Sexual function in patients with neurological disorders Flashcards
What are the key brain regions involved in sexual functioning? (6)
Subcortical:
- Septal region
- Hypothalamus
- Ansa lenticularis and pallidus
Cortical:
- Frontal lobes
- Parietal lobes: paracentral lobules
- Temporal lobes: amygdala
What is the human sexual response cycle and at what stage do problems occur in patients with neurological disorders?
Desire -> Arousal/Excitement -> Plateau -> Orgasm/Climax -> Resolution
Problems can occur during one or more of these stages
What are direct and indirect effects of brain injury on important aspects associated with sexuality and sexual function?
Direct:
- changes in sexual desire from disease
- disruption of genital response from disease/surgery/radiation
- disruption of sexual desire and response from pain/nonhormonal medication/antiandrogen treatment
Indirect:
- reduction of self-image
- depressed mood
- impaired mobility
- reduced emergency
- partnership difficulties
- sense of loss of sexuality from imposed infertility
- fear of sex worsening medical condition
Name 4 examples of how neuropsychological deficits affect sexuality
- Increased distractability (might be interpreted as lack of interest)
- Attention deficits (might affect arousal as it reduces one’s ability to maintain focus and to fantasize)
- Memory deficits (patient might forget dates, recent sexual encounters, significant episodes with regard to a relationship)
- Difficulties in appropriate social interaction/social cognition (social interaction might be inappropriate and signals wrongly interpreted)
Name some possible psychological consequences of brain injured patients on sexuality
- Changes in body image, loss of identity, adjustment issues, depression, anxiety etc -> might affect patients’ confidence and comfort in forming new relationships or relating to others
- Further consequences of TBI (e.g. personality change)
- > might lead to misinterpretation of social cues as sexual signals, exhibition of sexually disinhibited behavior, lack of initiation, indifference to sex, childishness and selfishness
- > might result in unsafe sex practices and unwanted pregnancy
Name 2 possible medical/physical consequences of brain injured patients on sexuality
- Both global amount of brain tissue destroyed and focality of injuries -> might determine sexual outcome (e.g. hyposexuality or sexual disinhibition due to prefrontal injury)
- many frequently prescribed medications (e.g. antihypertensives, antidepressants) might interfere with sexual functioning
Name 5 reasons for a change in sexual functioning as percieved by the patient (in order of most fequent)
- Tiredness/fatigue (47%)
- Decreased mobility (31%)
- Low confidence (31%)
- Feeling unatractive (23%)
- Pain (22%)
What is the perspective of professionals on the cause of sexual difficulties in brain injured patients?
Professionals working with TBI patients percieve sexual difficulties to be a consequence:
- primarily of the emotional and behavioral sequelae of TBI and their effect on the relationship
- secondly from a lack of soical opportunities
Conclusion:
Sexual dysfunction is secondary to the injury and that controlling behavioral, social, and dyadic problems would lead to improvement
What did Korpelainen et al. (1998) find in their research about sexual satisfaction and -behavior in stroke patients? (5)
- Less sexual drive over time
- Less frequent sex over time
- Less satisfaction over time
- Less satisfaction of spouses over time
- In both men and women
What are the originating brain regions for (1) ictal and (2) interictal sexual manifestations?
Ictal sexual manifestations typically originate from the right hemisphere
Interictal sexual alterations have been frequently reported in patients with temporal lobe epilepsy (most common: hyposexuality)
What are the most common effects of antiepileptic drugs and epilepsy surgery on sexual functioning?
Antiepileptic drugs: usually hyposexuality, sometimes hypersexuality
Epilepsy surgery:
- postoperative sexual change was significantly more likely in patients undergoing temporal resection (64%) than non-temporal resection (25%)
- TLE patients typically reported sexual increase to a percieved level of ‘normal’ functioning
- Changes in sex drive more likely in patients following right temporal resection than left temporal resection
- Hypersexuality had been reported in some patients after temporl lobectomy
What sexual deficit is mostly seen in Parkinson’s disease patients?
Hypersexuality
->observed following treatment with antiparkonsonian medications and deep brain stimulation
What are major determinants in sexual dissatisfaction/reduction in Parkinson’s disease patients? (3)
Age
Severity of disease
Depression
What is the conceptual model for sexual dysfunction in MS (Foley & Iverson, 1992)? + examples
Primary Sexual Dysfunction: physiological impairments directly due to demyelinating lesions in the spinal cord and/or brain
Examples:
- decreased libido, numbness or sensory paethesias in the genitals, loss of vaginal lubrication/erectilde dysfunction, problems with arousal and orgasm
Secondary Sexual Dysfunction: non-sexual physical changes which affect the sexual response indirectly
Examples:
- fatigue, weakness, difficulty with mobility, bladder and bowel dysfunction, side effects from MS medication
Tertiary Sexual Dysfunction: psychological, social and cultural issues that may affect sexual funtioning
Examples:
- negative self image of body image, fear of being rejected sexually, feeling of dependency, communication difficulties with partner, depression and anger
Name two ways to assess sexual functioning in brain injured patients
- Interview (remains the most relevant assessment tool)
- Questionnaires and rating scales
