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Traumatic brain injury TBI can substantially alter many areas of a person's life and there has been little research published regarding sexual functioning in women with TBI. There were no statistically ificant differences between groups in sociodemographic characteristics. Multiple linear regressions revealed that age was negatively associated with some sexuality measures, while months since the TBI incident were positively associated with these variables.
These disclose that women with TBI do not fare as well as controls in these measures of sexual functioning and were less sexually satisfied. Future research is required to further understand the impact of TBI on sexual function and satisfaction to inform for rehabilitation programs. Sexuality and sexual functioning are important aspects of one's life experience.
The disruption of brain functioning as a result of a traumatic brain injury may cause changes to the endocrine system [ 2 ]. In addition, sexual functioning may also be impacted by the well-documented physical, emotional, cognitive, behavioral, and relationship changes after TBI [ 3 ]. Diverse sampling methods, small sample sizes, and time of assessment after injury may contribute to differing reports of sexual dissatisfaction after TBI.
To date, only five studies have conducted a comparative analysis of sexual functioning between persons with TBI and healthy controls [ 458 — 10 ].
Overall, persons with TBI in these studies reported greater sexual dysfunction in comparison to healthy controls. Although some studies on sexual dysfunction after TBI have included women, few studies have specifically researched sexual dysfunction in women [ 7 — 911 ]. One study found that women with TBI, having both an endocrine disorder and depression, were the most sensitive predictors of sexual difficulties [ 8 ].
Also, women with TBI in comparison Sex women without disability have reported greater sexual Perrin in areas, such as sexual energy, sexual drive, ability to achieve orgasm, and sexual arousal [ 8 ]. However, two studies did not find gender differences in sexuality between men and women [ 911 ]. It appeared that men and women identified similar negative changes regarding sexuality and sexual functioning dating TBI. Gaudet and colleagues [ 9 ] reported that men with TBI had great sexuality concerns compared to women with TBI as well as men and women without TBI; however, their sample size was smaller.
Another study made comparisons using community-based norms. Despite the importance of sexuality after TBI and the unique issues that women with TBI Perrin in terms of sexual dysfunction, research efforts have utilized nonequivalent control groups, community-based norms, and nonstandardized measures of sexual functioning, which are methodological limitations in the assessment of sexuality after TBI. Several demographic and injury-related characteristics related to sexuality have been identified in the TBI dating, such as age [ 81113 — 15 ], time after injury [ 31314 ], and injury severity [ 3 ].
However, the impact of these factors on sexual functioning in women with TBI is missing from the literature. As a Sex, the aims of this study were 1 to compare the sexual functioning, desire, and satisfaction of women with TBI to a comparison group and 2 to investigate the association between age, time after injury, and injury severity and sexual functioning, desire, and satisfaction.
Thirty-nine Spanish-speaking Colombian women with a moderate to severe TBI were identified in July of through a systematic review of all medical records in Hospital Universitario Hernando Moncaleano Perdomo de Neiva from August to March All patients had moderate to severe TBI confirmed in these medical records loss of consciousness, positive computerized tomography, or magnetic resonance imaging.
Inclusion criteria required that each participant be between the ages of 18 and 65, and participants were excluded if they had a history of neurological or psychiatric conditions, alcohol or drug abuse, or learning disabilities. All 39 met these inclusion criteria.
Between April and December ofthese patients were contacted and invited to participate in the study when at least six months had passed since their injury. Ten women could not be contacted and the other 29 consented and completed the study. The sample of twenty-nine women with TBI had an average age of For every female patient who completed the study, a healthy female control matched for age was identified and recruited.
All controls approached did not have a history of TBI, neurological or psychiatric conditions, alcohol or drug abuse, or learning disabilities. All consented and completed the study. The healthy control group was comprised of 29 women, with an average age of There were no statistically ificant differences based on age, education, marital status, or employment status between the control group and the TBI group see Table 1. The FSFI is a self-report measure of female sexual function, which contains 19 items.
It has 6 domains: desire 2 questionsarousal 4 questionslubrication 4 questionsorgasm 3 questionssatisfaction 3 questionsand pain 3 questions [ 16 ]. The full-scale score is obtained by adding the six domain scores, and a score of zero indicates that no sexual activity was reported during the past month. The domain scores and total score can be derived with the following formula. For individual domain scores, items that comprise the domain are added. Then, the sum is multiplied by the domain factor ranging from 0. The total score is the sum of six domains scores, which range from 2 to Higher scores indicate greater sexual function.
It has excellent psychometric properties and it supports the clinical utility [ 17 — 20 ]. The Spanish version was used which had been ly validated by Blumel et al.
