Table 1 Summary of Studies that have included women and mTBI groups in evaluating TBI-associated changes in sexual functioning (1991–2019)

 O’Carroll et al. (1991, UK) (O'Carroll et al. 1991)

36 with closed head injury (17 non-injured partners used as comparison group)

17% female (n = 6)

83% male (n = 30)

Mild to moderate

(Mild:30.6%)

Patients previously admitted for head injury mean age 35.63 (+/− 11.55 SD) years

Prospective Cohort Study, outcomes assessed on average 4.06 years post injury

Golombok Rust Inventory of Sexual Satisfaction (GRISS)

Overall Findings:

 50% of head injured study participants (compared to 9% of partners fell in the ‘dysfunctional’ range for the GRISS

Gender-Specific Findings:

 Patient outcomes were male-focused, and partner outcomes were female-focused. No evaluation of sexual dysfunctions in head injured female study participants and their male partners.

 Kreuter et al. (1998, Sweden)

(Kreuter et al. 1998)

92 with traumatic brain injury. No comparison group

29% Female

(n = 27)

71% Male

(n = 65)

Mild to Severe TBI, (% mild not indicated)

Rehabilitation Patients. Median age 40 years, range 20–70 years

Prospective Cohort Study with outcomes assessed 1–20 years post-injury (median 9 years)

Sexual Interest and Satisfaction Scale

Overall Findings:

 For all respondents, 24% reported decreased and 23% non-existing frequency of intercourse. A quarter (26%) had no experience of sexual activity together with a partner after the injury.

 More than half of the 92 respondents (56%) reported dissatisfaction with the frequency of sexual activity

Gender-Specific Findings:

 No female-specific changes were highlighted. Mainly focused on male study participants

 Hibbard et al. (2000, USA)

(Hibbard et al. 2000a)

322 with traumatic brain injury (264 non-injured comparison group)

40% Female

(n = 129)

60% Male

(n = 193)

Mild to Severe TBI, (Mild:37% of female participants, 18% of male participants)

Community dwelling TBI patients between ages 16-64 years

Retrospective Cohort Study with outcomes assessed at 9.64 years (+/− 8.17SD) years for men, 9.30 (+/− 9.17 SD) years for women

Sexual interest and functioning components of the Quality of Life Interview (QOLI) questionnaire

Overall Findings:

 When contrasted to individuals without disability, individuals with TBI reported more frequent: (1) physiological difficulties influencing their energy for sex, sex drive, ability to initiate sexual activities and achieve orgasm (p < 0.001); (2) physical difficulties influencing body positioning, body movement and sensation (p < 0.001), and (3) body image difficulties influencing feelings of attractive and comfort with having a partner view one’s body during sexual activity (p < 0.001).

Gender-Specific Findings:

 Women with TBI reported more frequent difficulties in sexual arousal, pain with sex, masturbation and vaginal lubrication (p < 0.001) than women without TBI.

 For women with TBI, an endocrine disorder and level depression combined were the most sensitive predictors of sexual difficulties.

 Gaudet et al.

(2001, USA)

(Gaudet et al. 2001)

50 with traumatic brain injury (55 non-injured participants as comparison group)

48% female

(n = 24)

52% male

(n = 26)

Mild to Severe TBI, (% mild not indicated)

TBI support group participants, between ages 17–78 years

Prospective Cohort Study, time since injury not provided

Questionnaires created by investigators

Overall Findings:

 TBI individuals have more negative feelings about themselves, their sexuality, and their relationships with others.

Gender-Specific Findings:

 Female participants with TBI have more positive feelings about their sexuality than male participants with TBI (p = 0.044)l

 Goldin et al.

(2014, USA)

(Goldin et al. 2014)

220 with traumatic brain injury

(83 non-injured participants as comparison group)

48% female

(n = 105)

52% male

(n = 115)

Mild to Severe TBI, (% mild not indicated)

Community Dwelling individuals with average age 48 years (SD = 12.1)

Prospective Cohort Study, at least 12 months post-injury

Participation Objective Participation Subjective (POPS) questionnaire

Overall Findings:

 Individuals with TBI reported sex to be less important to their overall quality of life than comparison group without TBI.

Gender-Specific Findings:

 Women with TBI reported having sex less frequently (p = 0.006) and rated sexual activity of less importance (p = 0.015) than did men with TBI.

 These sex differences were not observed in the comparison group (p = 0.421, p = 0.283, respectively).

 Moreno et al. (2014, Colombia)

(Moreno et al. 2014)

28 with traumatic brain injury (27 non-injured partner participants as comparison group)

32.1% female (n = 9)

67.9% male (n = 19)

Mild to Severe TBI, (% mild not indicated)

University Hospital with participant average age of 39.7 years (SD = 11.46)

Prospective Cohort Study,on average

21.3 months post-injury (SD = 12.5).

Sexual Quality of Life Questionnaire (SQoL)

Index of Sexual Satisfaction (ISS)

Relationship Assessment Scale (RAS)

Overall Findings:

 Individuals with TBI scored significantly lower than healthy controls on the SQoL (p < 0.0001) and RAS (p < 0.0001) and had higher scores

 in the ISS (p < 0.0001).

Gender-Specific Findings:

 None Results not stratitifed by sex/gender

 Moreno et al., (2015, Canada)

(Moreno et al. 2015a)

41 with traumatic brain injury (41 non-injured participants as comparison group)

56.1% female (n = 23)

43.9% male (n = 18)

Mild to Severe

(65.9% mild)

Rehabilitation centre in Montreal with participant average age of 38 years (SD = 9.8)

Prospective Cohort Study,on average

2.6 years post-injury (SD = 1.4).

Sexual Quality of Life Questionnaire (SQoL)

Overall Findings:

 Compared to healthy controls, individuals with TBI showed lower sexual quality of life,

 (t (73) = 2.5, p < 0.05)

 and was negatively and significantly correlated with the total Postconcussion

 Symptom Scale score (r = −0.69, p < 0.01)

Gender-Specific Findings:

 None. Results not stratitifed by sex/gender

 Downing & Ponsford (2018 (Australia)

(Downing and Ponsford 2018)

55 with traumatic brain injury (55 non-injured partners participants as comparison)

25.5% female

(n = 11)

74.5% males (n = 41)

Mild to Severe

(27.3% mild)

Rehabilitation programme at Epworth Healthcare with participant mean age of 34.6 years (SD = 12.8

Prospective Cohort Study,on average

36 months post-injury (SD = 3)

Derogatis Interview for Sexual Function-Self Report (DISF-SR)

Overall Findings:

 Participants with TBI obtained lower T-scores

 than partners on all subscales.

Gender-Specific Findings:

 On the sexual arousal subscale, the difference between groups approached significance for females on lubrication subscale χ2(4,

 N = 50) = 9.46, p = .051.

 There were no other differences observed for any other items on the DISF-SR.

 Anto-Ocrah et al. (2019, USA)

(Anto-Ocrah et al. 2019a)

31 with traumatic brain injury

(55 extremity injured comparison group)

100% female

Mild only

(100% mild)

Emergency Department of Level-One Trauma Center mean age 30.7 (SD = 8.2)

Prospective Cohort, with outcomes assessed between 6 and 10 weeks post concussion

Brain Injury Questionnaire on Sexuality (BIQS)

Overall & Gender-Specific Findings:

 Compared to extremity injury women, those with concussions had 1.70 increased risk of sexual dysfunction (RR1.70, 95% CI:1.04, 2.76; p = 0.03)