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.