TBI Consumer Report: Coping with Sexual Problems After TBI Mount Sinai Medical Center Page 2 of 2

What Are the Treatment Options You Should Consider?

Medications for mood. If depression is contributing to your sexual problems, you will need to see either your physician or be referred to a psychiatrist to discuss the possibility of your taking an antidepressant medication. Be certain that the physician is knowledgeable about the impact of TBI on both the choice and dosage levels of medications selected. It is important to question all medication side effects, since some antidepressants may actually worsen your sexual difficulties, an outcome you want to avoid!

Medications for sexual functioning. New medications, such as Viagra and other sex-enhancing drugs, have been effective in addressing erectile dysfunction in many men without a disability. You may want to discuss with your doctor a trial of this type of medication.

Individual and couples counseling. Our results suggest that establishing and maintaining a relationship with a sexual partner may be challenging after TBI, especially for men. Furthermore, the quality of sex is often reduced after TBI for both men and women. These issues appear to be even more germane for individuals who experienced brain injury when older. Individual counseling with a professional who can comfortably discuss your sexual difficulties and mood is strongly recommended. Sessions should focus on open discussions of your sexual fears and changes in your sexual abilities post TBI. Individual counseling should be followed by (or combined with) couples counseling, in which both you and your partner are seen in joint sessions. We stress the need for couples counseling, as sexual difficulties by nature require the cooperation of you and your partner to address difficulties that affect you both. Joint counseling enhances open communication between partners and permits shared planning of alternative approaches to enhance sexual enjoyment.

Referral for endocrine workup. In this study, women with TBI with a reported endocrine (hormonal) disorder more often experienced sexual difficulties. If you are concerned about having a possible (but as yet undiagnosed) endocrine disorder, you should ask your physician to provide a referral to a specialist, who will do a neuroendocrine workup. Common symptoms of an endocrine disorder include rapid weight gain or loss, irregular menses, and changes in hair and skin texture. Appropriate treatment is likely to decrease many of the sexual difficulties experienced by women with endocrine disorders post TBI.

In sum, although many people with TBI in our study reported that they are doing just fine in terms of their sexual lives, for the many others whose stories right now have no such happy ending, getting help is a must. For some people, this will focus on ways to help them establish and maintain lasting and meaningful relationships. For others, help will focus on reducing problems that occur during sexual activity. For others, both of these parts of achieving a satisfying sexual and emotional life will need attention at the same time.

*Sexual dysfunction questions were adapted from a questionnaire developed by Dr. A. Jackson of the University of Alabama

To Find Out More

This study has been published: Hibbard, M.R., Gordon, W.A., Flanagan, S., Haddad, L., and Labinsky, E. (2000). Sexual dysfunction after traumatic brain injury. NeuroRehabilitation, 15, 107-120.

TBI Consumer Report is a publication of the Research and Training Center on Community Integration of Individuals with Traumatic Brain Injury, supported between 1993 and 2004 by Grant Nos. H133B30038 and H133B980013, to the Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York City, from the National Institute on Disability and Rehabilitation Research, United States Department of Education.

From Mount Sinai Medical Center. www.mssm.edu.

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