Bakgrund Endometrios är en sjukdom där livmoderslemhinna lokaliseras utanför livmodern som resulterar i en inflammatorisk process. Vanliga symtom inkluderar allvarlig smärta under menstruation och ägglossning, förstoppning, diarré och infertilitet. Hälso-relaterad livskvalitet definieras som hur mycket hälsoproblemet påverkar det vardagliga livet och hur stor möjlighet personen har att leva ett, enligt denna, tillfredsställande liv. Vårdande möten behöver tre nyckelfaktorer för att skapa trygghet, att patienten blir bemött med empati och lyssnad på, får personlig utformad information samt kompetens inom medicinteknik. Syfte Syftet var att belysa hur livskvaliteten påverkas hos kvinnor med diagnosen endometrios. Metod Icke-systematisk litteraturöversikt som inkluderade 15 originalartiklar med både kvalitativ och kvantitativ ansats. Artiklar hittades under sökningar av PubMed och CINAHL med användning av Booelsk söklogik. En kvalitetsgranskning gjordes på alla inkluderade artiklar med hjälp av Sophiahemmet högskolas bedömningsunderlag för kvalitetsgranskning. Analysen genomfördes med hjälp av en integrerad litteraturöversikt. Resultat Fyra huvudteman identifierades under sammanställningen av resultaten och de var livskvalitet kopplat till mötet med omvärlden, livskvalitet kopplat till sexlivet, livskvalitet kopplat till karriären och livskvalitet kopplat till psykiskt mående. Den mest centrala aspekten som påverkade kvinnor med endometrios liv var smärta. Smärtan påverkade arbetslivet negativt, det sociala livet och intima relationer påverkades också negativt och smärtan var en stor psykisk påfrestning. Slutsats Denna litteraturöversikt visade att kvinnor med endometrios har sämre livskvalitet jämfört med kvinnor utan sjukdomen. Deras liv påverkades i flera aspekter, deras sociala liv, intima relationer, psykiskt mående samt karriären påverkades negativt. Det framkom även att ett bra bemötande från hälso- och sjukvården men även från andra människor minskade lidandet hos kvinnan och förbättrade hennes livskvalitet. / Background Endometriosis is an illness where endometrium is found outside of the uterus resulting in an inflammatory process. Common symptoms include severe pain during menstruation and ovulation, constipation, diarrhoea and infertility. Health related quality of life is defined as how much everyday life is affected and how large the possibility is of the person living, according to them, a satisfactory life. Caring encounters need three key aspects to create security, the patient being met with empathy and listened to, get personally designed information and competence in medical technology.  Aim The aim was to illustrate how quality of life is affected in women with the diagnosis endometriosis.  Method Non-systematic review including 15 original articles with both qualitative and quantitative approaches. Articles were found during searches of PubMed and CINAHL using a Boolean approach. A quality review of all articles included was conducted using Sophiahemmet University assessment basis for scientific classification and quality. Analysis was conducted using the integrative review method. Results Four main themes were identified during the compilation of the results, and those were quality of life related to the meeting with the surrounding world, quality of life related to sex life, quality of life related to career and quality of life related to psychological being. The most central aspect that affected women with endometriosis lives was pain. The pain affected working life negatively, the social life and intimate relationships was also negatively affected, and the pain was a great mental strain. Conclusions This literature review showed that women with endometriosis has a lower quality of life compared to women without the disease. Their lives were affected in multiple aspects, their social lives, intimate relationships, psychological being and the career was negatively affected. It became evident that a good encounter with healthcare but also with other people lessened the suffering of the women and improved her quality of life.

