Altered Sexual Orientation Following Dominant Hemisphere Stroke

Things that make you go, hmmmm….

Check out this story of “change.”

Case Report

The patient, a 57-year-old right-handed man, sustained his first cerebral vascular accident in the right middle cerebral artery region at the age of 45, which resulted in right-sided hemiparesis that resolved completely within 3 months. He continued to run his private business successfully while living with his mother.

The patient lost his father in early childhood. There was no evidence of an emotional or conduct disorder during school years, and the patient eventually obtained his university degree. He continued to manage his successful practice until he sustained the second cerebral vascular accident in the left middle cerebral artery region at age 53.

The patient became aware of his homosexual orientation in his early teens and had several gay partners. He suffered a major depressive episode at age 26 that resolved within a few months. He also had a diagnosis of excessive harmful use of alcohol, but there was no evidence of dependence.

The patient started complaining of his changed personality and heterosexual orientation 6 months after his second stroke. At the same time he complained of excessive mood swings and changed interests. He became preoccupied with photography and had a successful photographic exhibition a year after his second stroke. His sexual orientation remained heterosexual 4 years following the second stroke, and he preferred to describe himself as bisexual because of his previous homosexual orientation.

Discussion

The mechanism by which a person acquires his sexual orientation is complex and ranges from pure psychological theories to more complex biological concepts. Our patient was aware of his homosexual orientation beginning in his early teens. He always enjoyed his gay relationships and had had at some point a live-in partner. He grew up with an absent father and had a strong bond with his mother. He went back to live with his mother after separating from his partner 4 years before his first stroke. It is unlikely that his psychological reaction to his first and/or second stroke could explain his altered sexual orientation, and his sexuality was accepted by his social network and family members.

Taking into consideration the interval between his first and second stroke, it is likely that an organic process within the left middle cerebral artery region is the cause of his altered sexual orientation.

The sexual needs of patients suffering from a brain injury are centered on hyper- and hyposexuality rather than altered sexual orientation. The alteration of sexual orientation raises serious challenges to patients and their care. It may be essential to address the issue of sexual orientation in assessing patient needs following brain injury in addition to other possible behavioral changes that might be encountered.

This is one of those head-scratchers that make you wonder what role “the middle cerebral artery region” plays in sexuality. I have had no chance to look into this but wanted post it due to the nature of the report.

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What Are Your Thoughts?leave a comment
  • carole

    One comes across stories that neurosurgeons and follow-up physicians tell about sexual orientation shifts following brain traumas. In the literature, there are allusions to these occurrences, but since the shifts are not the main topic of the reports, the details are few.

    I posted on an old thread not long ago a link to a story about a woman who had a tumor in the amygdala, a portion of the brain often thought to be highly related to sexual drive and maybe to orientation. The tumor had her convinced she was a man.

    The middle cerebral artery region? Maybe it is a clue to an area that might be involved with attractions, but the man’s vascular problems seem to indicate a blood flow problem which can account for all kinds of things and can effect a lot of areas.

    I have a question: in the phrase “his first cerebral vascular accident” is the word accident used in the layman’s sense or is it a term that has a specific medical meaning? Does it mean the same as “occurrence” in other words? Or, did the patient experience brain trauma (the stroke) as a result of a literal “accident.”

    The reason I ask is that I am wondering if arterial occlusions, blood flow problems might have been with him for a long while before any such thing as stroke occurred.

  • David Blakeslee

    Please post Yarhouse’s

    AACC conference presentation on mixed orientation couples.

    Thanks,

    David

  • David Blakeslee

    We can all guess about neurosis, ambivalence and the effect of personality change (stroke induced) on these characteristics…

    But they are all guesses.

    Hope this man is happy, comfortable in his own skin…not abusing alcohol and in loving and supportive relationships.

  • Timothy Kincaid

    Fascinating.

    I can’t imagine the difficulty had he been in a relationship at the time. Who knows, though, it might have proven to be an example of “reverse spousosexuality” in which his attractions become OSA but his affections were with his spouse.

    I do hope he’s happy and healthy and it certainly sounds as though he has good supportive friends.

  • Michael Bussee

    Taking into consideration the interval between his first and second stroke, it is likely that an organic process within the left middle cerebral artery region is the cause of his altered sexual orientation.

    Hmmm… They concluded that it is likely that the cause was organic? Shouldn’t that be “it is possible” that it did? Are there other such cases of orientation change following stroke?

    Isn’t it possible that his reversed sexual orientation had nothing to do with his stroke? Could this be an example of the old “post hoc, ergo propter hoc” fallacy? Just wondering…

  • carole

    @Warren,

    You might be interested in these two links if for no other reason than the bibliographies.

    http://jnnp.bmj.com/cgi/content/full/78/10/1042

    http://www.medlit.info/guests/Abstracts/Head-inj.htm

  • Eddy

    Isn’t it possible that his reversed sexual orientation had nothing to do with his stroke? Could this be an example of the old “post hoc, ergo propter hoc” fallacy? Just wondering…

    This possiblility would also be exciting and newsworthy. A seemingly successful change from gay to straight without the intervention of the ex-gays, reparative therapists or other outside sources…there doesn’t even appear to be motivation…for whatever the reasons it occurred, this change is noteworthy.

  • Timothy Kincaid

    This possiblility would also be exciting and newsworthy. A seemingly successful change from gay to straight without the intervention of the ex-gays, reparative therapists or other outside sources…there doesn’t even appear to be motivation…for whatever the reasons it occurred, this change is noteworthy.

    True.

    We sometimes see women with established lesbian orientations find themselves attracted to a man (or men) but we seldom see this in men. So it would definitely be noteworthy, regardless of the reason.

    But because of this rarity, I am inclined to consider that the strokes may have played a role. Correlation is not causation, but when two unusual things occur simultaneously it’s worth consideration.

  • Eddy

    I’m inclined to agree with you on this one, Timothy. I couldn’t quite wrap my brain around Michael’s suggestion that the change from gay to straight had a fair chance of coming from something other than the surgery.

  • Michael Bussee

    Timothy, I didn’t mean to imply that this was not “possible, exciting, or newsworthy” — or to off-handedly dismiss the idea that the strokes MAY have played a role. But as you point out, correlation is not causation. Let’s look at other stroke patients to see if there is a pattern.

    I think it was a bit over-stated and pre-mature to conclude, from this one case, that is was “likely” that the strokes caused the changed in orientation. Possible? Perhaps. But ‘Likely”? Not enough evidence. More such cases would be needed to draw that conclusion.

    It’s still a “hmmm”, not an “ah-hah!”

  • http://www.projectethic.com James

    Possible cognitive explanation? Trauma of all kinds can cause a person to re-examine all kinds of behaviors. Case studies are so curious.

  • http://ardentmormon.blogspot.com -L-

    I find the description “right cerebral artery distribution” to be so imprecise as to be amusing. It’s like saying, “The governance of Buffalo, NY is somehow related to the geographic area of the Western Hemisphere.

    @ Carole: Cerebrovascular accident is basically an idiom for stroke, there’s not too much to read into the literal meaning of “accident” itself.

  • Fg68at
  • Richard Willmer

    My goodness, the Mail is getting racey these days!