YES. HOWEVER, THE QUESTION MIGHT NOT BE SO STRAIGHTFORWARD AS IT SOUNDS.  FOR EXAMPLE, IN APATHY, A FREQUENT AREA OF INVOLVMENT IN TBI/MTBI, GENERAL APATHY, IN WHICH LOSS OF SEXUAL INTEREST IS OFTEN INCLUDED IN A SYNDROME OF SYMPTOMS, THE DORSOLATERAL AND MEDIAL PREFRONTAL/FRONTAL REGIONS ARE TYPICALLY INVOLVED, AND THE ASSOCIATED CIRCUITS THROUGH DOPAMINERGIC PATHWAYS. MORE DORSOLATERAL INVOLVEMENT IS USUALLY CHARACTERIZED BY PASSIVITY, REDUCED VERBAL OUTPUT, SLOWNESS IN INITIATING RESPONSES TO QUESTIONS, AND FLATTENED AFFECT. APATHY IMPLIES MORE MEDIAL INVOLVEMENT, AND ITS SUBCOTRICAL PROJECTIONS TO THE VENTRAL STRIATUM/NUCLEUS ACCUMBENS REGIONS, GENERALLY A "MOTIVATIONAL DRIVER," AND THIS CAN OCCUR INDEPENDENTLY OF DEPRESSION, ALTHOUGH APATHY IS OFTEN MISTAKEN FOR DEPRESSION. HOWEVER, THE KEY HERE IS THE LINKAGE TO THE Nac, THE "HEART" OF THE DOPAMINERGIC REWARD SYSTEM. HOWEVER, IN MTBI, THERE CAN BE LACK OF DIRECT "CORTICAL" INVOLVMENT, BUT INSTEAD, INVOLVMENT OF THE CEREBELLUM, WHICH HAS BEEN DEMONSTRATED TO SERVE AS A REGULATOR OF DOPAMINERGIC ACTIVITY IN MEDIAL ANTERIOR CORTICAL/VENTRAL STRIATAL REGIONS, AKIN TO A PHENOMENON OF DIASCHIZIS. BUT, THE CEREBELLUM IS ALSO INVOLVED IN MANY OF THE FUNCTIONS ASSOCIATED WITH THE PHYSIOLOGICAL RESPONSES OF ORGASIM; SO, IN GENERAL, THE MEDIAL/ACC REGIONS OF ANTERIOR CORTEX, THE VENTRAL STRIATUM, AND THE CEREBELLUM ARE ALL INVOLVED IN SEXUAL ACTIVITY. BUT "SEXUAL FUNCTIONG " IS A VERY GENERAL TERM, AND UNDER THIS OVER-ARCHING CATEGORY WE HAVE ATTRACTION, INTEREST, CONSUMPTION, ETC., AN EXTREMELY WIDE-ARRAY OF FACTORS THAT CAN BEST BE UNDERSTOOD WITHIN THE CONTEXT OF LARGE SCALE BRAIN SYSTEMS, WHICH ALWAYS IMPLIES INVOLVMENT OF WHITE MATTER TRACTS. I AM ATTACHING A PAPER WHICH I THINK WILL BE EXTREMELY RELEVANT TO YOUR QUESTION, "IF" I UNDERSTAND IT PROPERLY. --LK (LARGE FONT FOR ME - NOT YOU)

Thank you for the detailed explanation, Dr Koziol. I agree with the fact that sexual functioning is indeed a very general term. I should have been more specific. About almost a third of all my patients with mTBI do report or attest to changes in their sexual activity/ behaviour. The changes ranges from the loss of libido/interest, poor arousal, reduced or inability to maintain erection to reduced semen volume. In some rare occasion, I have some patients reporting hypersexuality. We screened these patients for psychological distress developed post trauma, and other physiological injuries that could possibly affect the sexual well being of the patients. We also screened them for any hormonal abnormalities at 1 month, 3 months and 6 months post trauma, and found no basis to support hypothalamic pituitary dysfunctions in this particular group. The same patients also underwent series of MRI which involved DTI sequences as well. Some of the tracts from our preliminary analysis seem to have been altered within hours post trauma and as well as at 6 months. Among the tracts that we are currently looking at or postulating to have effect on sexual dysfunction in patients with mTBI are medial lemniscus, corticospinal and spinothalamic tracts,  association fibers including superior longitudinal fasciculus, superior occipitalfrontal fasciculus and also the projection fibers like the  inferior and middle cerebellar peduncle.  Do you think we are headed in the right direction, Dr Koizol.

ON THE RIGHT TRACK? LET ME SAY A FEW THINGS. I AM NOT AN EXPERT IS THE AREA OF SEXUAL FUNCTIONING. I AM IN THE CLINICAL FIELD, AND I TRY TO APPLY BRAIN NETWORK DATA WITH CLINICAL DATA. SO, I WILL ATTACH ONE MORE PAPER. ALTHOUGH IT IS ABOUT ADHD, IT IS REALLY ABOUT THE IDENTIFICATION AND FUNCTIONS OF LARGE SCALE BRAIN SYSTEMS. THE PAPER IS APPLICABLE TO ANY DISORDER/SYMPTOM; THE CHALLENGE IS TO VIEW THE PREVIOUSLY ATTACHED PAPER, ALONG WITH YOUR IDEAS, WITHIN THE CONTEXT OF THESE LARGE SCALE BRAIN SYSTEMS. DRS. WANG, BUCKNER, AND IUE HAVE TOGETHER RECENTLY PUBLISHED ADDITIONAL PAPERS ABOUT HOW THESE BRAIN NETWORKS ARE PREFERENTIALLY CONNECTED WITHIN THE LEFT AND RIGHT HEMISPHERES OF THE CORTEX AND WITHIN THE CONTRALATERAL HEMISPHERES OF THE CEREBELLUM. TAKEN TOGETHER, COMBININHG THIS INFORMATION, SHOULD PUT YOU WELL ON YOUR WAY TO FINDING LIKELY ANSWERS TO YOUR QUESTIONS. THE OTHER AUTHORS ARE MEMBERS OF RESEARCH GATE. - LK