Neurosexuality for the 21st Century: Current Controversies and Future Directions

Presenters:

  • Grahame Simpson
  • Nathan Zasler
  • Caron Gan
  • Alexander Moreno

Objectives:

  • Learn about the existing evidence in relation to the prevalence and non-pharmacological treatments for sexual health concerns after ABI
  • Become familiar with advances in pharmacological treatment of sexual dysfunction after ABI
  • Learn clinical models and strategies (i) to support the development of adolescent sexuality and (ii) strategies that help create a safe therapeutic space to work with LGBTQIA+ clients after ABI.

Description:

Acquired brain injury (ABI) can create challenges for sexual well-being at neuroanatomical, physiological, functional, psychological, relational and societal levels. Given the breadth of the impact of TBI on sexuality, it is not surprising that recent research has found that rehabilitation services still struggle to meet the varied challenges. This symposium aims to advance practice through outlining the existing evidence base, providing an update in sexual pharmacology, and outlining models and clinical strategies to address unmet sexuality needs in the neglected areas of adolescent brain injury and sexual diversity respectively.

The overview of the evidence base will focus on the prevalence of sexual health concerns after ABI; the little that is known about non-pharmacological treatment approaches; and the effect of training in equipping staff to support positive sexual adjustment after ABI. The update on sexual pharmacology will address its importance; factors to consider prior to prescribing medication for sexual dysfunction; things to know before deciding on need for medications; drugs associated with sexual dysfunction; treating libido and arousal issues for females and males respectively; drugs in development; hypersexuality and compulsive sexual behaviors; erectile dysfunction; and the distinct approaches to treating orgasmic dysfunction in females and males.

Very few studies have addressed the sexual health needs of children and adolescents with acquired brain injury. This gap in clinical care is notable given the highest rate of brain injury occurs between 15 and 24 years of age, a time when young people are learning to navigate social, peer, and intimate relationships, including sexual relationships. As parents play a key role in promoting positive sexual development in children, this presentation will highlight a holistic framework for promoting positive sexual health in youth. Helping clinicians create a climate for adolescents and their parents to broach questions and giving them permission to talk about sexual health concerns will set the stage for promoting positive sexual development.

When universal heterosexuality is assumed by healthcare providers, the particular needs of lesbian, gay, bisexual, transgender, queer, intersex, asexual, and people with other sexual orientations and forms of gender expression (LGBTQIA+) with ABI often go unrecognized. Individuals with ABI may rely on professionals and family caregivers to advocate for their rights. When the professional or family caregiver lacks training or holds implicit or explicit homonegative or transphobic attitudes, the quality of care is compromised. Drawing upon the first systematic review that documented the gaps in the healthcare of LGBTQIA+ individuals with ABI, possibilities will be outlined for breaking the vicious cycle of invisibility and creating a culture change in the field of neurodisability through specific strategies that help create a safe environment to facilitate the development of a collaborative therapeutic relationship with LGBTQIA+ clients with ABI.

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