A obesidade está associada com um perfil hormonal reprodutivo alterado que afeta ambos os sexos. A perda de peso decorrente de intervenções cirúrgicas normaliza os níveis androgênicos nos indivíduos masculinos no curto prazo, porém nenhum estudo avaliou se estas alterações são duradouras, e se estão relacionadas a uma melhora da qualidade de vida sexual destes indivíduos. Objetivos: Avaliar o comportamento dos hormônios sexuais masculinos e a qualidade de vida sexual nos indivíduos obesos graves que perderam peso após a cirurgia bariátrica, em um seguimento pós-operatório cinco anos. Materiais e Métodos: Realizou-se um estudo prospectivo e observacional com 52 pacientes, que foram divididos em três grupos. O grupo operado compreendeu 23 indivíduos obesos graves que foram submetidos à cirurgia bariátrica há mais de cinco anos na Disciplina de Cirurgia do Aparelho Digestivo do Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP). O grupo obeso controle era formado de 14 indivíduos obesos (IMC 30 kg/m2) atendidos no ambulatório da mesma instituição. O grupo controle não-obeso foi composto de 15 indivíduos com IMC < 30 kg/m2 selecionados de um ambulatório de urologia geral. Foram avaliados parâmetros antropométricos (índice de massa corporal (IMC), circunferência abdominal, volume testicular, ginecomastia e pressão arterial), exames bioquímicos, análise hormonal (incluindo testosterona total (TT), testosterona livre (TL), globulina ligadora dos hormônios sexuais (SHBG), sulfato de dehidroepiandrosterona (SDHEA), dehidroepiandrosterona (DHEA), hormônio folículo-estimulante (FSH), hormônio luteinizante (LH), estradiol (E2), prolactina, hormônio tireoestimulante (TSH), tiroxina (T4) e leptina), e questionários validados IIEF e AMS. O protocolo foi aplicado entre agosto de 2010 e janeiro de 2011. Resultados: A idade média (dp) dos participantes foi 47.6 ± 12.6, 53.1 ± 8.7 e 51.4 ± 9.8, respectivamente, o IMC nos pacientes operados reduziu de 59.8 ± 12.1 kg/m2 para 35.1 ± 7.7 kg/m2 (P<0.001), e o percentual de perda do excesso de peso médio foi de 71%. Nos três grupos, respectivamente, foram encontrados os seguintes valores hormonais relevantes, sendo que os demais hormônios não se mostraram diferentes (média ± dp): TT- 534.2 ± 231.4, 297.0 ± 110.3 e 494.7 ± 143.3 (P=0.001); TL - 349.4 ± 169.2, 243.3 ± 75 e 378.8 ± 147.6 (P=0.03); SHBG - 48.8 ± 23.8, 23.5 ± 8.3 e 32.8 ± 15.7 (P=0.001); insulina - 7.9 ± 6.5, 17.1 ± 6.9 e 5.7 ± 2.6 (P<.001). No grupo operado, TT se correlacionou negativamente com IMC (P<0.02), circunferência abdominal (P=0.009), níveis de insulina (P=0.004), leptina (P=0.001) e glicemia (P=0.002). SHBG correlacionou-se negativamente com IMC (P=0.002), circunferência abdominal (P=0.003), triglicérides (P=0.02), e leptina (P=0.01). TL correlacionou-se negativamente com idade (P=0.003), glicemia (P=0.01) e insulina (P=0.03). Os exames de função hepática TGO/ALT, TGP/AST e GGT mostraram diferenças estatísticas significantes entre os grupos, assim como HDL e LDL - colesterol, PCR, leucócitos e fibrinogênio (P<0.05). No questionário IIEF, os índices médios globais do grupo obeso operado foram melhores do que os do grupo obeso controle (56.7 ± 14.5, 49.1 ± 11.9 e 61.7 ± 7.5), embora sem significância estatística para qualquer das três populações. Na análise por domínios deste questionário, houve diferença estatística significante relativa à função erétil (P=0.01) e satisfação sexual de modo geral (p=0.04), mas somente entre os grupos controles obesos e não- obesos. O questionário AMS mostrou que, embora sem significância estatística, os indivíduos do grupo operado apresentavam o mesmo padrão de respostas dos não-obesos controles (31.0 ± 9.4, 37.4 ± 15.1 e 31.0 ± 8.8). Conclusão: Após cinco anos ou mais, os níveis de alguns hormônios sexuais e certos aspectos da qualidade de vida sexual mostraram-se melhores nos operados que em obesos