At one level, sexual dysfunction following injury, can be a simple problem, but globally it is actually quite complex. In training, they referred to this as _multiple co-existing factors_ so let_s look at a few of the factors to consider:
1. Depressed individuals have decreased libido (sexual drive), and the patient may be referring more to his/her depressive symptoms than to a sexual dysfunction. It may actually be a decrease in sexual desire.
2. As we have discussed in the past, sexual desire is quite often influenced by mechanical pain from injury. It is simply painfully unpleasant to engage in any sexual activities since it requires mobility that the patient may not have, or has only with painful difficulty.
3. There are two important groups of medications that frequently impact sexual functioning, one is the narcotic pain medications and the other is the SSRI antidepressants. Indeed, there are recent articles regarding the use of a supplemental medication when using SSRI antidepressants to deal with the sexual complaints that occur.
4. Conflicts regarding self-image, sexual attractiveness or longstanding problems in a relationship may surface at many levels after injury (or physical illness) and decreased sexual response, intentional or involuntary, may be a means for the patient to respond to those relationship issues.
It is often quite difficult to determine which of these important variables are influencing a given patient without thorough evaluation of the patient. This is an important and excellent question.