Explaining the emerging conceptual framework of neurosexuality

People say the brain is the most powerful sexual organ. Neurosexuality knows it's true.

Neurosexuality is an emerging conceptual framework of study and practice that looks at the relationship between the brain and sexual functioning.

Human sexual responses such as arousal, fantasies, lubrication, erection and orgasm are all directed by parts of the central nervous system. As the body's hormone control center, the hypothalamus governs desire, lubrication and erection. The amygdala plays in important role in emotions such as pleasure. The orbitofrontal cortex, a decision-making locus, is involved in initiating sexual activity. The cerebellum controls motor response and the parietal lobes process sensory information.

According to Jhon Alexander Moreno, a neuropsychologist, researcher and assistant professor in Université de Montréal's's Department of Psychology, neurosexuality is a comprehensive framework that supports the integration of sexual rehabilitation into treatment for people living with neurological disorders.

"Many dimensions of sexual response are linked to specific areas of the brain," Morena noted, so someone with a brain lesion may well experience sexual dysfunction."

Sexual problems linked to disorders

Neurological disorders such as dementia, epilepsy, stroke, Lou Gehrig's disease and traumatic brain injury (TBI) are associated with a range of sexual problems, including decreased sexual desire, difficulty fantasizing and reaching orgasm, altered body image, erectile dysfunction, risky sexual behaviors and depression, which can decrease sex drive.

"The sexual problems commonly associated with TBI are hyposexuality and decreased libido," explained Moreno.

"Sometimes the opposite can happen and the patient has an increase in sexual desire, even leading to hypersexuality and compulsive behavior, such as an uncontrollable urge to approach strangers for erotic gratification. In either case, family and friends say they no longer recognize the patient, that they've become a different person."

Neurosexuality is an approach that calls on health professionals to integrate a patient's sexual functioning into their clinical assessment.

"Sexual health is part of overall health and should be addressed in rehabilitation along with all the other dimensions of health, such as mobility, social participation, cognition and emotions," said Moreno.

"These dimensions, which are affected by neurological disorders, also play a role in sexual functioning. My research shows that we do not automatically associate brain lesions with sexual problems, which is where neurosexuality comes in. It deserves more attention."

Taking a proactive approach

Moreno believes sexual functioning should be assessed using an approach and a clinical exam that normalize sexuality. He has found that people living with brain lesions often have questions about their sexual health and want health professionals to take a proactive approach.

"First, health professionals have to be familiar with these potential consequences; then they need to educate patients with brain damage and their intimate partners," said Moreno. "They have to make their patients feel comfortable talking about these issues. They must have a positive, respectful attitude toward sexuality and destigmatize sexual problems."

According to Moreno, after asking the right questions and identifying the problem, the health professional can initiate care using a multimodal approach, which could encompass not only pharmacological, motor and/or hormonal interventions, but also relational, behavioral and/or communication therapies.

"The transdisciplinary approach taken by neurosexuality is essential for understanding the complexity of sexual behavior and helping patients have pleasurable and fulfilling sexual and relational experiences," Moreno said.