Sexuality after Brain Injury

Sexuality, Sex and Rehabilitation after Brain Injury

By Carolyn Rocchio

Brain injury rehabilitation overlooks sexual impact of trauma

One of the common consequences of traumatic brain injury (TBI) is sexual dysfunction. Unfortunately addressing sexual issues as a component of rehabilitation is often overlooked for a variety of reasons.

“Sexuality is an integral part of the human experience” (Sander). We are all sexual beings and sexuality is part of our life experience. Social mores and cultural differences make sexuality a taboo issue in some societies. Many therapists and other direct care providers in hospital and rehabilitation settings are untrained about sexuality and persons with disabilities. Their personal values often interfere with their ability or comfort level discussing the topic. When sexuality is overlooked as part of rehabilitation, sexual dysfunction can become an issue that is very difficult for families to understand.  Social isolation, common for persons after TBI, limits opportunities for developing meaningful relationships.

Decreased dollars for rehabilitation services add to the problem.  With shorter number of days for care in rehabilitation programs to address the life altering effects of brain injury, such as mobility and cognitive impairments, there may be little time to discuss sexuality. Reimbursement for extended psychological and counseling has been all but eliminated from many insurance policies.

Hyposexuality and hypersexuality after brain injury

Sexual dysfunction after a brain injury may take the form of hyposexuality, as in loss of libido and lack of satisfaction. Hypersexuality can be equally problematic, but far more troubling to manage in rehabilitation and community settings. Hypersexuality manifests as inappropriate behaviors, such as verbal remarks, touching one self or others, exposing genitals, and sexual demands that are considered aberrant. These issues appear equally between men and women.

Cognitive, physical and emotional changes affect sexual functioning

Injury to structures of the brain can result in varying degrees of dysfunction. Systemically a complex set of changes can occur affecting emotions, cognition, behavior, and mobility. Physical changes may alter the ability to enjoy satisfaction, particularly when there are residual physical changes such as:

  • spasticity
  • hemiparesis
  • ataxia
  • movement disorders
  • decreased balance

Body positioning, balance, and arousal may require greater patience and guidance from partners. In addition, damage to the frontal or temporal lobes of the brain can affect the endocrine system and neurochemistry, resulting in such emotional responses as apathy, disinhibited behaviors, impulsivity, as well as physical changes in hormone levels.

Even more disabling are the cognitive changes. The frontal and temporal lobes of the brain regulate sexual functioning and are more frequently injured in car crashes and falls causing the brain to bounce around in the skull striking the bony protuberances on the inside of the skull. This often results in the following difficulties in maintaining or initiating satisfying sexual experiences:

  • decreased empathy for others
  • inability to understand nonverbal cues (feedback)
  • impaired social interaction with partners (inappropriate verbal/physical responses)
  • difficulty self monitoring (can become aggressive)

Emotional issues, such as depression, can have a negative effect on sexuality. Some persons with brain injury may exhibit a child-like dependency on their partner.  Self centeredness in the person after TBI may result in exclusion of the views of others.  Any of these can sabotage  relationships. Medications commonly prescribed to control seizures and other residual medical and psychological complications of TBI can create additional problems with sexual functioning.

Rehabilitation professionals do not routinely treat or even discuss sexuality with patients for some of the following reasons:

  • family members’ discomfort discussing the subject
  • therapists’ lack of training about sexuality
  • lack of reimbursement for services
  • level of cognitive recovery at time of individual’s discharge

How, when and what information on sex and sexuality should be addressed?

There is probably no perfect time that applies to all individuals due to the uniqueness of TBI, the person’s age and life situation, and the individual’s interest in resuming or initiating sexual activity. It is important that rehabilitation programs have printed materials for discussions with the patient, if appropriate during the inpatient stay.  They should also be included as part of a discharge plan to help guide discussion once the person is in the community and indicates interest and readiness for sexual activity.

These materials should include:

  • general discussion of the many ways brain injury or TBI can affect sexual functioning, i.e., emotionally, physically, cognitively, and psychologically
  • safe sex practices, HIV/AIDS, birth control, and sexually transmitted diseases
  • methods and devices for self stimulation in the absence of a partner
  • community resources should further treatment be required

With proper guidance, family and community support, most survivors of TBI will find ways to express themselves sexually in a responsible manner as part of the experience of their humanness.

References

Sander, AM. Integrating Sexuality into Traumatic Brain Injury Rehabilitation. Brain Injury/Professional. 7(1) 8-12, 2010

Recommended reading

This Fact Sheet is based on an article: Integrating Sexuality into Traumatic Brain Injury Rehabilitation. Brain Injury/Professional. 7(1) 8-12, 2010. Brain Injury/Professional is the largest professional circulation publication on the subject of brain injury and is the official publication of the North American Brain Injury Society (NABIS). Members of NABIS receive a subscription as a benefit of NABIS. Visit www.nabis.org to order the entire issue or join.

 

 

 

 

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10 responses to “Sexuality after Brain Injury”

  1. Michael St.pierre says:

    I suffered hemmoraghic strokes on an AVM in
    My thalamus. They were at ages 12, 14, 16,
    19, 24 and 31. After my last bleed my wife and
    I rarely have sex but I am obsessed with porn.
    I have even frequented strip clubs having sex
    With multiple dancers in an evening.

