Advising Patients on Sexual Health, Intimacy Issues After TBI

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WASHINGTON — Sexual health and intimacy problems are important issues for those who have sustained a brain injury, and providers need to be able to address the topics with TBI patients, researchers said at the Federal Interagency Conference on Traumatic Brain Injury held in Washington.

“There is no doubt that sexuality is an important topic for people after brain injury,” explains Angelle Sander, PhD, co-director of the Brain Injury Research Center at TIRR Memorial Hermann and assistant professor of physical medicine and rehabilitation at Baylor College of Medicine in Houston.

If providers do not bring the subject up of intimacy, Sander says that patients may not realize that sexual intimacy problems they are experiencing are due to their injuries.

“If they have problems with sexual functioning and they have no idea it is related to the TBI, they are going to attribute it to their relationship or to something within themselves and this causes even more difficulties like emotional problems with depression or marital relationship problems,” she says. 

Sander is an investigator for a multi-center longitudinal study that is seeking to determine the frequency, type and severity of changes in sexual functioning associated with TBI. The researchers expect results of that study will create the largest existing prospective database on sexual functioning after TBI. 

Sexual Health in TBI Patients

The areas of the brain most frequently damaged in TBI are areas critical to sexual function, Sander says. In addition, physical impairments that are common after TBI, such as problems with balance and cognitive impairment difficulties with attention, memory and planning also disrupt sexual behavior. In addition, an often overlooked contributor to sexual problems after TBI is medication side-effects, she adds.

Air Force Col. Michael Jaffee, staff neurologist at Wilford Hall Medical Center who serves as a DoD consultant on TBI and is a former national director of the Defense and Veterans Brain Injury Center, told U.S. Medicine that he suspects sexual dysfunction may in fact be “more common” among TBI patients than is currently understood. “When you look at the medical literature where there have been some smaller sample sizes that have been studied, oftentimes you have problems that are reported in approximately 50% of those smaller samples,” he says.

Jaffee says the military is to emphasize a “holistic, multidisciplinary, comprehensive” treatment for TBI patients, focusing on outcomes and enhancing quality of life for the patients and their families. Sexual function can have an impact on quality of life, and providers should look for opportunities to address these types of issues.

Providers could “benefit from more education,” on these issues he acknowledges, which DoD has taken some steps to provide. About a year ago, the Defense and Veterans Brain Injury Center supported a conference on this topic at WRAMC, “with the hopes of being able to increase awareness further for those providers and identify those areas of research that might be best developed to provide better and more targeted treatment,” he says.

Because  patients may not feel comfortable broaching the topic of sexual health with their doctors, injured servicemembers’ spouses may be more likely to bring it up.

“When you are dealing with a problem like this, it may not be reported or documented unless it is really specifically broached in a sensitive way with the patient,” he said. “There are so many different problems being addressed by the provider and the patient that it is important that there is a good therapeutic rapport that the patient feels comfortable discussing these issues.”

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