Traumatic Brain Injury and Sexual Issues:

Acquired brain injury (ABI) refers to any type of brain damage that occurs after birth. Causes can include damage resulting from infection, disease, lack of oxygen or a blow to the head. Traumatic brain injury (TBI) is one type of ABI. It is usually caused by a direct injury to the head - for example, in a car accident. Traumatic brain injury can cause changes in thinking, behaviour and body function, depending on which brain areas were affected and to what degree. Generally, the more severe the injury, the more significant the symptoms and loss of function will be.

Brain injury can alter the way a person experiences and expresses their sexuality. Common problems can include reduced sex drive, difficulties with sexual functioning (such as impotence) and behaving sexually at inappropriate times. Talking about sex can be embarrassing, but it is important for the person with brain injury and their loved ones to discuss the various issues. Seek professional advice. If your specialists don’t discuss sexual issues after brain injury, ask - everyone is entitled to express their sexuality.

Common changes to sexual behaviour
Some common changes in sexual behaviour after a traumatic head injury include:

• Reduced libido - about half of people with traumatic head injury experience a drop in sex drive. The remainder experience increased libido, or no change at all.
• Erectile problems - between 40 and 60 per cent of men have either temporary or permanent impotence following their injury.
• Inability to orgasm - up to 40 per cent of men and women report difficulties having an orgasm.
• Reduced frequency of sex - some of the possible reasons include disability, depression, relationship breakup and sexual problems.

• Emotions - depression, anxiety and stress reduce sex drive.
• Drugs - certain medications can dampen libido.
• Associated injuries - if, for example, the person sustained brain injury in an accident, they may have other injuries that directly affect their sexual functioning (such as a spinal cord injury).
• Relationship breakdown - a couple experiencing problems are less likely to have sex.
• Prior sexual difficulties - brain injury can exacerbate any sexual problems the person was having before the injury occurred.
• Reduced confidence - the person may feel less confident or attractive after the brain injury, which makes them less likely to feel sexual.
• Other illnesses - such as diabetes or hypertension (high blood pressure) can reduce libido.

• Talk about your expectations, fears and feelings. A couple can solve most relationship problems if they communicate frankly with each other.
• Take it easy, and try not to put too much pressure on yourselves.
• Focus on pleasure, rather than technique. You may need to adapt your prior style of lovemaking for a while. For example, if penis-in-vagina sex isn’t possible, experiment with other sexual activities including oral sex and mutual masturbation.
• Concentrate on boosting the romance in your relationship. Suggestions include remembering to appreciate and compliment each other, offering lots of affection (such as kissing and cuddling), and celebrating special occasions such as birthdays and Valentine’s Day.

• Seek treatment for depression, stress and anxiety, if necessary.
• If your reduced libido is due to medication, it may be possible to take different drugs under your doctor’s supervision.
• Treatment for erectile problems includes counselling and medication.
• Some people with brain injury forget about important sexual issues such as contraception, initiating sex or pleasuring their partner during sex. Counselling may be useful.
• Prior contraceptive methods may not be practical after brain injury - for example, a woman with memory problems may forget to take the pill every day. Seek advice on appropriate contraceptives.
• Use aids such as erotic videos and magazines to help arousal.

• Try to appear calm. If you appear shocked or distressed, it could make the person feel there is something wrong with their sexuality.
• Tell the person that their behaviour is inappropriate, and offer alternatives. For example, you could ask them to masturbate in their bedroom instead of the lounge room.
• You may need to remind the person many times to curb their inappropriate sexual behaviour, so be patient.
• Discuss the issue with the person’s therapists or other support staff. Family members and others closely involved with the person should also be consulted. Try to develop a consistent way of dealing with inappropriate behaviour.
• Talk about sexual issues with the person. Set firm boundaries on sexual behaviour. Help them to find appropriate and satisfying ways to express their sexuality.

• Your doctor
• Neurologist

• Brain injury can alter the way a person experiences and expresses their sexuality.
• Common problems can include reduced sex drive, difficulties with sexual functioning (such as erectile problems), and behaving sexually at inappropriate times.
• Talking about sex can be embarrassing, but it is important for the person with brain injury and their loved ones to discuss the various issues and seek professional advice.