Term Paper: Effect of Traumatic Brain Injury on Sexual Function

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¶ … Traumatic Head Injury on Sexual Function

Sexual Dysfunction Caused by Traumatic Brain Injury

Traumatic brain injury has a number of well documented long-lasting after effects which can inhibit the normal life of the injured individual. After serious head trauma, individuals suffer from both physical and emotional traumas, which must later be addressed and dealt with in order to return to every day living. One of the lesser documented consequences of some traumatic brain injuries are various physical, neuroatanomical, and psychological dysfunctions affecting sexual activity and behavior, "Overall, there was a fair greater tendency for TBI individuals to report a decrease in the frequency and quality of their sexual experiences," (Ponsford, 280). Following brain injury, many individuals suffer from a variety of sexual dysfunctions ranging from a decrease in sexual activity, hormonal imbalances, and psychological traumas which complicate sexual relationships in abnormal ways. Although not enough research has been done on the subject to confidently define and categorize these types of TBI caused sexual dysfunctions, there is evidence which shows that there is a correlation between the two. Even less research has been conducted on how to rehabilitate those individual's suffering from TBI caused sexual dysfunctions. Many cases of sexual dysfunctions reported by individuals with traumatic brain injury are done so after the injury with no pre-injury symptoms. These sexual dysfunctions are sometimes caused by damage to the brain itself, "neurological disability after TBI may result in Sexual Dysfunction after TBI," (Aloni & Katz, p. 269), as well as damage to brain function and the psychological after-effects of going through such a traumatic experience.

Several sexual dysfunctions associated with TBI are physiological. Direct damage to brain structures can cause abnormal brain functions which result in the individual's sexual dysfunctions. What researchers call Primary Sexual Dysfunctions "are caused directly by the injury," (Aloni & Katz, 269). In the case of Primary Sexual Dysfunctions, the reported dysfunction can be traced to the physical damage of traumatic brain injury. Individuals with similar injuries will therefore experience similar dysfunctions (Aloni & Katz, 270). Therefore, physical injury is the most associated cause of post traumatic brain injury leading to sexual dysfunctions.

Damage to brain structure is often associated with several different sexual dysfunctions which plague individuals who have had some sort of traumatic brain disorder. Different areas of the brain play different roles during a sexual experience. Damages to particular parts of the brain tend to affect individuals in specific neurological ways. Sexual arousal starts in the frontal-temporal area of the brain, (Aloni & Katz). This area, along with the hypothalamus, regulates sexual functioning. The temporal lobe is an important contributor to the experience of the orgasm, (Bianchi-Demichel & Ortigue, 2007). Along with the temporal lobes, the septal region and the parietal lobes also play a large role in both male and female sexual activity.

Multiple dysfunctions of a sexual nature are associated with damage to the areas of the brain which govern sexual activity. Deviant sexual behaviors, such as hyper sexuality, can be traced to damage to the frontal-lobe and the frontal-temporal areas (Blumer & Walker, 1974). Hyper sexuality is often described as extremely promiscuous behavior caused by abnormal sexual desires. Lesions found on the frontal lobe can also be contributors to the elicit behavior associated with hyper sexuality (Blumer & Walker, 1974). Damage or removal of the bilateral temporal lobes also is responsible for this unreasonable sexual appetite. Along with sexual hyperactivity, damage to the frontal lobes can cause changes not normally associated with neuroanatomy. Sexual preference is sometimes altered after damage to the Limbic system and hypothalamus (Miller & McIntyre, 1986). The Limbic system consists of the "hypothalamus and its Para ventricular nucleus, the medial preoptic area, amygdala, and hippocampus," (Aloni & Katz, 1999).

According to Kaplan, there are three levels of the sexual experience; desire, arousal, and orgasm. The stage of desire is most associated with the Limbic system, (Kaplan, 1974). Arousal and orgasm are associated with reflex nerves in the spinal chord (Kaplan 1974).

According to Francisco Bianchi-Demicheli and Stephanie Ortigue, in their 2007 article, "Toward an Understanding of the Cerebral Substrates of Woman's Orgasm," male and female orgasms are "physiology the same," (Bianchi-Demicheli & Ortigue, p. 2655). In both genders, an orgasm results from an explosion of activity all over the brain which is similar to a drug induced rush. However there are differences in each gender's neuroanatomy which seems to be affected by the occurrence of a traumatic brain injury. Different brain areas associated with orgasms serve different functions within the different gender's sexual experiences.

