0
0

Chapter 25. Sexual Dysfunction

Nathan D. Zasler, M.D.; Michael F. Martelli, Ph.D.
DOI: 10.1176/appi.books.9781585624201.682649

Sections

Excerpt

Traumatic brain injury (TBI) may adversely affect the expression of sexuality and/or sexual functions because of a variety of different factors. A TBI may affect myriad aspects of functioning germane to sexual expression, including cognitive, emotional, behavioral, physical, and psychosocial functioning. The complexity of these factors, not only singly but also integrated into their influence on human behavior, presents clinical assessment and treatment challenges as well as methodological challenges for research (Sandel et al. 2007). Brain injury may produce sexual dysfunction at the genital level as well as adversely affect expression of sexuality at the nongenital level. Ultimately, the mediating factors in these functional alterations include disruption of neuroanatomical pathways or aberrations in neurophysiological function, or both, as a result of the TBI. To better comprehend the effect of brain injury on sexuality, one must first understand the basic neuroanatomical pathways and neurophysiological mechanisms that are involved in the mediation of sexual function.

Your session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Table Reference Number
Table 25–1. Sexual neuroanatomy: substructures and theoretical behavioral correlates
Table Reference Number
Table 25–2. Sexual neurophysiology: hormone source and effect
Table Reference Number
Table 25–3. Sexual pharmacology: drug class and clinical effect
Table Reference Number
Table 25–4. General Rehabilitation Assessment Sexuality Profile
Table Reference Number
Table 25–5. Posttraumatic neuroendocrine dysfunction: clinical presentation and appropriate laboratory evaluation

References

Acerini CL, Tasker RC: Traumatic brain injury induced hypothalamic-pituitary dysfunction: a paediatric perspective. Pituitary 10:373–380, 2007
[PubMed]
 
Acerini CL, Tasker RC: Neuroendocrine consequences of traumatic brain injury. J Pediatr Endocrinol Metab 21:611–619, 2008
[PubMed]
 
Agha A, Thornton E, O'Kelly P, et al: Posterior pituitary dysfunction after traumatic brain injury. J Clin Endocrinol Metab 89:5987–5992, 2004
[PubMed]
 
Aloni R, Katz S: Sexual function after traumatic brain injury. Harefuah 134:816–821, 1998
[PubMed]
 
Aloni R, Katz S: A review of the effect of traumatic brain injury on the human sexual response. Brain Inj 13:269–280, 1999
[PubMed]
 
Aloni A, Keren O, Cohen M, et al: Incidence of sexual dysfunction in TBI patients during the early post-traumatic in-patient rehabilitation phase. Brain Inj 13:89–97, 1999
[PubMed]
 
Basson R: Female sexual response: the role of drugs in the management of sexual dysfunction. Obstet Gynecol 98:350–353, 2001
[PubMed]
 
Bauer HG: Endocrine and metabolic conditions related to pathology in the hypothalamus: a review. J Nerv Ment Dis 28:323–328, 1959
 
Behan LA, Agha A: Endocrine consequences of adult traumatic brain injury. Horm Res 68 (suppl 5):18–21, 2007
 
Bell KR, Pepping M: Women and traumatic brain injury. Phys Med Rehabil Clin N Am 12:169–182, 2001
[PubMed]
 
Bezeau SC, Bogod NM, Mateer CA: Sexually intrusive behavior following brain injury: approaches to assessment rehabilitation. Brain Inj 18:299–313, 2004
[PubMed]
 
Blanchard R, Kuban ME, Klassen P, et al: Self-reported head injuries before and after age 13 in pedophilic and non-pedophilic men referred for clinical assessment. Arch Sex Behav 32:573–581, 2003
[PubMed]
 
Blumer D: Changes of sexual behavior related to temporal lobe disorders in man. J Sex Res 6:173–180, 1970a
 
Blumer D: Hypersexual episodes in temporal lobe epilepsy. Am J Psychiatry 126:1099–1106, 1970b
 
Blumer D, Migeon C: Hormone and hormonal agents in the treatment of aggression. J Nerv Ment Dis 160:127–137, 1975
[PubMed]
 
Blumer D, Walker AE: Sexual behavior in temporal lobe epilepsy. Arch Neurol 16:31–43, 1967
 
Boller F, Frank E: Sexual Dysfunction in Neurological Disorders: Diagnosis, Management and Rehabilitation. New York, Raven, 1982
 
Bond MR: Assessment of psychosocial outcome of severe head injury. Acta Neurochir (Wien) 34:57–70, 1976
[PubMed]
 