  2. Dear Sarah,
    Changes in sexuality and your responsiveness after a brain injury can be disturbing and puzzling but they are not uncommon. I encourage you to talk with your physician to determine if there have been any hormonal changes since your injury.

  3. Sarah says:

    Hi. I suffered from a rather severe concussion in January of 2012 witch the severe balance issues caused a second bad concussion in early February of 2012. I am now working again and doing my level best to get my life back. Most things are going well but my sex life. My body can and does experiences orgasms, but I do not feel them. It does not mater what I do or my Partner does. I feel the movements of “what is happening” but not the pleasure of any of it. But I and my Partner are both of an agreement that my body is experiencing orgasms, I just do not feel them. I just do not know what to do.

  4. Dear Stuart,
    I regret that I do not have any information on the medication recommended but I encourage you to continue discussing it with your neurologist.
    Marilyn Lash

  5. Stuart Phelps says:

    Its been almost six years since my TBI. My medical chart labeled it a Severe Traumatic Brain Injury.

    My wife and I were on a “full dress touring” Harley Davidson motorcycle. In the midst of making a right hand turn we were struck from behind by another person on a motorcycle. I understand that I was thrown forward and landed on my forehead.

    A little over a year after the accident I suffered a seizure. Found a Neurologist that takes TBI patients. Following an EEG, I was told that about a third of my brain is just scar tissue and there are five areas electrically active for seizures.

    Three months after the accident my wife and I took a short trip over Labor Day. We were able to have gratifying sex several times that weekend.

    Since then, it has become increasingly difficult. By that I mean that it is not difficult for me to become erect, and stay erect, but it is very infrequent that I am able to achieve orgasm. My wife does not have a problem reaching orgasm.

    I take Oxcarbapazine as an seizure preventative medication. I take Venlafaxine as an anti-depressant.

    I have discussed this with my Neurologist. He sent me a note that I might look into Amantadine as a medication to ease my sexual dysfunction. But I can’t really find anything on the web to let me learn about this medication.

    Thoughts?

    Stuart

  6. The loss of intimacy and a sexual relationship is a huge loss in a marriage. So many partners feel unworthy and unloved as a result, but this loss is just as much a consequence of the brain injury as the loss of mobility or speech but often not recognized by family, friends or clinicians. I know that doesn’t make it any easier but you are not alone.

  7. LB says:

    As a spouse of a brain-injured person who has less interest in sex than a child does… I keep looking for information on how to deal with this loss. If he believes it’s a problem (and I’m not sure he actually believes that or cares), he can’t sustain interest in fixing the problem for long enough to take any steps toward a solution. So tips don’t help. And it’s gone on so many years, I no longer have sexual interest in him. I had to kill that off to deal with the rejection, I think, and I don’t expect it to come back (even though he’s in a good treatment program right now).

    If he could take care of himself, I could divorce him and find someone to love me. But he can’t, and I can’t abandon him just because he’s disabled now. I try one day at a time, but then I’m destroyed over and over by some reminder of what I’ll never have again. Someone touching my face, someone looking at me with love, someone wanting to be close to me. I am only in my early 30s, and I am dying in a way I can’t just grieve and move on from. No one can tell me what to do, it seems, and I guess I’ll hit “submit comment” just in case someone going through this needs to know they’re not the only one.

  8. Thank you for sharing well written article and references. Myself, its been over 2 decades since a gunshot to my head/neck and subsequant hemiparesis. It took a long while , years for interest with the limited movement, spatisity, ‘shaking’. You really need a caring partner. I think that others can be helped by findings in neuroplasticity and ability to retrain the brain. Sure injuries, nerve damage , dragging a foot , etc may still be there but with simple and developing mind brain training, frontal lobes and brain functioning can be improved. Years later, I still drag my foot, slur words at times when I’m tired , etc, but I;m working as an engineer with good mental focus again and a pretty good memory and sexual relationship,healthy. Certainly not the same as when I could use both sides well, balance is difficult, awkward movement at time. I would encourage all with similar head injuries to start some sort of brain training even simple brain games, at whatever level. Improvement is not guaranteed but noone wants to get worse in any way.
    Take Care
    Leon

  9. Mrs Longhurst says:

    I have tears streaming down my face. It has been 14 months since a truck did a U-turn into us as we were travelling at 110kmph. I feel nothing. I have processing deficits, am happy enough in myself-have a husband who has adored and proteted and supported and cherished me and I feel nothing. At first I thought it was an aberration,then -give it time… Now I don’t feel a thing. Our closeness after 25 years has changed.I just want to be left alone. We have tried….. I can’t do it at the moment-but at the same time resent him….. There are moments when I just want to let him go ….So that he can have a life.I don’t know what to do…..

  10. Carolyn,
    Thank you for this informative article. This topic has not been addressed in any of my husbands treatment, and we find ourselves floudering out here alone. I appreciate the referrals for more information. I read your book, Ketchup on the Baseboard not long after Bill’s injury, and it gave me hope. Almost 5 years later, I am beginning to understand this is a long term commitment. Thank you again.

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