In the female brain, an orgasm is most associated with the insula, the Limbic system, nucleus accumbens, basalganglia, superior parietal cortex, dorsolateral prefrontal cortex, and the cerebellum (Bianchi-Demicheli & Ortigue, 2007). The spinal chord also plays a larger role in the female orgasm than in the male orgasm, "The current models of sexual function acknowledge a combined role of the central (spinal and cerebral) and peripheral processes during an orgasm experience," (Bianchi-Demicheli & Ortigue, p. 2645). Unlike their male counterparts, the female spinal chord plays a strong role in sexual activity, "Super spinal sites of female orgasm have been mainly localized in the nucleus paraglagantocellularis and the Limbic system," (Bianchi-Demicheli & Ortigue, p. 2647). Therefore brain trauma involved with spinal chord damage could possibly have severe affects on the female sexual experience.

Female orgasm is also felt differently than male orgasm. Females have several genital sites where orgasm can be achieved, just as males do; however, "a surprising percentage, 5-10%, of women have never experienced an orgasm, despite of self and partner induced stimulation," (Bianchi-Demicheli & Ortigue, p. 2647). Other women can have multiple orgasms within a short amount of time (Bianchi-Demicheli & Ortigue, 2007); much unlike the more universal characteristics of the male orgasm.

Males have increased brain activity in all areas except the frontal cortex right before orgasm. These high levels later decrease with ejaculation. This sudden rush of activity is associated with the concept that male orgasm is more sudden and violent than a female's orgasm (Bianchi-Demicheli & Ortigue, 2007). The hypothalamus and preoptic area in males, however, showed no major increased activity, as it did with the female orgasm. There is more activation in the right cerebral hemisphere in males, and less activity in the amygdale, which was quite active in female orgasm.

Along with dysfunctions caused by damage or change in brain structure due to a traumatic brain injury, there are also multiple psychological dysfunctions which are related to such injuries. Secondary sexual dysfunctions are defined as "the delayed after effect caused by the primary injury," (Aloni & Katz, p. 270). Secondary dysfunctions normally deal with an individual's emotional or psychological reaction to the initial trauma of the brain injury, (Aloni & Katz, 1999). Although individuals with similar injuries will have similar primary dysfunctions, they may have completely different secondary dysfunctions related to that shared injury. The desire stage of sexual activity can be extremely affected by secondary dysfunctions. Many individuals with previous history of traumatic brain injury reported decrease in libido and sexual desire (Elliott, 708). Diminishing of the frequency of sexual encounters is also reported by traumatic brain injury patients, "Out of twenty-one males with traumatic brain injury, fifty-seven percent had a decrease in libido and sixty-two percent had less sexual intercourse," (Kruetzer, p. 179).

Increased stress and anxiety are prime are also prime factors of secondary dysfunctions (Aloni & Katz, 1999). According to Laurel Elliot's 1996 work, "Head Injury and Sexual Dysfunction," post-traumatic stress caused by an initial traumatic brain injury can cause several dysfunctions in sexual behavior. Stress associated with traumatic brain injury can lead to headaches, emotional instability, dizziness, fatigue, and anxiety (Elliot, 1996). Individuals with traumatic bran injuries were also reported to suffer from "sexual delusions and limited psychosexual social abilities," (Elliot, p. 707).

There are also different psychological sexual dysfunctions based on the gender of the individual who suffered the injury. Hyper sexuality can also be a psychological after-effect of a traumatic brain injury. Individuals who have an increase in sexual libido due to brain damage, often have psychological issues with dealing with this new found lust, they attempt to engage in sexual behavior beyond what they are actually capable of. To these individuals, sex becomes "a one sided-act, done without regard for their partner," (Lezak, p. 593-94).

Emotional factors are most prevalent in woman's sexual activity, "A woman's sexual experience encompasses different components, such as self-esteem, body-image, relationship factors, pleasure, and satisfaction," (Bianchi-Demicheli & Ortigue, p. 2648). The neurological differences between male and female brain activity also has an affect on the psychological sexual dysfunctions found in women, "the present activation of the hippocampus [...] emphasizes that higher-order functional mechanisms take place during a woman's orgasm," (Bianchi-Demicheli & Ortigue, p. 2655). There is a ton of emotional cognition that is occurring during the female orgasm. However, men also show signs of heightened cognition during orgasm, (Bianchi-Demicheli & Ortigue, 2007), but not in the exact way females experience orgasm.

Emotional… [END OF PREVIEW]

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