epublishing store: Intro

Sexual Health eBook Volume2
Chapter 13

Neurological Impairment of Sexuality in Men and Women, Barry R. Komisaruk and Beverly Whipple

In this chapter we review the two-way interaction between specific diseases and sexuality and the effect of brain injury, spinal cord injury, and selected surgical procedures on sexual response in men and women. Thus we will focus on conditions in which the neurological system is in some ways impaired or affected. Finally, we will summarize research about brain involvement in the sexual responses of women with and without spinal cord injury. Multiple sclerosis will be covered in detail in chapter 14 of this volume.

Two very different perspectives on the interaction between disease and sexuality in women (more “holistic”) and men (more “nuts and bolts”) have been described, as follows: “Sexual disorders in women may involve multiple psychological, interpersonal, and biologic/organic causes, and these influences are not always separate entities” (Jones, Kingsberg & Whipple, 2005, p. 4); by contrast, in men, “any medical disease, drug or surgical procedure that interferes with either central control of ejaculation or the peripheral sympathetic nerve supply to the vas [deferens] and bladder neck, the somatic efferent [i.e., output to voluntary muscle] nerve supply to the pelvic floor or the somatic afferent [i.e., sensory input from the skin] nerve supply to the penis can result in delayed ejaculation, anejaculation, and anorgasmia” (Lue et al., 2004, p. 18).

Certain diseases, such as diabetes and Parkinsonism, may exert deleterious effects on sexuality, and there is recent evidence that sexual activity can affect prostate and breast cancer. Brain damage can exert not only depressant, but also disinhibitory effects on sexuality. Spinal cord injury affects sexual response differentially, depending on the site of injury. Recent research on spinal cord injury in women provides evidence of a previously unrecognized sensory pathway from the genital system directly to the brain that bypasses spinal cord injury at any level and can support sexual response, including orgasm. A limited number of the many disorders and diseases that affect sexuality will be discussed. Medications and the underlying disease condition, in addition to their effect on relationships, may contribute to sexual problems and concerns. Finally, recent findings on the effects of surgical hysterectomy, prostatectomy, and sex change surgery on sexual response are reviewed. Many of the findings reviewed are unexpected and surprising; some provide insights into potential novel therapies.

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