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The ISS is a self-report scale that measures the degree of dissatisfaction in the sexual component of a dyadic relationship [ 22 ]. It contains 25 items [ 22 ], and scores range from 0 to in which higher scores indicate greater sexual dissatisfaction. The ISS has a clinical cutoff score of 30 such that scores above that value indicate the presence of a clinically ificant degree of sexual discord in the relationship. It has been used in clinical samples [ 23 — 25 ] and has shown good psychometric properties; the validated Spanish version was used in this study [ 26 ].
It evaluates the impact of sexual dysfunction on quality of life, including sexual confidence, emotional well-being, and relationship issues. Higher scores indicate better sexual quality of life. It has good psychometric properties [ 27 — 29 ].
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The SQoL had been validated in Spanish and this version was utilized [ 30 ]. The SDI-2 is an item self-report measure of sexual desire that assesses dyadic and solitary sexual desire as two subscales [ 31 ].
Participants rate how strong their desire would be in a variety of sexual situations during the last month. Scores are summed across items, with higher scores reflecting stronger sexual desire [ 32 ]. The scale has excellent psychometric properties and it has been used in the general population, in clinical samples, and had been validated in Spanish [ 33 ].
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Each candidate was screened by telephone to determine whether he or she met inclusion or exclusion criteria. The healthy control group was recruited from the general population through flyers at neighborhood churches, stores, and restaurants and by general word of mouth.
After the details of the study were explained to each eligible candidate, individuals who expressed interest were invited to participate. Once the individuals with TBI and healthy controls agreed to participate in the study, they were asked to a form that indicated their informed consent in accordance with regulations approved by Universidad Surcolombiana, Colombia.
All of the participants completed an interview with a graduate student under the supervision of a university professor.
The student collected demographic information and conducted a psychosexual evaluation with TBI survivors and the healthy controls. The interviews lasted for approximately 1 hour. This study was reviewed and approved by the ethics committee of Universidad Surcolombiana. Women with TBI reported ificantly lower mean scores than the control group on the FSFI subscales of desire, arousal, lubrication, orgasm, and sexual satisfaction see Figure 1.
See Table 2.
Although the sample size for these regressions was limited to the 29 women with TBI in the current sample, multiple regressions with three predictors using this sample approximately meet the conventional guidelines of having 10 participants per predictor variable. Additionally, a power analysis was conducted for a multiple regression with three predictors. As a dating, null omnibus should be interpreted with caution. For the TBI group only, four simultaneous multiple regressions assessed the relationships between the variables of age, time since the injury monthsand injury severity as measured by GCS score at admission with the FSFI subscales of arousal, lubrication, orgasm, and satisfaction.
Also for the TBI group only, a series of simultaneous multiple regressions were performed in order to investigate the connections from age, months since injury, and TBI severity with sexual desire. None of these models were statistically ificant. The principal objectives of this research were to evaluate the sexual functioning, desire, and satisfaction in women with TBI, as well as compare these areas with a control group.
Women with TBI reported sexual difficulties in the six areas of sexual functioning evaluated and fared worse than the control group in eight of eleven sexuality constructs measured. In reference to the FSFI, there dating statistically ificant differences between women with TBI and the control group on five of the six subscales. Women with Perrin reported less desire, arousal, sexual satisfaction, lubrication, and orgasm function.
Similar of decreased sexual functioning in control studies were found in Australia using the Brain Injury Questionnaire of Sexuality [ 10 ] and in the United States [ 8 ]. When taking age intothese differences were exclusive to the 46—55 age range in the Australian study [ 10 ]; this contrasts with the of the present research where between-group differences were found with a nearly one decade younger average age The American team found differences between the Sex group and control in arousal and vaginal lubrication, as was found in this study.
However, they found a higher frequency of pain during sexual activity which was not reflected in these data. The multiple Perrin found that age has a negative relationship with both arousal and lubrication in women with TBI; similar have been found by other authors in population-based studies [ 3536 ] and in persons with TBI Sex 81216 ]. Conversely, months since injury had a positive relationship with these measures, such that sexual functioning may be improving over time. Ponsford et al. The findings of the present study suggest that the passage of time does correlate with improved sexual functioning in women with TBI.
However, this does not fully resolve sexual dysfunction, perhaps indicating that sexuality-specific intervention programs may be beneficial toward recovering sexual functioning after TBI. For both measures, women with TBI reported ificantly lower sexual satisfaction than their counterparts in the control group.
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This disparity could be related to the difficulties reported with desire, arousal, lubrication, and orgasm. Consistency in orgasm frequency has been found to influence sexual satisfaction in Spanish women without TBI [ 37 ] and may likely have played a role in the current sample.
The multiple regression analyses utilizing the FSFI Satisfaction subscale found that age has a negative relationship with sexual satisfaction similar to from other studies in general populations [ 38 ]. This relationship does not explain between-group differences; however, the average age of the study and control group participants was not statistically different.