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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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