Bradford JM: The neurobiology, neuropharmacology and pharmacological treatment of the paraphilias and compulsive sexual behavior. Can J Psychiatry 46:24–25, 2001
 
Britton KR: Medroxyprogesterone in the treatment of aggressive hypersexual behavior in traumatic brain injury. Brain Inj 12:703–707, 1998
[PubMed]
 
Casanueva FF, Castro AI, Micic D, et al: New guidelines for the diagnosis of growth hormone deficiency in adults. Horm Res 71 (suppl 1):112–115, 2009
 
Chigier E: Sexuality of physically disabled people. Clin Obstet Gynaecol 7:325–343, 1980
[PubMed]
 
Clayton DO, Shen WW: Psychotropic drug-induced sexual function disorders: diagnosis, incidence and management. Drug Saf 19:299–312, 1998
[PubMed]
 
Cohen H, Rosen R, Goldstein L: Electroencephalographic laterality changes during human sexual orgasm. Arch Sex Behav 5:189–199, 1976
[PubMed]
 
Coslett H, Heilman K: Male sexual function: impairment after right hemisphere stroke. Arch Neurol 43:1036–1039, 1986
[PubMed]
 
Crowe SF, Ponsford J: The role of imagery in sexual arousal disturbances in the male traumatically brain injured individual. Brain Inj 13:347–354, 1999
[PubMed]
 
Dinsmoor W: Treatment of erectile dysfunction. Int J STD AIDS 15:215–221, 2004
 
El-Galley R, Rutland H, Talic R, et al: Long-term efficacy of sildenafil and tachyphylaxis effect. J Urol 166:927–931, 2001
[PubMed]
 
Elliott ML, Biever LS: Head injury and sexual function. Brain Inj 10:703–717, 1996
[PubMed]
 
Ferguson DM, Steidle CP, Singh GS, et al: Randomized, placebo-controlled, double blind, crossover design trial of the efficacy and safety of Zestra for women with and without female sexual arousal disorder. J Sex Marital Ther 29 (suppl 1):33–44, 2003
 
Finger WW, Lund M, Slagle MA: Medications that may contribute to sexual disorders: a guide to assessment and treatment in family practice. J Fam Pract 44:33–43, 1997
[PubMed]
 
Garden FH: Dating services for the disabled: Sexuality Update Newsletter. American Congress of Rehabilitation Medicine 1:4, 1988
 
Garden FH, Bontke CF, Hoffman M: Sexual functioning and marital adjustment after traumatic brain injury. J Head Trauma Rehabil 5:52–59, 1990
 
Goutier-Smith PC: Sexual function and dysfunction. Clinical Neurobiology 1:634–642, 1986
 
Gozzi M, Raymont V, Solomon J, et al: Dissociable effects of prefrontal and anterior temporal cortical lesions on stereotypical gender attitudes. Neuropsychologia 47:2125–2132, 2009
[PubMed]
 
Grossman WF, Sanfield JA: Hypothalamic atrophy presenting as amenorrhea and sexual infantilism in a female adolescent: a case report. J Reprod Med 39:738–740, 1994
[PubMed]
 
Gualtieri CT: Neuropsychiatry and Behavioral Pharmacology. New York, Springer-Verlag, 1991
 
Halvorsen JG, Metz ME: Sexual dysfunction, II: diagnosis, management and prognosis. J Am Board Fam Pract 5:177–192, 1992
[PubMed]
 
Hamed SA: Neuroendocrine hormonal conditions in epilepsy: relationship to reproductive and sexual functions. Neurologist 14:157–169, 2008
[PubMed]
 
Heath RG: Pleasure response of human subjects to direct stimulation of the brain: physiologic and psychodynamic considerations, in The Role of Pleasure in Behavior. Edited by Heath RG. New York, Harper & Row, 1964, pp 219–243
 
Herzog A: Endocrinological aspects of epilepsy, in Neurology and Neurosurgery Update Series (5[11]). Princeton, NJ, Continuing Professional Education Center, 1984
 
Hibbard MR, Gordon WA, Flanagan S, et al: Sexual dysfunction after traumatic brain injury. NeuroRehabilitation 15:107–120, 2000
[PubMed]
 
Horn LJ, Zasler ND: Neuroanatomy and neurophysiology of sexual function. J Head Trauma Rehabil 5:1–13, 1990
 
Jarrow JP, Burnett AL, Geringer AM: Clinical efficacy of sildenafil citrate based on etiology and response to prior treatment. J Urol 162:722–725, 1999
 
Jha S, Patel R: Kluver-Bucy syndrome—an experience with six cases. Neurol India 52:369–371, 2004
[PubMed]
 