controles, e compatíveis com os da população não obesa. Tal sucedeu a despeito da manutenção na categoria de obesos de quase ¾ dos indivíduos. Pode-se afirmar, portanto, que a cirurgia bariátrica, ainda sem reverter a totalidade das anormalidades androgênicas, revelou-se um método útil e vantajoso a longo prazo sob este prisma / Obesity is associated with an altered reproductive hormonal profile that can affect both sexes. The weight loss caused by bariatric surgery normalizes male hormone levels in the short term. However, the outcome of the levels of these hormones in the long term, and whether they are related to an improved sexual quality of life has not been evaluated. Objective: Evaluate the outcome of sex hormones and sexual quality of life of male subjects who underwent bariatric surgery for morbid obesity over a long follow-up period (> 5 years). Material and Methods: This was a prospective, observational study. Male patients (N=52) were consecutively recruited and three groups were considered: I) Bariatric subjects who underwent Roux-en-Y gastric bypass (RYGB) >5 years earlier (n=23) at the Division of Digestive Surgery, Department of Gastroenterology at the Faculty of Medicine, São Paulo University; II) Overweight and obese non-operated controls (n= 14) (IMC 30 kg/m2) recruited from the outpatient clinic of the same institution; III) Non-obese controls (n= 15) (IMC < 30 kg/m2) recruited from a urological outpatient clinic. Clinical, hormonal and biochemical parameters were evaluated, including retrospective information collected from hospital files. Variables analyzed were anthropometric parameters (body mass index (BMI), waist circumference, testicular volume, gynecomastia and blood pressure), inflammatory markers (C- reactive protein, fibrinogen), total testosterone (TT), free testosterone (FT), sex hormone binding globulin (SHBG), follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S), estradiol (E2), prolactin, thyroid-stimulating hormone (TSH), thyroxine (T4) and leptin, along with two validated questionnaires (International Index of Erectile Function (IIEF) and the Aging Males` Symptoms (AMS). The protocol was applied between August 2010 and January 2011. Results: Mean age (sd) of the subjects was 47.6 ± 12.6, 53.1 ± 8.7 and 51.4 ± 9.8, respectively, BMI of the operated patients decreased from 59.8 ± 12.1 kg/m2 to 35.1 ± 7.7 kg/m2 (P<0.001), and mean percentage weight loss was 71%. In the three groups, respectively, the following hormones showed significant differences in mean levels (mean ± sd): TT- 534.2 ± 231.4, 297.0 ± 110.3 and 494.7 ± 143.3 (P=0.001); FT- 349.4 ± 169.2, 243.3 ± 75 and 378.8 ± 147.6 (P=0.03); SHBG - 48.8 ± 23.8, 23.5 ± 8.3 and 32.8 ± 15.7 (P=0.001); insulin - 7.9 ± 6.5, 17.1 ± 6.9 and 5.7 ± 2.6 (P<.001). In the operated group, TT correlated negatively with BMI (P<0.02), waist circumference (P=0.009), insulin levels (P=0.004), leptin (P=0.001) and glucose (P=0.002). SHBG correlated negatively with IMC (P=0.002), waist circumference (P=0.003), triglycerides (P=0.02), and leptine (P=0.01). TL correlated negatively with age (P=0.003), glucose (P=0.01) and insulin (P=0.03). Liver function tests (LFT) TGO/ALT, TGP/AST and gamma-glutamyltransferase (GGT) showed statistically significant differences among the groups, as well as HDL and LDL cholesterol, CRP, leucocytes and fibrinogen (P<0.05). The operated group scored higher in the IIEF questionnaire than the obese controls (56.7 ± 14.5, 49.1 ± 11.9 e 61.7 ± 7.5), but no significant differences among the three groups were found. Significant improvements in the IIEF domains erectile function (P=0.01) and overall sexual satisfaction (p=0.04) were found, but only between the obese controls and non-obese individuals. In the AMS questionnaire, operated patients and non-obese individuals showed the same pattern of responses, but no significant differences between these groups could be found (31.0 ± 9.4, 37.4 ± 15.1 e 31.0 ± 8.8). Conclusion: Despite almost ¾ of patients that were submitted to bariatric surgery 6- 16 years earlier were still categorized in the obese category, these individuals have shown a healthier sex hormone profile than obese control individuals and, in some aspects, they behaved like non-obese individuals. Bariatric surgery proved to be a reliable method to improve both male androgens and sexual quality of life in the longterm, even when a complete resolution of the hormonal imbalance has not been achieved

