A human sexual response format was used to describe possible sexual dysfunctions after TBI. Additional material was also included to qualify the information drawn from the above format. A number of possible conclusions were drawn, indicating that the causes and effects of sexual functioning after TBI are very confusing and that the literature does not clarify this confusion. One cannot accurately differentiate between primary and secondary sexual problems and, therefore, cannot evaluate the contribution of each problem to the presented sexual dysfunction.

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The use of surrogate sex therapists for survivors after Traumatic Brain Injury (TBI) who have Very Limited Functional Ability (VLFA) is discussed. It includes the rationale of using surrogate therapy with this population as well as some of the professional and ethical issues that such therapy can evoke. It is suggested that surrogate therapy can provide satisfaction and positive experiences to the restricted lives of some of the VLFA-TBI survivors. The use of surrogate therapy is viewed as a part of the integral rehabilitation process aimed at improving the quality of life and the fulfillment of basic human intimacy needs. Often requiring help in this important area of life, they are not always able to initiate and control emotional behaviors to promote healthy sexual relationship and activity. Surrogate therapy is an activity that can help survivors with TBI monitor and initiate feelings, reactions and motivation in intimate relationships, as well as provide a certain amount of control over their lives. A case study is presented to illustrate the process of sex therapy with a surrogate partner for a VLFA-TBI survivor.