o) Sexuality and ABI

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Sexuality After an Acquired Brain Injury

Brain injury can change the way a person experiences and expresses their sexuality and can in some cases cause distress to the injured individual and their partner. Changes in sexuality following a brain injury can range from physical difficulties such as perception and balance to sexual dysfunction. They may also be due to behavioural changes, including difficulties with communication and impulse control. The nature of the changes will depend on the part of the brain affected.
Following a brain injury there is no right time to resume sexual activity. It is important to take account of sexual history and undergo a physical examination before any aids or interventions are used.

What is sexuality?

Human sexuality can be defined as the expression of sexual sensation and related emotional intimacy between human beings. In the centre of the brain there is a structure known as the hypothalamus, which plays an important role in regulating sex drive by controlling the release of sex hormones.

Following an injury, this part of the brain can be damaged and result in sexual appetite and behaviour being affected. Research has discovered that at least half of people with a brain injury have experienced problems with sexuality and sexual behaviour.

Researchers have proposed three common areas of change to sexual behaviour following an injury: sexual dysfunction, altered libido and inappropriate sexual behaviour.

Sexual dysfunction

Sexual dysfunction can be classified as any problem or condition that does not allow for a satisfactory sex life. Examples of dysfunction include:

• Emotional - depression, anxiety or stress
• Physical injuries - injuries, such as a spinal cord injury, that may cause problems
• Relationship difficulties
• Low self-esteem or lack of confidence
• Erectile dysfunction
• Previous sexual problems

A change in libido

It is common following a traumatic brain injury to experience changes in libido. Many people experience depression following an injury which can result in a disinterest in sexual activity, leaving a partner feeling unsatisfied and unloved. Adults who are single can have difficulty finding and keeping partners following a brain injury, due to a lack of social skills or cognitive limitations.

On the other hand, sometimes the person with the brain injury can experience an increase in libido which can result in the development of inappropriate sexual behaviours or an increased urge to have sex.

Inappropriate sexual behaviour

Changes in adult sexuality can result in a heightened or decreased interest in sex. Examples of inappropriate behaviour include masturbating in public, lewd verbal responses, impulsiveness, touching others and fantasising.

Other changes resulting from brain trauma can include lack of motivation, apathy and aggressive behaviour which can isolate the individual and affect their partner. A number of people also lose the ability to socialise or can fail to recognise social cues and in turn exhibit inappropriate behaviour such as grabbing or using sexual language.

Sexual solutions

For couples, it is important to communicate openly and discuss your fears, feelings and expectations. This may be done under the guidance of a professional through counselling or psychotherapy.

The problems that need to be addressed generally fall into three areas: physical, cognitive or emotional and behavioural. The type of injury determines the problems that are experienced, but sometimes there can be a crossover of all three areas.

Physical difficulties

• Erectile dysfunction - this can be addressed through a number of options such as penile injections, surgical implants and in some cases medication.
• Weakness in parts of the body - a doctor may be able to suggest incorporating new techniques during sexual activities such as changing positions or massaging.
• Pain - medications may be useful before sexual activity.
• Lack of moisture - water-based lubricants and lubricated condoms

Cognitive/emotional solutions

Cognitive problems such as poor memory, high levels of frustration and short attention span can affect social interaction and sexual expression. A person with a brain injury may need professional help with increasing their own awareness of how their behaviour affects other people.

Aids to behavioural difficulties

Treatments for disruptive sexual behaviour include modification techniques such as training in dating, self-monitoring of sexual urges and massage therapy. Rehabilitation is essential in combating behavioural difficulties and aims to help both the injured person and their loved ones to become aware and respond appropriately to the needs of the affected person. Sexual counselling can help individuals to communicate needs and feelings about all sexual issues and make all parties involved aware of the difficulties.

For survivors of a brain injury with no sexual partner, attention needs to be paid to promoting self awareness. Rehabilitation can be important to teach individuals what behaviour is appropriate when interacting with people in activities such as dating.

Making use of a professional such as a medical doctor or psychologist is often the best way to address issues and concerns related to sexuality for the individual with the injury, their partner and family members.

For many people addressing issues relating to sex can be difficult and embarrassing. Professionals working in the area of brain injury are aware of this too, and should be sensitive and open to your situation. Do not let embarrassment stop you asking for the help you need.