Sexual dysfunction after traumatic brain injury: A systematic review and meta-analysis

This is the authors' abstract. We don't add key points for this paper.

Background and Objective: Sexual dysfunction (SD) is generally described as any ongoing, clinically important disruption in sexual desire, arousal, orgasm, or resolution, or the occurrence of pain during intercourse, stemming from organic, psychological, or relational causes. The occurrence of SD in traumatic brain injury (TBI) is not well-studied. This review quantified the risk, magnitude, and report the predictors of SD post-TBI. Methodology: We searched PubMed, Google scholar, Scopus, EMBASE and Cochrane from inception to July 2026 (PROSPERO registration# CRD420261479835) in line with PRISMA 2020 guidelines). Eligible studies enrolled adults (≥18 years) with confirmed TBI and measured SD using defined outcomes. Two reviewers independently screened records, extracted data, and appraised risk of bias using the Newcastle-Ottawa Scale and JBI checklists. Standardized mean differences (Hedges g) and prevalence were pooled using random effects models (restricted maximum likelihood, Hartung-Knapp adjustment). Results: Twenty-two studies (19 distinct samples comprising 2,663 adult patients) met the inclusion criteria. Alongside, one claims-based cohort of 72,624 individuals was analyzed separately. Sexual functioning was consistently poorer after TBI (pooled Hedges g 0.59; 95% CI 0.32-0.86) with no detectable heterogeneity I² = 0%). Reported prevalence was highly heterogeneous I² = 96.6%); this variation tracked the stringency of each study’s case definition rather than true differences in burden. Across within-study contrasts, depression (5/5 studies) and lower community participation (3/3) were consistently associated with worse sexual function; SD was more common in women, whereas inappropriate sexual behavior was more common in men. Conclusion: TBI substantially and consistently increases the risk of SD. Wide variation in prevalence estimates reflects inconsistent case definitions, and not weak evidence. Standardized assessment, routine clinical screening, and adapted intervention pathways are needed.