More than three million Americans face traumatic brain injury each year, a condition that is associated with physical, cognitive and emotional problems.

To help clinicians understand the complexity of interactions between psychological factors, physical factors, and relationship factors, investigators have applied a biopsychosocial model in which all three areas intersect to affect sexuality after TBI:
- Neuropsychological and psychological effects — A review of existing literature reveals that cognitive deficits and changes in body image, loss of identity, adjustment, depression, and anxiety can affect an individual's confidence level and ease in forming new relationships.
- Medical and physical issues — Medications prescribed to those with TBI may interfere with sexual function. Drugs such as antihypertensives, antidepressants, stimulants, and anticonvulsants can lower libido and cause erectile, ejaculatory, arousal, or orgasmic problems. Physical changes after TBI can also pose additional limitations in sexual functioning.
- Relationship changes — Stress on the patient and family members can cause marked shifts in relationships. For example, spouses of TBI survivors often perceive important personality changes. Social skills such as meeting people, explaining the TBI to others, and learning appropriate boundaries may need to be taught or relearned.
The critical review also provides perspectives from multiple viewpoints: Professional, survivor, and patient/partner. The team's evaluation of the existing literature notes methodological limitations that include insufficient sample sizes and an underrepresentation of women. "Sexual difficulties are common in TBI survivors and affect both the individual and the family system. Sexual dysfunction is only one part of sexual difficulties observed in TBI patients, as the existence of other deficits in cognition, emotion and functionality may affect the expression of sexuality," says Moreno. "Assessment, treatment, and systematic follow-up of post-TBI sexual difficulties should always be part of the clinical agenda throughout all rehabilitation and post-rehabilitation stages."Advertisement
The research team further notes that future studies need to explore the partner's perspectives and that researchers should favor studies considering both the patient's and the partner's viewpoints. In addition, they mention the need to include Lesbian, Gay, Bisexual, Transgender and Intersex (LGBT) considerations in the assessment and rehabilitation agenda of TBI.Advertisement