Is It Safe to Have Sex With a Concussion?
- Yes, you can have sex after a concussion, but it comes with caveats.
- A concussion isn't always directly responsible for sexual dysfunction, but its symptoms often are.
- People with brain injuries need to ease back into physical activity—sex included.
One way or another, you've suffered a concussion. Maybe you received a blow to the head while playing a contact sport, such as football. Maybe you were in a car accident.
Regardless, if you're in pain and experiencing some of the signs and symptoms accompanying a head injury, having sex may be the last thing on your mind. If the injury is relatively mild or you're starting to feel better, though, you may wonder whether it's OK to resume sexual activity.
That will raise the question: Is it safe to have sex after a concussion?
First, you need to understand how a concussion affects the brain and body.
What is a concussion?
A concussion is a form of mild traumatic brain injury (TBI) that causes the brain to move rapidly back and forth. That motion stretches and bruises blood vessels and nerves and potentially results in a temporary loss of consciousness, according to Mayo Clinic.
Concussions can impact a man physically, behaviorally and cognitively, said Javier F. Cárdenas, M.D., the chief of the Division of Sports Neurology at the West Virginia University Rockefeller Neuroscience Institute in Morgantown, West Virginia.
All three of those domains may have a negative impact on sex and intimacy.
Physical effects include headache, dizziness, nausea and insomnia. Irritability, anxiety and depression are potential behavioral effects. Cognitive effects include difficulty focusing, short-term memory loss and trouble finding words when talking.
"Is it safe to have sex after a concussion? The short answer is absolutely," Cárdenas said. "However, getting to that point of a sexual encounter can be a challenge after a concussion."
How can concussions affect sexual function?
A concussion may cause a man to experience sexual dysfunction. The impact can be both direct and indirect. Sexual dysfunction in men who have suffered a concussion is "definitely not universal," Cárdenas said.
"Most of the time, it's because they are irritable, their mood has changed, they have a headache or they're not feeling well," he said. "Just like we would with any other type of injury or illness, as opposed to having a primary sexual dysfunction as a direct result of the concussion."
A TBI might be a distractor during sex rather than a cause, said Laurence Levine, M.D., a professor of urology at Rush University Medical Center in Chicago.
"You might not feel like having sex because you might be distracted by the headache that you have or the general change in your behavior as a result of having a concussion," he said.
Often, a concussion occurs from the way the brain slides around inside the skull. The sheer deceleration or acceleration can directly damage parts of the brain. That may result in sexual problems, said Tony Masri, M.D., a neurologist and sleep medicine specialist at Helyx Health, a sleep and mental health practice in the San Francisco Bay Area.
The pea-sized pituitary gland is situated under the hypothalamus at the base of the brain. It is vital to the regulation of hormones that impact various bodily functions. A concussion's effect on the pituitary can cause hormonal disruptions, including testosterone production.
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The pituitary gland receives blood from the internal carotid artery, and blood flow can be impacted by a brain injury, Masri said.
"You have the injury itself, or whatever parts of the brain is going to hit the skull, then you have the axonal shear injury of the axons being broken, which are the communication channels between the different parts of the brain and organs," Masri said. "Third, you have the impact of blood flow, which is usually temporary."
If you've just had a concussion, Levine recommends not doing anything that would increase your blood pressure, because that might encourage swelling or bleeding if there's weakened brain tissue from the injury.
"Does sexual activity cause an increase in blood pressure? Well, not directly," Levine said. "But certainly, the heightened activity that one might be doing during that time might cause some changes in blood pressure, which I think might be ill-advised shortly after a concussion."
It's recommended that a man refrain from using sildenafil (Viagra) following a concussion because it can affect blood pressure and worsen symptoms, Cárdenas said.
"When you sustain a concussion, the normal changes in your body's blood pressure can then affect the changes in blood pressure in your head," he said. "Normally, what happens in our bodies actually does not necessarily affect the blood pressure in our head and in our brains.
"When somebody has extremely high blood pressure, they can have a hemorrhagic stroke. That is where we see this decoupling of this normal regulation of the pressure in the head."
What should you do if you aren't recovering from a concussion?
Concussions can impact testosterone levels and erectile function and cause reduced libido.
"The pituitary gland is going to be impacted, and the communication between the hypothalamus and the pituitary is going to be disrupted," Masri said. "If you are having symptoms of low testosterone after a traumatic brain injury, and in the first two to three months, you're not recovering, I think you should get tested."
Men who suffered a TBI were 2.5 times more likely to have erectile dysfunction (ED) than the general population, according to a 2000 to 2010 population-based study.
Former professional American-style football players who reported concussion symptoms were more likely to have low testosterone, a 2019 study suggested. The players who reported the most concussion symptoms had almost two times the risk of ED compared to those with the fewest symptoms.
Post-traumatic hypopituitarism—when the pituitary is not active enough—can be seen after head trauma, which can affect libido.
"It tends to be temporary and tends to be more magnified in a more severe brain injury," Cárdenas said.
The effects of concussions on sexual function may last for a couple of months, but it tends to improve by six months, Cárdenas said.
Hormone tests can be conducted to specifically look at the pituitary function, and there are hormone replacement treatment options.
"I want to make sure that people know that if they have sexual dysfunction, after everything else from a concussion has resolved, there are ways to test for it, and there are ways to treat it," Cárdenas said. "Usually, it's done with a neurologist in conjunction with an endocrinologist."
What is the recovery and prognosis of a concussion?
Masri has a general philosophy for concussion treatment: Rest is best.
"Sex involves some form of cardio, especially for men, but I would say to take it easy," he said. "Try to refrain for at least a couple of days. If you're not ready for moderate-level exercise, you're probably not ready for sex physically."
Start small and go slow—and don't push your limit.
"Toughing it out or pushing through it is not going to help," Masri said. "It's not going to make you recover any faster. If anything, it's going to make you more frustrated."
A good night's sleep is critical when recovering from a brain injury, especially when treating underlying sleep apnea.
"There's clear evidence that if you have sleep apnea and you treat it, your recovery from a TBI is going to be significantly better and faster," Masri said. "Because treating apnea will improve oxygenation to the brain, will improve sleep and the sleep itself will help with the healing."
Medication is not typically required for a concussion, but acetaminophen (Tylenol) may be used to manage pain. Masri discourages the use of opioids.
Most people recover from a concussion within two to three weeks, Cárdenas said. "If it's a concussion and they're feeling well enough to have sex, then it is perfectly safe."
The bottom line
If you aren't ready for a moderate workout, you probably aren't ready for sex either. Speak to your doctor if your symptoms aren't improving or are worsening.
While you work on feeling better, know there are other ways to strengthen your relationship with less physical contact.