Sexuality >1 year after brain injury rehabilitation: A cross-sectional study in Sweden

Figures & data

Figure 1. Flow chart for inclusion and exclusion in the study.

Figure 2. Examples of questions/statements, examples of response options, and coding.

Table 1. Background characteristics of participants and non-responders (n = 624).

		Participants^1		Non-responders^2
		n = 250		n = 374
		n	%	n	%	p
Gender	male	140	56	228	61	0.217
	female	110	44	146	39
Age, years	mean (SD)^3,	53.66	(14.24)	53.95	(15.98)	0.815
	range	20–90		20–94
Diagnosis						0.232
	Subarachnoid Hemorrhage (SAH)	86	34.4	101	27.0
	Traumatic Brain Injury (TBI)	116	46.4	199	53.2
	Post- infectious /-inflammatory	21	8.4	35	9.4
	Anoxic Brain Injury	27	10.8	39	10.4
LOS, days	mean (SD),	35.15	(27.79)	36.56	(31.48)	0.568
	range	5–183		2–262
Discharged to						0.022
	Independent living without dependence	173	69.2	220	58.8
	Independent living with personaldependence	68	27.2	120	32.1
	Other	9	3.6	34	9.0
Ethnicity	Born in Sweden	228	91.2	330	88.2	0.591
Educational level						0.003
	Elementary school	21	8.4	67	17.9
	Senior high school	115	46.0	154	41.2
	University	72	28.8	80	21.4
	Other	42	16.8	73	19.5
FIM Item for Comprehension						0.213
	Independent with aid or extra time	84	33.6	144	38.5
	Fully independent	166	66.4	230	61.5
FIM^4 Cognitive Items Total Score, mean (SD),		32.16	(3.01)	31.58	(3.41)	0.032
	range	17–35		14–35
FIM^4 Physical Items Total Score, mean (SD),		85.77	(9.58)	83.56	(13.58)	0.018
	range	27–91		13–91
Residence (n = 246)
	City	109	44.3
	Smaller town	75	30.5
	Countryside	62	25.2
Vocational situation (n = 247)
	Working	96	38.9
	Sick leave	44	17.8
	Disability pension	26	10.5
	Retired	64	25.9
	Unemployed, Studying, Other	17	6.8
In a present relationship (n = 247)		166	67.2
In a relationship at injury (n = 246)
	Yes, same as present	142	57.7
	Yes, a relationship that is now ended	40	16.3
	No	64	26
Sexual orientation (n = 245)
	Heterosexual	232	94.7
	Homo-/bisexual	4	1.6
	Other	9	3.7
Perceived health in the past 12 months (n = 245)
	Good (very/fairly)	178	72.7
	Bad (fairly/very)	67	27.3
Medication^5,6 (n = 249)		203	81.5
Other disease^5,7 in the past 12 months (n = 246)		124	50.4
Walking ability (n = 249)
	None	14	5.6
	Limited/with aid	44	17.7
	Walking without aid	191	76.7
Independent in daily activities (n = 247)		221	89.5
Bladder and/or bowel symptoms (n = 249)		102	41.0

For participants and non-responders, the chi-square test was calculated for nominal variables, and student’s t-test was calculated for the variables age, Length of Stay (LOS) at rehabilitation, and Functional Independence Measure (FIM). ¹ Data for participants was collected from the Web-Rehab register and from the questionnaire. ² Data for non-responders was collected from the Web-Rehab register only. ³ Standard deviation. ⁴ Possible results: FIM cognitive total score 5–35, FIM physical total score 13–91. ⁵ More than one option possible. ⁶ Analgesics (n = 49), neurostimulants (n = 5), sleeping medication (n = 37), epilepsy medication (n = 22), blood pressure medicine (n = 121), antidepressants (n = 62), contraceptives (n = 9), estrogen (n = 5), testosterone (n = 8), and other (n = 94). ⁷ Depression (n = 37), diabetes (n = 28), epilepsy (n = 12), cancer (n = 5), chronic obstructive pulmonary disease (n = 5), rheumatic disease (n = 5), heart disease (n = 21), and other (n = 54).

Table 2. Experience of decreased sexual desire, dissatisfaction with sexual desire, and decreased satisfaction with sexual life in relation to cognitive functions, physical impairment, health/illness, and medication.

