The aim of the current study was to compare sexuality in individuals with TBI with that in healthy controls matched for age and gender. In doing this, the current study aimed to characterize those individuals who reported a decrease in sexuality relative to those reporting an increase according to certain demographic and injury variables. Method: A total of 865 participants with predominantly moderate to severe TBI and 142 controls completed the Brain Injury Questionnaire of Sexuality (BIQS), the Hospital Anxiety and Depression Scale, and the Rosenberg Self-Esteem Scale on one occasion. Results: The results indicated that there was a significant difference between participants with TBI and controls on all the BIQS subscales as well as the total score. Age, depression, anxiety, and self-esteem levels significantly differentiated participants with TBI who reported decreased sexuality from those who reported increased sexuality. Participants with TBI attributed sexual changes to various causes - most commonly, fatigue, low confidence, pain, decreased mobility, and feeling unattractive. Conclusions: Further research examining the factors contributing to sexual changes is warranted.