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Brain Trauma and Sexuality
by Stanley Ducharme, Ph.D.

The majority of people with spinal cord injuries have been injured as a result of trauma. These often include motor vehicle accidents, sporting injuries, falls or acts of violence. It is not surprising therefore that mild brain injury often accompanies the spinal cord injury. Also not surprisingly, is the fact that these head injuries often go undiagnosed in the emergency room or during the individual’s hospitalization and rehabilitation. An emergency room CAT scan or MRI of the brain is not a routine procedure after SCI. Stabilization of the spinal is naturally the priority at this critical time.

Yet, recent studies in the rehabilitation literature have documented that from 24% to 59% of individuals with spinal cord injury have experienced some loss of consciousness at the time of injury. This loss of consciousness may have been a result of respiratory compromise (especially in high level quadriplegia) or from a brain concussion. Such concussions often occur from a violent shaking of the brain during a whiplash injury or from direct impact with a solid object. Fortunately, most of the cognitive and memory problems associated with mild brain injury tend to clear up within several weeks after injury. In some cases however, the residual effects of a brain concussion may last for months, years or indefinitely.

Memory impairment, poor attention, impulsive behavior, difficulty in planning, lack of judgement and poor organization are the most commonly seen problems of a concussion injury. Loss of balance, blurred vision and ringing in the ears are additional symptoms of these injuries. In addition to the cognitive and physical changes, brain concussions can also have a direct impact on sexual functioning and sexual expression. For the person with the injury and their partner, these changes can complicate an already difficult sexual adjustment following a spinal cord injury.

Like the spinal cord, certain portions of the brain are critical in regulating and controlling sexual activity. Specific limbic structures of the brain, the frontal lobe and the hypothalamus play a crucial role in sexual and related behaviors. In addition to these structures, the brainstem is an equally important organ that carries the sexual messages back and forth between the brain and the spinal cord. Any slight damage to these areas can impact on how sexual urges are expressed and how the sexual organs will work.

Because of the confusion regarding sexuality and brain injury, many people believe that sexual desire increases when a brain concussion has occurred. People who have had a concussion may seem pre-occupied with sex, speak about sex at inappropriate times or demonstrate inappropriate sexual behaviors. Because of their sexual pre-occupation, it may appear as if they desire sex more frequently. Commonly, individuals with these problems may be unaware that they are speaking or acting in socially unacceptable ways.

These behaviors, which were not present before the injury, can be confusing and frightening to partners and to spouses. Often, the spouse may report that, “my husband doesn’t seem like the same man I married”. In other cases, spouses have stated, “ all my husband seems interested in is sex. Even paying the bills and watching the kids seem less important to him”. For the partner, responding to frequent sexual demands can undermine feelings of closeness and warmth. The spouse may even find it difficult to be affectionate and actually find it disturbing to have physically intimate contact. Some studies have shown that emotional detachment by the spouse becomes a necessary way to cope with such an untenable situation.

In reality, the sexual drive has not changed in people who have sustained a brain concussion. It is the regulatory centers of the brain that have been damaged. The ability to control sexual urges and desires has been diminished. The person may no longer be able to prevent sexual words and actions from being expressed. This area is the frontal lobe of the brain which allows us to inhibit or “hold back” impulses and urges. This is a fragile area of the brain, located behind the forehead, which is easily damaged when the brain has been shaken against the very rough bony areas of the anterior skull.

A number of related problems may surface during love making if a brain concussion has occurred and has not yet cleared. These may include becoming distracted during sexual activity, talking aimlessly, excessive fatigue, becoming confused or lacking emotional sensitivity. Touching may become awkward or too rough. The person may become self-centered, neglecting the pleasure and needs of the partner. In other cases, the individual may forget small but important aspects such as shutting the bedroom door to insure privacy or being careless about hygiene, birth control and STDs.

Physical sexual problems can also occur from mild brain injury but are more rare. For example, difficulty with erections and arousal in women can also be related to a brain injury as well as the spinal cord injury. Problems in achieving orgasms may occur for both sexes because of damage to either the brain or spinal cord injury. When the cause is a brain injury, the individual may become distracted or have intrusive thoughts that can decrease sexual excitement and diminish arousal. Issues such as fertility, ejaculation and childbirth are typically not seen in individuals with concussions or brain injury. Nevertheless, each case is unique and no clear patterns have been identified in the scientific literature.

Today, there are effective treatments for people with problems in controlling their sexual urges, words and behaviors. Treatment usually involves a combination of medications, behavioral programs and counseling. The medications can help slow down the cognitive process so that an individual can evaluate the situation before speaking or acting inappropriately. These few seconds or pauses can make a remarkable difference during intimate or social situations.

Typical medications used for these problems are often various anti-depressant medications, certain seizure medications or medications that help with pre-occupations about sex and obsessive thinking about sex. These are common medications prescribed by psychiatrists. Using the medication allows extra time, enabling the person to better understand the consequences of his words or behavior. For less severe problems or for people who feel uncomfortable with medications, behavior therapy and counseling can be very effective as well.In summary, mild brain injury is a common occurrence seen in people with spinal cord injury. Estimates range from 24 to 59% of new injuries experience some loss of consciousness or brain concussion. Often the cognitive difficulties will clear in a matter of weeks, but in some cases the effects may linger indefinitely. It is common among people with these types of injuries to see some effect upon their sexual expression. Most frequently, these changes are behavioral rather than physical. A pre-occupation with sex or inappropriate sexual behavior can be especially difficult for spouses. Partners often feel uncomfortable and may withdraw from sexual contact and emotional intimacy.

Treatment is available for these problems but often not so easy to locate. Professionals at rehabilitation centers are often not equipped to provide direct treatment themselves but may be a good starting point in helping families to locate resources and providers who have expertise in these areas.

For family members, simply understanding these changes and being able to support the person while setting limits may be an excellent place to start. Responding to inappropriate sexual behaviors in a firm but gentle consistent manner will often improve this difficult situation.

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