	Decreased Sexual Desire (n = 234)						Dissatisfaction with Sexual Desire (n = 222)						Decreased Satisfaction with Sexual life^1 (n = 192)
	Yes (n = 148)		No (n = 86)				Yes (n = 120)		No (n = 102)				Yes (n = 102)		No (n = 90)
	n	%	n	%	Chi-Square	p-value	n	%	n	%	Chi-Square	p-value	n	%	n	%	Chi-Square	p-value
Decreased memory	126	85.7	56	65.1	13.464	0.000	104	87.4	67	66.3	13.994	0.000	87	85.3	59	65.6	10.225	0.001
Increased tiredness	134	91.2	60	69.8	17.811	0.000	108	90.8	74	72.5	12.528	0.000	90	88.2	65	72.2	7.881	0.005
Decreased concentration	121	82.3	55	64.7	9.118	0.003	102	85.0	66	65.3	11.620	0.001	86	84.3	58	65.2	9.390	0.002
Speaking difficulties	52	35.1	21	24.4	2.910	0.088	47	39.2	18	17.6	12.331	0.000	36	35.3	25	27.8	1.246	0.264
Mood changes	98	66.7	36	41.9	13.663	0.000	82	68.9	45	44.1	13.809	0.000	67	65.7	44	48.9	5.531	0.019
Reduced initiative to sexual activity^2	83	86.5	12	19.0	71.873	0.000	69	84.1	22	30.6	45.548	0.000	59	77.6	23	32.9	29.671	0.000
Health (12 months)					9.635	0.002					23.484	0.000					14.659	0.000
Good	95	65.5	71	84.5			68	58.6	89	88.1			65	65.0	79	88.8
Bad	50	34.5	13	15.5			48	41.4	12	11.9			35	35.0	10	11.2
Other diseases (12 months)	83	57.2	31	36.5	9.248	0.002	72	60.5	33	33.0	16.470	0.000	57	55.9	29	33.3	9.627	0.002
Medication	135	91.8	55	64.0	28.031	0.000	107	89.9	71	69.6	14.454	0.000	91	89.2	60	66.7	14.476	0.000
Bladder/bowel symptoms	70	47.6	25	29.1	7.731	0.005	57	47.9	31	30.4	7.025	0.008	50	49.0	27	30.0	7.200	0.007
Dependent in ADL	17	11.7	5	5.8	2.188	0.139	15	12.8	5	4.9	4.118	0.042	7	6.9	3	3.3	1.206	0.272
Walking ability					1.172	0.279					4.320	0.038					2.954	0.086
Yes	111	75.0	69	81.2			87	72.5	85	84.2			82	81.2	81	90.0
No/decreased	37	25.0	16	18.8			33	27.5	16	15.8			19	18.8	9	10.0

¹Filter for resumed sexual activity was used for the variable Decreased Satisfaction with Sexual Life. ² Reduced initiative to sexual activity was reported by 102 participants. While 80 participants reported not being in a relationship at present, some who are not in a relationship might still initiate sexual activity with someone. Further, 70 participants reported, Not adequate to me. I don’t have a partner. Remaining variables have internal dropouts 0.0%-2.2%.

Table 3. Decreased orgasm, dissatisfaction with orgasm, and dissatisfaction after sex in relation to cognitive functions, physical impairment, health/illness, and medication.