A obesidade está associada com um perfil hormonal reprodutivo alterado que afeta ambos os sexos. A perda de peso decorrente de intervenções cirúrgicas normaliza os níveis androgênicos nos indivíduos masculinos no curto prazo, porém nenhum estudo avaliou se estas alterações são duradouras, e se estão relacionadas a uma melhora da qualidade de vida sexual destes indivíduos. Objetivos: Avaliar o comportamento dos hormônios sexuais masculinos e a qualidade de vida sexual nos indivíduos obesos graves que perderam peso após a cirurgia bariátrica, em um seguimento pós-operatório cinco anos. Materiais e Métodos: Realizou-se um estudo prospectivo e observacional com 52 pacientes, que foram divididos em três grupos. O grupo operado compreendeu 23 indivíduos obesos graves que foram submetidos à cirurgia bariátrica há mais de cinco anos na Disciplina de Cirurgia do Aparelho Digestivo do Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP). O grupo obeso controle era formado de 14 indivíduos obesos (IMC 30 kg/m2) atendidos no ambulatório da mesma instituição. O grupo controle não-obeso foi composto de 15 indivíduos com IMC < 30 kg/m2 selecionados de um ambulatório de urologia geral. Foram avaliados parâmetros antropométricos (índice de massa corporal (IMC), circunferência abdominal, volume testicular, ginecomastia e pressão arterial), exames bioquímicos, análise hormonal (incluindo testosterona total (TT), testosterona livre (TL), globulina ligadora dos hormônios sexuais (SHBG), sulfato de dehidroepiandrosterona (SDHEA), dehidroepiandrosterona (DHEA), hormônio folículo-estimulante (FSH), hormônio luteinizante (LH), estradiol (E2), prolactina, hormônio tireoestimulante (TSH), tiroxina (T4) e leptina), e questionários validados IIEF e AMS. O protocolo foi aplicado entre agosto de 2010 e janeiro de 2011. Resultados: A idade média (dp) dos participantes foi 47.6 ± 12.6, 53.1 ± 8.7 e 51.4 ± 9.8, respectivamente, o IMC nos pacientes operados reduziu de 59.8 ± 12.1 kg/m2 para 35.1 ± 7.7 kg/m2 (P<0.001), e o percentual de perda do excesso de peso médio foi de 71%. Nos três grupos, respectivamente, foram encontrados os seguintes valores hormonais relevantes, sendo que os demais hormônios não se mostraram diferentes (média ± dp): TT- 534.2 ± 231.4, 297.0 ± 110.3 e 494.7 ± 143.3 (P=0.001); TL - 349.4 ± 169.2, 243.3 ± 75 e 378.8 ± 147.6 (P=0.03); SHBG - 48.8 ± 23.8, 23.5 ± 8.3 e 32.8 ± 15.7 (P=0.001); insulina - 7.9 ± 6.5, 17.1 ± 6.9 e 5.7 ± 2.6 (P<.001). No grupo operado, TT se correlacionou negativamente com IMC (P<0.02), circunferência abdominal (P=0.009), níveis de insulina (P=0.004), leptina (P=0.001) e glicemia (P=0.002). SHBG correlacionou-se negativamente com IMC (P=0.002), circunferência abdominal (P=0.003), triglicérides (P=0.02), e leptina (P=0.01). TL correlacionou-se negativamente com idade (P=0.003), glicemia (P=0.01) e insulina (P=0.03). Os exames de função hepática TGO/ALT, TGP/AST e GGT mostraram diferenças estatísticas significantes entre os grupos, assim como HDL e LDL - colesterol, PCR, leucócitos e fibrinogênio (P<0.05). No questionário IIEF, os índices médios globais do grupo obeso operado foram melhores do que os do grupo obeso controle (56.7 ± 14.5, 49.1 ± 11.9 e 61.7 ± 7.5), embora sem significância estatística para qualquer das três populações. Na análise por