Johnson C, Knight C, Alderman N: Challenges associated with the definition and assessment of inappropriate sexual behavior amongst individuals with an acquired neurological impairment. Brain Inj 20:687–693, 2006
[PubMed]
 
Kaplan HS: Disorders of Sexual Desire and Other New Concepts and Techniques in Sex Therapy. New York, Brunner/Mazel Publications, 1979
 
Kelly G, Todd J, Simpson G, et al: The Overt Behaviour Scale (OBS): a tool for measuring challenging behaviours following ABI in community settings. Brain Inj 20:307–319, 2006
[PubMed]
 
Knight C, Alderman N, Johnson C, et al: The St. Andrew's Sexual Behaviour Assessment (SASBA): development of a standardized recording instrument for the measurement and assessment of challenging sexual behavior in people with progressive and acquired neurological impairment. Neuropsychol Rehabil 18:129–159, 2008
[PubMed]
 
Kokshoorn N, Wassenaar M, Biermasz N, et al: Hypopituitarism following traumatic brain injury: the prevalence is affected by the use of different dynamic tests and different normal values. Eur J Endocrinol 162:11–18, 2010
[PubMed]
 
Kosteljanetz M, Jensen TS, Norgard B, et al: Sexual and hypothalamic dysfunction in post-concussional syndrome. Acta Neurol Scand 63:169–180, 1981
[PubMed]
 
Kreuter M, Dahllof AG, Gudjonsson G, et al: Sexual adjustment and its predictors after traumatic brain injury. Brain Inj 12:349–368, 1998a
 
Kreuter M, Sullivan M, Dahllof AG, et al: Partner relationships, functioning, mood and global quality of life in persons with spinal cord injury and traumatic brain injury. Spinal Cord 36:252–261, 1998b
 
Kreutzer JS, Zasler ND: Psychosexual consequences of traumatic brain injury: methodology and preliminary findings. Brain Inj 3:177–186, 1989
[PubMed]
 
Laan E, Everaerd W, Evers A: Assessment of female sexual arousal: response specificity and construct validity. Psychophysiology 32:476–485, 1995
[PubMed]
 
Lehne GK: Brain damage and paraphilia: treatment with medroxyprogesterone acetate. Sex Disabil 7:145–157, 1986
 
Levin RJ: The physiology of sexual function in women. Clin Obstet Gynecol 7:213–252, 1980
[PubMed]
 
Lezak MD: Living with the characterologically altered brain injured patient. J Clin Psychiatry 39:592–598, 1978
[PubMed]
 
Luef GJ: Epilepsy and sexuality. Seizure 17:127–130, 2008
[PubMed]
 
MacLean P: Brain mechanisms of primal sexual functions and related behavior, in Sexual Behavior: Pharmacology and Biochemistry. Edited by Sandler M, Gessa G. New York, Raven, 1975, pp 1–11
 
Masters WH, Johnson VE: Human Sexual Response. Boston, MA, Little, Brown, 1966
 
Mauss-Clum N, Ryan M: Brain injury and the family. J Neurosurg Nurs 13:165–169, 1981
[PubMed]
 
McConaghy N, Balszczynski A, Kidson W: Treatment of sex offenders with imaginal desensitization and/or medroxyprogesterone. Acta Psychiatr Scand 77:199–206, 1988
[PubMed]
 
McKenna KE: Neural circuitry involved in sexual function. J Spinal Cord Med 24:148–154, 2001
[PubMed]
 
McMahon CG, Touma K: Treatment of premature ejaculation with paroxetine hydrochloride. Int J Impot Res 11:241–245, 1999
[PubMed]
 
Meinhardt W, Kropman RF, Vermeij P: Comparative tolerability and efficacy of treatments for impotence. Drug Saf 20:133–146, 1999
[PubMed]
 
Mesulam M: Principles of Behavioral Neurology. Philadelphia, PA, FA Davis, 1985
 
Miller BL, Cummings JL, McIntyre H, et al: Hypersexuality or altered sexual preference following brain injury. J Neurol Neurosurg Psychiatry 49:867–873, 1986
[PubMed]
 
Montejo AL, Llorca G, Izquierdo JA, et al: Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. J Clin Psychiatry 62:10–21, 2001
[PubMed]
 
Morales A, Surridge DHC, Marshall PG, et al: Non-hormonal pharmacological treatment of organic impotence. J Urol 128:45–47, 1982
[PubMed]
 
O'Carroll RE, Woodrow J, Maroun F: Psychosexual and psychosocial sequelae of closed head injury. Brain Inj 5:303–313, 1991
[PubMed]
 