	Decreased orgasm^1(n = 157)						Dissatisfaction with orgasm^1(n = 168)						Dissatisfaction after sex^1 (n = 167)
	Yes (n = 59)		No (n = 98)				Yes (n = 63)		No (n = 105)				Yes (n = 64)		No (n = 103)
	n	%	n	%	Chi-Square	p-value	n	%	n	%	Chi-Square	p-value	n	%	n	%	Chi-Square	P-value
Decreased memory	51	86.4	71	72.4	4.162	0.041	57	90.5	73	69.5	9.876	0.002	58	90.6	71	68.9	10.568	0.001
Increased tiredness	53	89.8	73	74.4	5.469	0.019	58	92.1	77	73.3	8.751	0.003	57	89.1	78	75.7	4.531	0.033
Decreased concentration	53	89.8	68	70.1	8.204	0.004	56	88.9	70	67.3	9.865	0.002	58	90.6	70	68.6	10.781	0.001
Speaking difficulties	29	49.2	22	22.4	11.974	0.001	28	44.4	25	23.8	7.764	0.005	28	43.8	24	23.3	7.698	0.006
Mood changes	41	69.5	50	51.0	5.157	0.023	43	68.3	52	49.5	5.622	0.018	42	65.6	53	51.5	3.231	0.072
Reduced initiative to sexual activity^2	33	76.7	30	38.5	16.277	0.000	35	76.1	34	40.0	15.592	0.000	36	78.3	34	40.5	17.075	0.000
Health (12 months)					1.667	0.197					5.014	0.025					12.258	0.000
Good	40	70.2	77	79.4			41	66.1	84	81.6			38	61.3	87	85.3
Bad	17	29.8	20	20.6			21	33.9	19	18.4			24	38.7	15	14.7
Diseases (12 months)	34	58.6	37	38.5	5.866	0.015	41	65.1	35	34.3	14.837	0.000	38	59.4	34	34.0	10.203	0.001
Medication	53	89.8	69	70.4	8.020	0.005	59	93.7	72	68.6	14.421	0.000	56	87.5	73	70.9	6.208	0.013
Bladder/bowel symptoms	27	45.8	33	33.7	2.280	0.131	32	50.8	33	31.4	6.225	0.013	29	45.3	35	34.0	2.144	0.143
Dependent in ADL	4	6.8	5	5.1	0.192	0.661^3	4	6.3	4	3.8	0.560	0.454^3	7	10.9	2	1.9	6.265	0.012^3
Walking ability					0.001	0.972					0.109	0.741					0.628	0.428
Yes	50	84.7	82	84.5			54	85.7	91	87.5			53	82.8	89	87.3
No/decreased	9	15.3	15	15.5			9	14.3	13	12.5			11	17.2	13	12.7

¹Filter for resumed sexual activity was used for the variables. ² Reduced initiative to sexual activity is reported by 102 participants. While 80 participants reported not being in a relationship at present, some who are not in a relationship might still initiate sexual activity with someone. Further, 70 participants reported, Not adequate to me. I don’t have a partner. Remaining variables have internal dropouts 0.0%-1.9%. ³ Expected 1 cell < 5 = 25%.

Table 4. Erectile dysfunction, early ejaculation, absent ejaculation, and decreased lubrication in relation to cognitive functions, physical impairment, health/illness, and medication^1.