domínios deste questionário, houve diferença estatística significante relativa à função erétil (P=0.01) e satisfação sexual de modo geral (p=0.04), mas somente entre os grupos controles obesos e não- obesos. O questionário AMS mostrou que, embora sem significância estatística, os indivíduos do grupo operado apresentavam o mesmo padrão de respostas dos não-obesos controles (31.0 ± 9.4, 37.4 ± 15.1 e 31.0 ± 8.8). Conclusão: Após cinco anos ou mais, os níveis de alguns hormônios sexuais e certos aspectos da qualidade de vida sexual mostraram-se melhores nos operados que em obesos controles, e compatíveis com os da população não obesa. Tal sucedeu a despeito da manutenção na categoria de obesos de quase ¾ dos indivíduos. Pode-se afirmar, portanto, que a cirurgia bariátrica, ainda sem reverter a totalidade das anormalidades androgênicas, revelou-se um método útil e vantajoso a longo prazo sob este prisma / Obesity is associated with an altered reproductive hormonal profile that can affect both sexes. The weight loss caused by bariatric surgery normalizes male hormone levels in the short term. However, the outcome of the levels of these hormones in the long term, and whether they are related to an improved sexual quality of life has not been evaluated. Objective: Evaluate the outcome of sex hormones and sexual quality of life of male subjects who underwent bariatric surgery for morbid obesity over a long follow-up period (> 5 years). Material and Methods: This was a prospective, observational study. Male patients (N=52) were consecutively recruited and three groups were considered: I) Bariatric subjects who underwent Roux-en-Y gastric bypass (RYGB) >5 years earlier (n=23) at the Division of Digestive Surgery, Department of Gastroenterology at the Faculty of Medicine, São Paulo University; II) Overweight and obese non-operated controls (n= 14) (IMC 30 kg/m2) recruited from the outpatient clinic of the same institution; III) Non-obese controls (n= 15) (IMC < 30 kg/m2) recruited from a urological outpatient clinic. Clinical, hormonal and biochemical parameters were evaluated, including retrospective information collected from hospital files. Variables analyzed were anthropometric parameters (body mass index (BMI), waist circumference, testicular volume, gynecomastia and blood pressure), inflammatory markers (C- reactive protein, fibrinogen), total testosterone (TT), free testosterone (FT), sex hormone binding globulin (SHBG), follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S), estradiol (E2), prolactin, thyroid-stimulating hormone (TSH), thyroxine (T4) and leptin, along with two validated questionnaires (International Index of Erectile Function (IIEF) and the Aging Males` Symptoms (AMS). The protocol was applied between August 2010 and January 2011. Results: Mean age (sd) of the subjects was 47.6 ± 12.6, 53.1 ± 8.7 and 51.4 ± 9.8, respectively, BMI of the operated patients decreased from 59.8 ± 12.1 kg/m2 to 35.1 ± 7.7 kg/m2 (P<0.001), and mean percentage weight loss was 71%. In the three groups, respectively, the following hormones showed significant differences in mean levels (mean ± sd): TT- 534.2 ± 231.4, 297.0 ± 110.3 and 494.7 ± 143.3 (P=0.001); FT- 349.4 ± 169.2, 243.3 ± 75 and 378.8 ± 147.6 (P=0.03); SHBG - 48.8 ± 23.8, 23.5 ± 8.3 and 32.8 ± 15.7 (P=0.001); insulin - 7.9 ± 6.5, 17.1 ± 6.9 and 5.7 ± 2.6 (P<.001). In the operated group, TT correlated negatively with BMI (P<0.02), waist circumference (P=0.009), insulin levels (P=0.004), leptin (P=0.001) and glucose (P=0.002). SHBG correlated negatively with IMC (P=0.002), waist circumference (P=0.003), triglycerides (P=0.02), and leptine (P=0.01). TL correlated negatively with age (P=0.003), glucose (P=0.01) and insulin (P=0.03). Liver function tests (LFT) TGO/ALT, TGP/AST and gamma-glutamyltransferase (GGT) showed statistically significant differences among the groups, as well as HDL