Oddy M, Humphrey M: Social recovery during the first year following severe head injury. J Neurol Neurosurg Psychiatry 43:798–802, 1980
[PubMed]
 
Oddy M, Humphrey M, Uttley D: Subjective impairment and social recovery after closed head injury. J Neurol Neurosurg Psychiatry 41:611–616, 1978
[PubMed]
 
Padma-Nathan H: Neurologic evaluation of erectile dysfunction. Urol Clin North Am 15:77–80, 1988
[PubMed]
 
Penfield W, Rasmussen T: The Cerebral Cortex of Man. New York, Macmillan, 1950
 
Rees PM, Fowler CJ, Maas C: Sexual function in men and women with neurological disorders. Lancet 369:512–525, 2007
[PubMed]
 
Rosen RC: Sexual pharmacology in the 21st century. J Gend Specif Med 3:45–52, 2000
[PubMed]
 
Rosen RC, Riley A, Wagner G, et al: The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49:822–830, 1997
[PubMed]
 
Rosen RC, Lane RM, Menza M: Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol 19:67–85, 1999
[PubMed]
 
Rosen RC, Brown C, Heiman J, et al: The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208, 2000
[PubMed]
 
Rosenbaum M, Najenson T: Changes in life patterns and symptoms of low mood as reported by wives of severely brain-injured soldiers. J Consult Clin Psychol 44:881–888, 1976
[PubMed]
 
Sandel ME, Williams KS, Dellapietra L, et al: Sexual function following traumatic brain injury. Brain Inj 10:719–728, 1996
[PubMed]
 
Sandel ME, Delmonico R, Kotch MJ: Sexuality, reproduction and neuroendocrine disorders following TBI, in Brain Injury Medicine: Principles and Practice. Edited by Zasler N, Katz D, Zafonte R. New York, Demos, 2007, pp 637–669
 
Sarwer DB, Durlak JA: A field trial of the effectiveness of behavioral treatment for sexual dysfunctions. J Sex Marital Ther 23:87–97, 1997
[PubMed]
 
Simpson G, Long E: An evaluation of sex education and information resources and their provision to adults with traumatic brain injury. J Head Trauma Rehabil 19:413–428, 2004
[PubMed]
 
Simpson G, Tate R, Ferry K, et al: Social, neuroradiologic, medical, and neuropsychologic correlates of sexually aberrant behavior after traumatic brain injury: a controlled study. J Head Trauma Rehabil 16:556–572, 2001
[PubMed]
 
Steers WD: Neural pathways and central sites involved in penile erection: neuroanatomy and clinical implications. Neurosci Biobehav Rev 24:507–516, 2000
[PubMed]
 
Stewart JT: Carbamazepine treatment of a patient with Klüver-Bucy syndrome. J Clin Psychiatry 46:496–497, 1985
[PubMed]
 
Tanriverdi F, Unluhizarci K, Kelestimur F: Persistent neuroinflammation may be involved in the pathogenesis of traumatic brain injury (TBI) induced hypopituitarism: potential genetic and autoimmune factors. J Neurotrauma 27:301–302, 2010
[PubMed]
 
Voorham-van der Zalm PJ, Lycklama a Nijeholt GA, Elzevier HW, et al: "Diagnostic investigation of the pelvic floor": a helpful tool in the approach in patients with complaints of micturition, defecation and/or sexual dysfunction. J Sex Med 5:864–871, 2008
 
Walker AE: The neurological basis of sex. Neurol India 24:1–13, 1976
[PubMed]
 
Weddell R, Oddy M, Jenkins D: Social adjustment after rehabilitation: a two year follow-up of patients with severe head injury. Psychol Med 10:257–263, 1980
[PubMed]
 
Whipple B, Brash-McGreer K: Management of female sexual dysfunction, in Sexual Function in People With Disability and Chronic Illness: A Health Professional's Guide. Edited by Sipski ML, Alexander CJ. Gaithersburg, MD, Aspen, 1997, pp 509–534
 
Zasler ND: Sexuality in neurologic disability: an overview. Sex Disabil 9:11–27, 1991
 
Zasler ND, Horn LJ: Rehabilitative management of sexual dysfunction. J Head Trauma Rehabil 5:14–24, 1990
 
Zasler ND, Kreutzer JS: Family and sexuality after traumatic brain injury, in Impact of Head Injury on the Family System: An Overview for Professionals. Edited by Williams J, Kay T. Baltimore, MD, Paul H Brookes, 1991, pp 253–270
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 16.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 42.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 20.  >
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 2.  >
Topic Collections
Psychiatric News
 
  • Print
  • PDF
  • E-mail
  • Chapter Alerts
  • Get Citation