Sexual Dysfunction Following Injury: Time for Enlightenment and Understanding Charles Simkins, The Centre for Neuroskills Page 1 of 5

Discussion of Medical Literature

As I researched and thought about what to say and include in this article, I was amazed to discover that just about every medical textbook that I reviewed had at least some information about sexual dysfunction, whether neurology, psychiatry, orthopedics, neuropsychology, or other areas, somewhere in each book there was some discussion about relationships between trauma, medications, emotions, injury, or something to sexual dysfunction.

I decided to include this section with just quotes from the medical literature not, in any way, to try and teach the medical substance of the quotes, but rather, for the purpose of making the reader aware of how extensively this topic is discussed in some of the very same medical books that may well be on your doctors' shelves. This knowledge may help people feel a little more comfortable about discussing issues of sexual dysfunction with a doctor.

It is also important to remember that there are physicians, specialists, and health care providers who specialize in working with people with sexual dysfunction and people have the right to request such referrals.

Rehabilitation of the Adult and Child with Traumatic Brain Injury, Second Edition, by Rosenthal, Griffith, Bond, and Miller, 1990. At page 206, the chapter is entitled "Sexuality and Sexual Dysfunction."

Human sexuality conceptually embraces the composite of those factors that result in our capacity to love and procreate. A related aspect of sexuality is the individual's perception and expression of "womanliness" or "manliness." By these terms, it is predictable that a catastrophic event such as brain injury will almost ineluctably affect the sexuality of the survivor. Sexual disabilities may include disturbances of any of the component functions of sexuality: sexual drive, interests, beliefs, attitudes, behaviors, identity, activities, responses, and fertility.

In this chapter, they refer to:

Disabilities resulting from physical or organic factors as primary dysfunction, and secondary sexual dysfunctions resulting from brain trauma are those disturbances of psychosocial abilities or sexual responses due to the mental deficits in psychologic reactions consequent to the injury. Secondary sexual dysfunctions may arise in the partner, if one exists, as the consequences of reactions to the disabled person and the altered life situation.

Current evidence indicates that secondary factors account for the great majority of sexual dysfunctions in brain injured subjects. However, more recent data suggest that primary factors may be less rare than previously surmised . . . In contrast to the growing body of general information on psychosocial aspects of brain trauma, very little has been written about sexuality.

Page 207:

Sexual responses - erection, vaginal lubrication, ejaculation, orgasm, and fertility - are not altered as a direct consequence of brain injury unless the hypothalamic-pituitary function has been disturbed or disrupted. The resulting endocrinopathies have received increasing attention, with recognition that testicular and ovarian hypofunction can occur. Some women with mesial temporal lobe foci of seizures have recently been reported to have hypogonadotropic hypogonadism. Women often become temporarily amenorrheic following severe trauma, but menses should ordinarily resume within 4 to 6 months. Persistent amenorrhea should alert the clinician to the possibility of pituitary dysfunction. Similarly, men frequently have transient impotence, but the ability to achieve an erection should reappear after several months.

Page 207:

Trauma to the craniofacial area, primary or secondary sexual organs, and orthopedic injuries resulting in amputation, contractures, deformities, and chronic pain are potential sources of dysfunction . . . Abdominal or pelvic vascular injuries can compromise circulation to the genitalia, producing impotence or other alterations in sexual responses.

Recurrent medical complications, sustained bed rest, and inactivity with its many consequences cause deconditioning and other effects that impinge upon sexual activity. A multitude of drugs produce side effects that influence sexual acts and responses . . .

Finally, pre-existing disorders may become additive factors contributing to the primary sexual dysfunction. Cardiac, vascular, pulmonary, or other types of diseases may already have compromised sexual function of the elderly before injury.

In the book Principals of Neurology by Adams, Victor, and Ropper, Sixth Edition, at page 517, under the heading of "Altered Sexuality" it states:

The normal pattern of sexual behavior in both male and female may be altered by cerebral disease quite apart from impairment due to obvious physical disability or to diseases that destroy or isolate the segmental reflex mechanisms.

Hypersexuality in men or women is a rare but well-documented complication of neurologic disease. Kleist pointed out that lesions of the orbital parts of the frontal lobes may remove moral-ethical restraints and lead to indiscriminate sexual behavior, and that superior frontal lesions may be associated with a general loss of initiative which reduces all impulsivity, including sexual.

At page 518:

In our clinical work we find that hyposexuality, meaning loss of libido, is most often due to a depressive illness. Certain chemical agents - notably antihypertensive, anticonvulsant, serotoninergic antidepressant and neuroleptic drugs - may cause a loss of libido. A variety of cerebral diseases may also have this effect.

At page 545, under the heading of "Disturbances of Sexual Function," it says:

Sexual function in the male, which is not infrequently affected in neurologic disease, may be divided into several parts: (1) sexual impulse, drive, or desire, often referred to as libido; (2) penile erection, enabling the act of sexual intercourse (potency); and (3) ejaculation of semen by the prostate through the urethra, whereby impregnation of the female may be accomplished.

The arousal of libido in men and women may result from a variety of stimuli, some purely imaginary. Such neocortical influences are transmitted to the limbic system and thence to the hypothalamus and spinal centers.

The difference aspects of sexual function may be affected separately. Loss of libido may depend upon both psychic and somatic factors. It may be complete, as in old age or in medical and endocrine diseases, or it may occur only in certain circumstances or in relation to a certain situation or individual.

Copyright (c) 2006 Charles Simkins. Reprinted from the Centre for Neuroskills. Used with permission. All rights reserved. www.neuroskills.com

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