5th Edition of International Neurology Conference 2026

Abstract

Sexual health and intimacy are core determinants of quality of life, yet they remain among the most neglected domains in neurological care and rehabilitation. Patients living with traumatic brain injury, stroke, spinal cord injury, multiple sclerosis, neurodegenerative disease, and cancer-related cognitive impairment consistently identify intimacy as a priority, yet clinicians rarely assess it. This presentation advances a rehabilitationgrounded framework for understanding why intimate functioning breaks down after neurological injury and disease, and argues that cognition, not sexual circuitry alone, is often the decisive factor. First, we map the distributed neural architecture of sexual response: mesolimbic dopaminergic reward pathways driving desire and motivation, limbic-hypothalamic structures governing arousal and drive, and prefrontal regions mediating inhibition, appraisal, and pair-bonding. Disruption at each node produces predictable phenotypes that recur across etiologies, including disinhibition and hypersexuality with orbitofrontal damage, apathy and hyposexuality with frontal-subcortical disruption, and altered arousal with hypothalamic or pathway-level lesions. Framing presentation by network rather than diagnosis clarifies why conditions as distinct as frontotemporal dementia, brain injury, stroke, and treatment-related neurotoxicity can converge on similar intimate sequelae. Second, we argue that intimacy fails not only through direct disruption of sexual networks but through cognitive mediators. Executive dysfunction, slowed processing speed, attentional impairment, and disrupted emotional regulation degrade the communication, perspective-taking, and co-regulation on which intimate relationships depend. This cognition-intimacy bridge reframes sexual difficulty across rehabilitation populations as a relational and neurocognitive problem, not merely a physiological one, with direct implications for how interdisciplinary teams target intervention. Finally, we address the clinical gap directly: why sexual health is so seldom raised, the barriers that silence both providers and patients, and a practical model for initiating these conversations. Drawing on rehabilitation psychology and frameworks such as PLISSIT, we offer concrete strategies for screening, normalizing patient and partner concerns, delivering education, and routing patients to appropriate care. Attendees will leave equipped to integrate sexual health into neuropsychological assessment and rehabilitation planning, with particular attention to populations for whom these concerns are routinely overlooked.