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Sexuality/Sexual Dysfunction in Acquired Brain Injury

Condition: Sexual dysfunction in acquired brain injury refers to the inability of patients to engage in satisfactory sexual activity, due to problems with desire, arousal, orgasm, or pain.

Background: People with acquired brain disorders often experience sexual disorders due to problems with the nervous system, nerve functioning, behavior, or mental ability. Hormone problems or medications used to treat other symptoms may also negatively affect sexual performance in these patients.

Risk Factors: Following traumatic brain injury, 30% of men experience erectile dysfunction, and 40% experience orgasm problems. Following stroke, more than half of patients experience sexual dysfunction. Other risk factors include certain medications, psychological issues, dependence on others for daily tasks, and the presence of other diseases, including diabetes.

History and Symptoms: A patient’s general medical history, including medications, will offer insight to the problem. Specific questions about desire, sexual orientation, experiences, abuse, pain, sexual response, orgasm, menstrual cycle (women), libido, or change in need for shaving facial hair (men) can provide important information.

Physical Exam: A physical exam will be performed to assess communication ability, range of motion, muscle strength and control, sensation, pelvic floor, genitals, and rectum in order to assess potential causes of the problem.

Diagnostic Process: Blood and urine tests may be used to assess hormone levels, liver or kidney function, blood sugar levels, or immune status. Other tests may be used to assess sexual arousal and response. MRI or electrodiagnosis may be used to test sexual response or nerve function.

Rehab Management: Erectile dysfunction can be treated with medications or medical devices, such as constrictor bands, vacuum pump, or penis implants. If the problem lies in the desire for sexual activity, treatment with antidepressants, botanical massage oil, hormone supplementation, or natural dietary supplements (yohimbine) can be helpful. Sexual behavior disorders can be treated with behavioral therapy, medications (antidepressants or anticonvulsants), or hormonal therapies. Sex therapy with both partners as well as physical exercises may be used to improve sexual satisfaction. To treat sensorimotor disorders, changes in positioning and use of sex toys may be advised.

Other Resources for Patients and Families: Resources, including counseling, for patients and partners are available.

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