Traumatic brain injury and sexual rehabilitation

Abstract

Summary Objective This article describes the various consequences of a traumatic brain injury (TBI) on sexuality. The physical, cognitive, emotional, relational and social consequences of TBI, to which are added “secondary” conditions such as depression, anxiety and fatigue can all influence sexual function and behavior. Method A review of the clinical scientific literature along with our experience in a rehabilitation center served this analysis. Results The sequellae of a TBI, including the physical, cognitive and social consequences are described as the secondary conditions which can all contribute to the emergence and maintenance of sexual difficulties. Sexual dysfunctions affecting desire, arousal or orgasm can all appear. Disinhibition and hypersexuality are also reported and can become a social handicap for the patients and their surrounding. For those in couple, marital adjustment may become difficult. To overcome these difficulties, different therapeutic strategies can be offered and adapted according to the patient's capacity for introspection, planning and reflection. Our clinical experience leads us to favor the cognitive behavioral approach. The use of a logbook is encouraged to overcome concentration difficulties or memory problems, and the use of modeling, role playing, training with social and sexual habilities, basic sexual education and education on the specific impact of TBI on sexual function may be useful. Extinction of sexually inappropriate behaviors and reinforcement of appropriate behaviors are considered to overcome hypersexuality. Clinicians must be creative and patient. They must repeatedly verify the therapeutic gains and must repeat therapeutic advices. Discussion Sex therapy can offer a variety of therapeutic strategies to overcome sexual difficulties arising from TBI. Cognitive behavioral approaches prove useful as they are more directives and can help patients overcoming their sexual difficulties in addition to preventing these difficulties during early interventions.