	Erectile dysfunction (ED)^2(n = 112)						Early ejaculation^2 (n = 110)							Absent ejaculation^2 (n = 111)						Decreased lubrication^3(n = 58)
	Yes (n = 57)		No (n = 55)				Yes (n = 44)		No (n = 66)					Yes (n = 54)		No (n = 57)				Yes (n = 18)		No (n = 40)
	n	%	n	%	Chi-Square	p-value	n	%	n	%		Chi-Square	p-value	n	%	n	%	Chi-Square	p-value	Nn	%	n	%	Chi-Square	p-value
Decreased memory	46	80.7	37	67.3	2.631	0.105	37	84.1	44	66.7		4.129	0.042	42	77.8	40	70.2	0.830	0.362	17	94.4	29	72.5	3.643	0.056
Increased tiredness	48	84.2	37	67.3	4.389	0.036	38	86.4	46	69.7		4.063	0.044	45	83.3	39	68.4	3.350	0.067	17	94.4	33	82.5	1.489	0.222
Decreased concentration	48	84.2	32	59.3	8.577	0.003	35	79.5	45	69.2		1.430	0.232	44	83.0	36	63.2	5.462	0.019	16	88.9	31	77.5	1.048	0.306
Speaking difficulties	18	31.6	13	23.6	0.882	0.348	14	31.8	16	24.2		0.764	0.382	20	37.0	11	19.3	4.335	0.037	11	61.1	11	27.5	5.957	0.015
Mood changes	40	70.2	23	41.8	9.146	0.002	32	72.7	31	47.0		7.157	0.007	33	61.1	30	52.6	0.812	0.367	11	61.1	21	52.5	0.372	0.542
Reduced initiative to sexual activity^4	30	65.2	14	37.8	6.171	0.013	23	65.7	21	44.7		3.569	0.059	26	65.0	18	42.9	4.040	0.044	11	73.3	15	41.7	4.249	0.039
Health (12 months)					1.650	0.199						0.525	0.469					0.023	0.879					0.022^5	0.883
Good	41	73.2	45	83.3			32	74.4	53	80.3				41	77.4	44	78.6			14	77.8	31	79.5
Bad	15	26.8	9	16.7			11	25.6	13	19.7				12	22.6	12	21.4			4	22.2	8	20.5
Diseases (12 months)	28	49.1	21	38.9	1.178	0.278	24	55.8	24	36.4		3.997	0.046	28	51.9	20	35.7	2.911	0.088	10	55.6	14	36.8	1.747	0.186
Medication	49	86.0	40	72.7	3.006	0.083	38	86.4	50	75.8		1.856	0.173	48	88.9	40	70.2	5.911	0.015	16	88.9	28	70.0	2.419^5	0.120
Bladder/bowel symptoms	29	50.9	13	23.6	8.862	0.003	16	36.4	26	39.4		0.103	0.749	25	46.3	17	29.8	3.199	0.074	9	50.0	12	30.0	2.150	0.143
Dependent in ADL	4	7.0	2	3.6	0.631^6	0.427	1	2.3	5	7.6		1.440^6	0.230	4	7.4	2	3.5	0.824^6	0.364	2	11.1	0	0	4.603^6	0.032
Walking ability					0.819	0.365						0.005	0.941					0.007	0.933					2.535^6	0.111
Yes	46	80.7	47	87.0			37	84.1	55	84.6				45	83.3	47	83.9			14	77.8	37	92.5
No/decreased	11	19.3	7	13.0			7	15.9	10	15.4				9	16.7	9	16.1			4	22.2	3	7.5

¹Filter for resumed sexual activity was used. ² Males. ³ Females. ⁴ Reduced initiative to sexual activity is reported by 102 participants. While 80 participants reported not being in a relationship at present, some who are not in a relationship might still initiate sexual activity with someone. Further, 70 participants reported, Not adequate to me. I don’t have a partner. Remaining variables have internal dropouts 0.0%-3.4%. ⁵ Expected 1 cell < 5 = 25%; ⁶ Expected 2 cells < 5 = 50%.

Table 5. Factors associated with dissatisfaction with sexual desire.

	Dissatisfaction with sexual desire^1
	B^2	S.E^3	p-value^4	Exp (B)^5	95% C.I. Exp (B)^6
Age	0.027	0.027	0.320	1.027	0.974	1.082
Gender (male)	−0.729	0.644	0.258	0.482	0.136	1.706
Decreased memory	−0.090	1.174	0.939	0.914	0.092	9.118
Increased tiredness	0.240	1.376	0.861	1.272	0.086	18.852
Decreased concentration	0.362	1.555	0.816	1.436	0.068	30.258
Mood changes	−0.011	0.768	0.988	0.989	0.220	4.450
Reduced initiative to sexual activity	1.798	0.676	0.008	6.039	1.606	22.709
Bad health (12 months)	0.608	0.761	0.424	1.837	0.413	8.169
Other diseases (12 months)	1.217	0.716	0.089	3.377	0.831	13.729
Medication	−0.456	0.850	0.592	0.634	0.120	3.355
Bladder/bowel symptoms	−0.958	0.772	0.214	0.384	0.085	1.741
Decreased orgasm	1.988	0.895	0.026	7.301	1.263	42.193
Dissatisfied after sex	0.788	0.805	0.328	2.198	0.454	10.645
Decreased satisfaction with sexual life	2.078	0.641	0.001	7.985	2.273	28.053
Constant	−4.243	1.785	0.017	0.014

Binary logistic regression analysis. Correct predicted percentage of this model = 85.1%; Dissatisfaction with sexual desire = 0, 90%; Dissatisfaction with sexual desire = 1, 79.6%. ¹ Filter for Resumed sexual activity was used. ² B = Beta. ³ S.E. = Standard Error. ⁴ p-value < 0.05 = significant. ⁵ Exp (B) = odds ratio. ⁶ C.I = confidence interval.