and LDL cholesterol, CRP, leucocytes and fibrinogen (P<0.05). The operated group scored higher in the IIEF questionnaire than the obese controls (56.7 ± 14.5, 49.1 ± 11.9 e 61.7 ± 7.5), but no significant differences among the three groups were found. Significant improvements in the IIEF domains erectile function (P=0.01) and overall sexual satisfaction (p=0.04) were found, but only between the obese controls and non-obese individuals. In the AMS questionnaire, operated patients and non-obese individuals showed the same pattern of responses, but no significant differences between these groups could be found (31.0 ± 9.4, 37.4 ± 15.1 e 31.0 ± 8.8). Conclusion: Despite almost ¾ of patients that were submitted to bariatric surgery 6- 16 years earlier were still categorized in the obese category, these individuals have shown a healthier sex hormone profile than obese control individuals and, in some aspects, they behaved like non-obese individuals. Bariatric surgery proved to be a reliable method to improve both male androgens and sexual quality of life in the longterm, even when a complete resolution of the hormonal imbalance has not been achieved

L’étude de la sexualité dans le contexte des maladies neurologiques est un domaine émergent qui nous permet de mieux comprendre les corrélats cérébraux et neurocomportementaux de divers aspects de la sexualité. Les changements au sujet de la sexualité sont fréquents à la suite de troubles neurologiques tels que les blessures de la moelle épinière, la sclérose en plaques, l’accident vasculaire cérébral, l'épilepsie et les traumatismes craniocérébraux (TCC). Compte tenu de la complexité de la sexualité après un TCC, celle-ci doit être analysée à partir d'une perspective biopsychosociale qui comprend trois facteurs interdépendants : a) les facteurs neuropsychologiques et psychologiques, b) les variables médicales et physiques, et c) les facteurs relationnels. L’objectif de cette thèse était d’étudier certains éléments de la sexualité auprès de personnes ayant subi un TCC afin de fournir des preuves empiriques pour contribuer à la validation d’une perspective biopsychosociale de la sexualité après un TCC. Trois études quantitatives originales ont été effectuées auprès de personnes ayant subi un TCC léger, modéré ou grave et ayant reçu des services de réadaptation post-TCC, et d’un groupe de témoins en bonne santé, tous vivant dans la communauté. Les groupes étaient comparables en ce qui concerne l’âge, le sexe, le nombre d’années de scolarité, le statut d’emploi et relationnel, et le revenu annuel. Les variables ciblant la sexualité, incluses dans cette thèse, étaient la qualité de vie sexuelle, le comportement sexuel à risque, et la sociosexualité (p. ex., les différences individuelles en ce qui concerne la volonté d’une personne à avoir des relations sexuelles sans engagement). Les variables neuropsychologiques et psychologiques incluaient les fonctions exécutives, la dépression et l’anxiété. Les aspects médicaux et physiques englobaient les symptômes postcommotionnels. Les facteurs relationnels comprenaient les attitudes envers l'infidélité. Les résultats démontrent que par rapport aux témoins en santé, les individus avec un TCC ont montré une diminution de la qualité de vie sexuelle, alors que les groupes étaient comparables sur le plan du comportement sexuel à risque, de la sociosexualité et des attitudes envers l'infidélité. Par ailleurs, les résultats ont montré une différence entre les hommes et les femmes sur le plan de la sociosexualité (p. ex., plus restrictive chez la femme). Chez les personnes ayant subi un TCC, une faible qualité de vie sexuelle était significativement associée à un nombre élevé de symptômes postcommotionnels, un comportement sexuel plus à risque corrélait avec une plus grande fréquence de symptômes dysexécutifs, et une plus faible acceptation de l'infidélité était liée