Effects of TBI on Human Sexuality

Welcome to the TBI-HELP Live Chat

Today's topic is: "Effects of TBI on Human Sexuality"

Our Guest is: Dr. Robert Stewart, Psychologist, Jamaica Hospital Medical Center

Tonight's Topic Summary:
Sexual difficulties following TBI are common and manifest at psysiological, physical and emotional levels. Multiple treatments are discussed, as are patient and family sexuality resources.

[19:03:07] mod: Good evening and welcome to our chat session. Tonight it is our pleasure to have as our guest speaker Dr. Robert Stewart, Psychologist from Jamaica Hospital Medical Center. Welcome Dr. Stewart..
[19:03:59] Dr.Stewart: Thank you, and it's my pleasure to be here this evening.
[19:05:36] mod: Tonight our topic with Dr. Stewart is "The Effects of Traumatic Brain Injury on Human Sexuality"
[19:06:13] mod: How common are sexual difficulties following traumatic brain injury (TBI)?
[19:08:09] Dr.Stewart: According to some studies, nearly one quarter of previously sexually active patients were no longer sexually active after their TBI. In one specific study conducted here in NYC at the Mount Sinai School of Medicine, only 50% of men with TBI had sex in the past year. The quality of sex is also significantly impaired for both men and women, with TBI survivors reporting more sexual problems. 2/3 of women and less than half of men with TBI were in meaningful relationships at the time of the interview.
[19:12:40] mod: Rail: What are some of the most common sexual complaints following TBI?
[19:13:54] Dr.Stewart: Rail, good question ... sexual complaints can be grouped into three general categories: Physiological, Physical, and Emotional. Physiological issues relate to energy for sex, libido, difficulty with erection/vaginal lubrication, and achieving orgasm. Physical can involve body positioning, body movement, and sensation. Emotional complaints include body image, self-esteem, feelings of attractiveness, and comfort with being seen naked by a partner.
[19:17:35] mod: Do TBI survivors ever become over-sexual?
[19:19:53] Dr.Stewart: The literature suggests a relatively small number of TBI survivors report increased - or hyper- sexuality. The percentage for hypersexuality is around 14%. Approximately 57% (in the same study) of TBI survivors report hyposexuality, or a decrease in sexuality.
[19:23:44] mod: Do some medications play a part in the sexual functioning of a TBI?
[19:26:12] Dr.Stewart: Since depression is a major comorbid diagnosis with TBI, and itself contributes significantly to decreased sexual functioning, one avenue of tx is antidepressant medication. However, there is a catch ... many of the newer antidepressants - SSRI's like Prozac, Paxil, Zoloft, etc - often have a negative impact on sexuality, reducing libido and making erection/lubrication and orgasm more difficult. Therefore, the take home message is trying to treat the depression effectively with medications that minimally exacerbate already existing sexual difficulties in the TBI patient.
[19:30:26] mod: Rail: I'm glad that you opened up the "cognitive" area-is there any % in the literature where the cause of sexual disinterest is cognitive. Is it significantly different than the % in the general population?
[19:33:29] Dr.Stewart: Cognitive deficits can contribute to disinterest in sex in-so-much-as it may actually result in decreased awareness of sexual difficulties.
[19:33:55] mod: Rail: How much does depression affect sexual activity in TBI survivor?
[19:36:09] Dr.Stewart: I may have mentioned depression earlier, but depression is the best predictor of sexual dysfuncon in men with TBI, as found in a study at Mount Sinai. In the same Sinai study, depression and endocrine dysfunction were the best predictors of sexual functioning in women.
[19:38:13] mod: Rail: How often is the "depression" of the pt's significant other a contributing factor?
[19:40:49] Dr.Stewart: Although I'm not sure of specific data available, my sense is that depression would be among many possible issues that would complicate the relationship. On that same topic, TBI often strains marriages, with wives/partners, for example, often feeling increasingly lonely and isolated due to major life, role, and personality changes
[19:44:43] mod: James: In the US is sex ever part of the physical therapy - In Hong King it seems to be part of the picture for the young single patient.
[19:48:29] Dr.Stewart: James ... quite honestly this is beyond my realm of expertise, but in general sexual surrogates are not mainstream in NYC ... I have heard of them being used for other disorders, such as severe social anxiety, but not for TBI-related sexuality issues.
[19:49:20] mod: Rail: When should the rehabilitation support team address sexuality with the pt. and the family?
[19:50:37] Dr.Stewart: Rail, in one study I came across, TBI patients in sub-acute treatment reported having been asked to that point about sexual functioning by their doctor. Oops, sorry ... only 11% reported being asked. Most professionals agree that sexuality should be addressed in both inpatient and outpatient treatment ... however, often TBI patients do not report symptoms until after 1 year post-TBI .... and during the inpatient phase, often professionals only become aware of sexuality for those hypersexual TBI patients with disinhibition and inappropriate behaviors.
[19:55:49] mod: Rail: How early do the patients bring up the sexual issue in the recovery process/
[19:57:58] Dr.Stewart: Rail, this follows the thread I was just responding to, with one study in the literature pointing to only 7.7% of TBI patients in the subacute phase reporting sexual dysfunction ... most complaints of dysfunction begin more than 1 year post.
[19:58:47] mod: What are the recommendations for treating TBI-related sexual difficulties?
[19:59:41] Dr.Stewart: Briefly, individual therapy is recommended with a therapist knowledgeable and comfortable with TBI and sexuality. Also, .. peer support groups have been found to provide excellent forums for TBI survivors to discuss issues of sexuality and normalize not only their brain injury but also their specific sexual problems. If a person is in an intimate relationship, couples therapy is highly recommended (in addition to the above), to facilitate communication and increase intimacy ... such activities as couple sensate focus can be completed at home and then discussed in couples therapy safely. Finally, medications may also be helpful, including antidepressants and meds such as Viagra.
[20:03:44] mod: Where can both the patient and family go to find out more information on this subject?
[20:05:48] Dr.Stewart: Online, a few excellent websites exist (including this one), such as Mount Sinai's RTC website for TBI (www.mssm.edu/tbinet/). Another helpful site is www.tbinet.org, which offers information about many support groups for patients and family ... I also saw on that site info regarding groups and information for Spanish-language TBI survivors.
[20:07:43] mod: Well, I see that our time is up and I want to take this opportunity to thank Dr. Stewart for a very interesting and informative session. I welcome him back in the future and I also want to take this opportunity to wish all of our audience a happy and healthy holiday season and a joyous, peaceful New Year. Good Night, Be safe! See you in 2002!
[20:08:55] Dr.Stewart: Thank you very much for this great opportunity, and I look forward to coming back again. Happy Holidays.