For the more than 3 million Americans living with traumatic brain injury,
there is often an unspoken problem: many suffer from sexual dysfunction,
something that is easily overlooked as patients struggle with overwhelming
physical and emotional issues that can last for years, new research has
The sexual difficulties usually become most apparent about six months after
the injury and, if left unaddressed, worsen with time, said study author Jhon
Alexander Moreno, a researcher in neuropsychology at the University of
The cause of the injury can also influence whether a person will struggle
with sexual problems, Moreno said. "The psychological stressors that an athlete
or a soldier faces are quite different, so a traumatic brain injury with the
same severity can lead to different sexual difficulties."
Traumatic brain injury (TBI) is the result of an external force that
traumatically injuries the brain. It can be caused by a penetrating injury, such
as a bullet or flying metal, or a blow to the head, from something such as a car
accident or a forceful tackle on the football field.
The review, which was published in NeuroRehabilitation: An International
Journal, analysed the results of 14 studies that together included almost 1
500 patients, spouses, partners and people without TBI, as well as
rehabilitation professionals reporting on their experience with these
The study found that 50% to 60% of people with TBI have sexual difficulties,
such as reduced interest in sex, erectile dysfunction, pain during sex,
difficulties in vaginal lubrication, difficulties achieving orgasm or staying
aroused, and a sense of diminished sex appeal, Moreno said.
The research found that partners of those with TBI experienced personality
and emotional changes, and a modification of family roles that can lead to a
crisis, Moreno said. "For the spouse, the survivor becomes a different person, a
person they do not recognise as the one they fell in love with in the past," he
"The spouse becomes a caregiver and this imbalance in the relationship
directly affects sexual desire."
Marital separation rates can be as high as 78% among people with TBI, Moreno
'More holistic approach'
The research also showed that people with TBI commonly experience thinking
problems, depression, anxiety and changes in body image. Some of their
medications - such as blood-pressure drugs, antidepressants, stimulants and
anticonvulsants - can lower sex drive and cause other physical and mental
problems. Some develop personality changes, such as reduced social skills and
trouble knowing what is inappropriate to say or do with others, the study
Yet experts said sexual issues associated with TBI don't get much attention
from physicians and rehabilitation professionals.
"It's not something that's really dealt with acutely or soon afterwards,"
said Kenneth Podell, co-director of the Methodist Concussion Center in Houston.
"When the patient goes home, the focus is still on primary things. Then, as
people are settling into their routine, that's where [the problems] seem to be
The sexual problems that people with TBI experience are so intertwined with
the complex psychological and social aftereffects of the injury that patients
need a more holistic approach to rehabilitation, Moreno said.
"Yet most places don't have a multi-disciplinary approach to TBI; Methodist
[Concussion Center] does not have it," Podell said. "You find
[multi-disciplinary teams] in certain rehabilitation hospitals or centers, and
yet even then you're getting a neurologist, a psychologist, a speech pathologist
- but you don't necessarily have a sex therapist."
Podell said most studies reviewed in the research included only those with
moderate and severe TBI, which he said could make the problems associated with
TBI - including sexual dysfunction - appear more common than they actually are.
He emphasised that not everybody with TBI develops complicated problems.
"TBI is very dose-dependent," he said.
"A mild TBI produces mild deficits, a moderate TBI produces moderate deficits
and a severe TBI produces severe deficits."
How certain factors affect a TBI patient's ability to recover - such as
gender, cause of injury, sexual orientation, socioeconomic status and culture -
still needs to be explored, Moreno said.
Learn more about traumatic brain injury from the US Centers for
Disease Control and Prevention.