à une sociosexualité moins restrictive. Les résultats de ces trois études soutiennent une perspective biopsychosociale de la sexualité après le TCC. Elles apportent des connaissances nouvelles en ce qui a trait aux domaines de la sexualité qui peuvent être touchés après un TCC, ainsi qu’à certaines variables neuropsychologiques et psychologiques, médicales et physiques, et relationnelles qui sont associées à ces changements. Les implications théoriques, ainsi que pour la pratique clinique et la réadaptation sont discutées. Les limitations des études sont présentées et des recommandations pour la recherche sont proposées. Le modèle biopsychosocial peut être utilisé comme une référence pour guider la recherche future dans ce domaine. D’autres études sur la sexualité et le développement d'interventions multidisciplinaires dans ce domaine pour les personnes TCC sont nécessaires. / The study of sexuality in the context of neurological disorders is an emerging area leading us to better understand the brain and neurobehavioral correlates of various aspects of sexuality. Changes in sexuality are common following neurological disorders, such as spinal cord injury, multiple sclerosis, stroke, epilepsy, and traumatic brain injury (TBI). Given the complexity of sexuality after TBI, it needs to be analyzed from a biopsychosocial perspective that includes three interrelated factors: a) neuropsychological and psychological factors, b) medical and physical variables, and c) relationship factors. The objective of this thesis was to study certain aspects of sexuality in individuals with TBI to provide empirical evidence to contribute to the validation of a biopsychosocial perspective of sexuality after TBI. Three original quantitative studies were conducted in individuals with mild, moderate, and severe TBI who received post-TBI rehabilitation services and in a group of healthy controls living in the community. The groups were comparable in age, sex, years of education, work and relationship status, and annual income. The variables targeting sexuality included in this thesis were sexual quality of life, risky sexual behavior, and sociosexuality (e.g., individual differences regarding the willingness to engage in uncommitted sexual relationships). Neuropsychological and psychological variables included executive function, depression and anxiety. Medical and physical aspects encompassed postconcussion symptoms. Relationship factors involved attitudes toward infidelity. The results demonstrate that compared to healthy controls, individuals with TBI showed lower sexual quality of life, while the groups were comparable in risky sexual behavior, sociosexuality, and attitudes toward infidelity. Furthermore, the results showed differences between men and women regarding sociosexuality (e.g., more restrictive in women). In individuals with TBI, lower sexual quality of life was significantly associated with the presence of post concussion symptoms; an increase in risky sexual behavior correlated with greater frequency of dysexecutive symptoms, and lower acceptance of infidelity was linked to a less restricted sociosexuality. The results of these three studies support a biopsychosocial perspective of sexuality following TBI. They provide new knowledge in the areas of sexuality that may be affected after a TBI, as well as some neuropsychological and psychological, medical and physical, and relational variables associated with these changes. The theoretical implications, as well as those related to clinical practice and rehabilitation are discussed. The limitations of the studies are presented and recommendations for research are proposed. The biopsychosocial model can be used as a reference to guide future research in this area. Other studies about sexuality and the development of multidisciplinary interventions in this area for individuals with TBI are warranted.