be the cause of significant distress for patients and their families [4].
The number of TBIs rises every year, so one must expect that sexual problems related to head injury will also rise. That is why these issues should not be neglected and overlooked. Sexual activity can have a positive effect on rehabilitation, and that is why the patient’s partner must be involved in the rehabilitation process [4]. Communication between partners is vital to improving their sexual life, and patients must feel able to express their feelings and concerns freely.
Fortunately, sexual assessment has become a routine part of the rehabilitation process in the last few years. Creating an atmosphere of openness and a protocol for addressing sexual problems should be part of any rehabilitation program [3].
The severity of sequelae after a TBI varies based on the head injury characteristics. This also applies to sexual problems.
What is the role of different parts of the brain in regulating sexuality?
Research shows that injuries to different parts of the brain might have different effects:
- frontal (especially basal zone) and frontotemporal areas lesions may lead to hypersexuality or sexual disinhibition
- frontal convexity lesions can cause hyposexuality
- medial septal areas lesions can cause hypersexuality
- temporal lobe seizures due to a TBI may manifest with hyposexuality and post-ictal sexual arousal
- frontal lobe seizures due to a TBI may manifest with disinhibited sexual behavior
- limbic system lesions can affect sexual behavior [3].
Research shows a significant amount of stress on relationships and families after a head injury that may lead to separation. That is why the patient’s family must be included in the rehabilitation process for the successful social reintegration of the injured [4].
How is sexual functioning affected by TBI?
After a head injury, patients may notice a decrease/increase in desire or decreased arousal manifested as:
● difficulty in vaginal lubrication in women
● difficulty in maintaining an erection in men
● difficulty or inability to reach orgasm
● reproductive changes such as:
● irregular menstrual cycles or periods in women
● decreased sperm production in men
What are the main causes for such changes?
There are many causes for changes in sexuality functioning after TBI, such as:
● damage to parts of the brain implicated in sexual functioning
● hormonal changes (testosterone, progesterone, estrogen)
● medication side effects
● fatigue
● movement problems
● self-esteem problems because patients may feel less attractive due to the injury
● changes in thinking abilities
● emotional changes – patients may feel sad, irritable, or nervous
● difficulty in interacting with the partner or new people due to changes in the relationship and social activities
TBI can cause motor problems, as highlighted in Fig. 3.
Cognitive skills affected in TBI:
● attention
● memory
● communication
● planning
● reasoning
● imagination
How can sexual functioning after TBI be improved?
There are many things that people who suffered a head injury and encountered sexual problems, as a result, can do in order to improve their sexual life, such as:
● talking to a health professional that patients feel comfortable with (doctor, nurse, rehabilitation professional) about the problem without feeling embarrassed as sexuality is a normal part of human behavior
● getting a comprehensive medical exam
● blood workout – must include hormone levels
● urine screen
● psychotherapy/counseling
● sex therapy
● couples therapy
● communicating with the partner to decide the best time of the day and the most comfortable position for intimate relationships
● increase their social network
● use different sexual aids – books, movies
It is well recognized that from the group of patients that suffered a head injury, the proportion of patients that experienced a TBI at a young age lack the self-confidence and social skills necessary to initiate contact with the opposite sex and form relationships. However, this appears not to apply to middle-aged patients who suffered a TBI, probably because they have already established sexual relationships prior to the injury or because they are more open to admitting the changes in their behavior. Therefore, re-training these skills and developing an assessment method is one of the most significant challenges that scientists will have to face to improve the psychosocial outcome following a head injury [3].
Even after a TBI, patients should keep in mind to practice safe sex to protect themselves from an unplanned pregnancy or sexually transmitted diseases. There are certain things that patients can do to stay safe:
● use a method of birth control that they feel is right for them
● plan ahead/use different devices always to be protected, as thinking abilities might be impaired after a TBI
● get tested for sexually transmitted diseases if they have engaged in risky sexual behavior
Sexuality is a normal part of human functioning, and patients with TBI should feel comfortable talking about their problems.
References
1. Nicholl, J. & LaFrance, W. C. Neuropsychiatric sequelae of traumatic brain injury. Semin. Neurol. 29, 247–255 (2009). DOI: 10.1055/s-0029-1223878
2. Sexuality After Traumatic Brain Injury | Model Systems Knowledge Translation Center (MSKTC). Retrieved from: https://msktc.org/tbi/factsheets/sexuality-after-traumatic-brain-injury.
3. Ponsford, J. Sexual changes associated with traumatic brain injury. Neuropsychol. Rehabil. 13, 275–289 (2003). DOI: 10.1080/09602010244000363
4. Elliott, M. L. & Biever, L. S. Head injury and sexual dysfunction. Brain Inj. 10, 703–717 (1996). DOI: 10.1080/026990596123972
