Sexuality After Traumatic Brain Injury

      Changes in sexual functioning are common after traumatic brain injury (TBI). The information below describes common sexual problems after TBI and ways to improve them.

      How can a traumatic brain injury affect sexual functioning?

      • Decreased desire: Many people may have less interest in sex.
      • Increased desire: Some people have increased interest in sex after TBI and may want to have sex more often than usual. Others may have difficulty controlling their sexual behavior; they may make inappropriate sexual advances or comments.
      • Decreased arousal: Many people have difficulty becoming sexually aroused after TBI. Men may have difficulty getting or keeping an erection. Women may have decreased vaginal lubrication.
      • Difficulty or inability to reach orgasm/climax: Both men and women may have difficulty reaching orgasm or climax. They may not feel physically satisfied after sexual activity.
      • Reproductive changes: Women may experience irregular menstrual cycles or periods; they may also have trouble getting pregnant. In some cases, periods may not occur for weeks or months after injury. However, a woman can still get pregnant even if her period has not returned. Men may have decreased sperm production.

      What causes changes in sexual functioning after TBI?

      There are many reasons sexual problems happen after TBI. Some are directly related to damage to the brain. Others are related to physical problems, or changes in thinking or relationship dynamics.
      Possible causes of changes in sexual functioning after TBI include:
      • Damage to the parts of the brain that control sexual functioning.
      • Hormonal changes: Damage to the brain can also affect the production of sex hormones like testosterone, progesterone, and estrogen.
      • Medication side effects: Many medications commonly used after TBI have negative side effects on sexual functioning.
      • Fatigue/tiredness: Many people with TBI tire easily, which in turn affects sexual functioning.
      • Problems with movement: Spasticity (tightness of muscles), physical pain, weakness, slowed or uncoordinated movements, and balance problems may make it difficult to have sex.
      • Self-esteem problems: Some people feel less confident about their attractiveness after TBI. This can affect their comfort with sexual activity.
      • Changes in thinking abilities: Difficulty with attention, memory, communication, planning, reasoning, and imagining can affect sexual functioning.
      • Emotional changes: Individuals with TBI often feel sad, nervous, or irritable. These changes can affect sexual functioning.
      • Changes in relationships and social activities: Adjusting to life after a TBI often puts stress on intimate relationships. Some people lose relationships after TBI or may have trouble meeting new people. This can make it difficult to find a sexual partner.

      What can be done to improve sexual functioning after TBI?

      • Talk with your doctor, nurse practitioner, or other health professional. Sexuality is a normal part of human functioning, and problems with sexuality can be addressed just like any other medical problem. If you are not comfortable discussing sexual problems with your doctor, it is important to find a health professional who you do feel comfortable talking with.
      • Get a comprehensive medical exam, which should include blood work. Women should get a gynecology exam and men may need a urology exam. Ask your doctor to check your hormone levels and medications.
      • Consider psychotherapy or counseling to help with emotional issues that can affect sexual functioning. If you and your partner are having problems with your relationship, consider marital or couples therapy.
      • Consider starting sex therapy. A sex therapist is an expert who helps people to overcome sexual problems and improve sexual functioning (you can search for a certified local therapist at
      • Plan sexual activities during the time of day when you are less tired.
      • When having sex, position yourself so that you can move without pain. This may mean having sex in an unfamiliar position. Discuss this with your partner.
      • Arrange things so that you will be less distracted during sex.
      • If you have trouble becoming sexually aroused, it may help to watch movies or read books/magazines with sexual content.
      • There are sexual aids developed to help people with disability (you can read more about these aids at
      • Expanding your social network can increase opportunities of forming intimate relationships.

      Importance of safe sex

      After a TBI, it is just as important to protect yourself from unplanned pregnancy and from sexually transmitted disease as it was before injury.
      • Do research to help figure out what methods of birth control and protection from sexually transmitted disease work best for you.
      • Because of changes in thinking abilities, it may be harder to remember to use protection or to remember to take it with you. You can plan ahead by always carrying a condom or other method of protection.
      • For women who use birth control pills or other timed methods of contraception, using a calendar or alarm on a smartphone can help you remember to keep up your regimen.
      • If you are unsure whether your partner has a sexually transmitted disease, it is best to use a condom.
      • If you have engaged in any risky sexual behavior, one of the best things you can do for yourself is to get tested for sexually transmitted diseases and get treated if needed.


      This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.


      Our content is based on research evidence whenever available and represents the consensus of expert opinion of the investigators on the TBI Model Systems Directors.


      Sexuality after Traumatic Brain Injury was developed by Angelle M. Sander, PhD, and Kacey Little Maestas, PhD, in collaboration with the investigators of the TBI Model Systems Module Project on Sexuality after TBI and the University of Washington Model Systems Knowledge Translation Center and funded by NIDRR/U.S. D.O.E grant # H133A060070 . Portions of this document were adapted from Sexual Functioning and Satisfaction after Traumatic Brain Injury: An Educational Manual by A.M. Sander et al. Copyright © 2011. May be reproduced and distributed freely with appropriate attribution.