Sexuality after Traumatic Brain Injury

Changes in sexual functioning are common after TBI. If you are experiencing sexual problems, there are things you can do to help resolve these problems. The information below describes common sexual problems after TBI and ways to improve sexual functioning. How does a traumatic brain injury affect sexual functioning? The following changes in sexual functioning can happen after TBI:

ƒƒ Decreased Desire: Many people may have less desire or interest in sex.

ƒƒ Increased Desire: Some people have increased interest in sex after TBI and may want to have sex more often than usual. Others may have difficulty controlling their sexual behavior. They may make sexual advances in inap- propriate situations or make inappropriate sexual comments.

ƒƒ Decreased Arousal: Many people have difficulty becoming sexually aroused. This means that they may be interested in sex, but their bodies do not respond. Men may have difficulty getting or keeping an . Women may have decreased vaginal lubrication (moisture in the vagina).

ƒƒ Difficulty or Inability to Reach /Climax: Both men and women may have difficulty reaching orgasm or climax. They may not feel physically This publication was produced by the TBI Model satisfied after sexual activity. Systems in collaboration with the Model Systems ƒƒ Reproductive Changes: Women may experience irregular menstrual cycles Knowledge Translation or periods. Sometimes, periods may not occur for weeks or months after Center (http://msktc. washington.edu) with injury. They may also have trouble getting pregnant. Men may have de- funding from the National creased sperm production and may have difficulty getting a woman preg- Institute on Disability and nant. Rehabilitation Research in the U.S. Department of Education, grant no. What causes changes in sexual functioning after TBI? H133A060070. There are many reasons sexual problems happen after TBI. Some are direct- ly related to damage to the brain. Others are related to physical problems or changes in thinking or relationships. Follow us! Possible causes of changes in sexual functioning after TBI include: ƒƒ Damage to the Brain: Changes in sexual functioning may be caused by dam- Visit age to the parts of the brain that control sexual functioning. http://tbimodelsystems.org/social to sign up. ƒƒ Hormonal Changes: Damage to the brain can affect the production of hor- mones, like testosterone, progesterone, and estrogen. These changes in Traumatic Brain Injury Model System Consumer Information hormones affect sexual functioning.

Copyright © 2011 Model Systems Knowledge Translation Center (MSKTC). ƒƒ Medication Side Effects: Many medications com- ƒƒ Get a comprehensive medical exam. This monly used after TBI have negative side effects should include blood work and maybe a urine on sexual functioning. screen. Make sure you discuss with your provider any role your medications may play. ƒƒ Fatigue/Tiredness: Many people with TBI tire Women should get a gynecology exam and very easily. Feeling tired, physically or mentally, men may need a exam. Ask your doc- can affect your interest in sex and your sexual tor to check your hormone levels. activity. ƒƒ Consider or counseling to help ƒƒ Problems with Movement: Spasticity (tightness with emotional issues that can affect sexual of muscles), physical pain, weakness, slowed or functioning. uncoordinated movements, and balance prob- ƒƒ Adjusting to life after a TBI often puts stress lems may make it difficult to have sex. on your . If you and your ƒƒ Self-Esteem Problems: Some people feel less partner are having problems with your rela- confident about their attractiveness after TBI. tionship, consider marital or couples therapy. This can affect their comfort with sexual activ- ƒƒ Consider starting . A sex therapist ity. is an expert who helps people to overcome sexual problems and improve sexual function- ƒƒ Changes in Thinking Abilities: Difficulty with ing. You can search for a certified sex therapist attention, memory, communication, planning in your geographic area on the following web- ahead, reasoning, and imagining can also affect site: http://www.aasect.org/ sexual functioning. ƒƒ Talk with your partner and plan sexual activi- ƒƒ Emotional Changes: Individuals with TBI often ties during the time of day when you are less feel sad, nervous, or irritable. These feelings tired. may have a negative effect on their sexual func- tioning, especially their desire for sex ƒƒ When having sex, position yourself so that you can move without being in pain or becoming ƒƒ Changes in Relationships and Social Activities: off balance. This may mean having sex in a dif- Some people lose relationships after TBI or ferent way or unfamiliar position. Discuss this may have trouble meeting new people. This with your partner. makes it difficult to find a sexual partner. ƒƒ Arrange things so that you will be less dis- What can be done to improve sexual tracted during sex. For example, be in a quiet environment without background noise, such functioning after TBI? as television. ƒƒ Talk with your doctor, nurse practitioner, or ƒƒ If you have trouble becoming sexually aroused, other health or rehabilitation professional it may help to watch movies or read books/ about the problem, so they can help you find magazines with erotic images and other sexual solutions. Some people may feel embarrassed content. talking openly about sexual issues. It may help ƒƒ There are sexual aids developed to help to keep in mind that sexuality is a normal people with disability. A good website for these part of human functioning, and problems with aids is: www.Mypleasure.com/education/disabil- sexuality can be addressed just like any other ity/index.asp medical problem. If you are not comfortable discussing sexual problems with your doctor, it ƒƒ Increasing your social network can increase is important to find a health professional who the opportunity to form intimate relationships.

Traumatic Brain Injury Model System Consumeryou Information do feel comfortable talking with. You may consider joining a club or becoming involved in other social organizations.

Sexuality after Traumatic Brain Injury Page 2 of 3 Importance of Brain Trauma and Sexuality by Stanly Ducharme. http://www.stanleyducharme.com/resources/ After a TBI, it is just as important for you to pro- combin_injury.htm tect yourself from unplanned and from sexually transmitted disease as it was before your Traumatic Brain Injury and Sexual Issues by Bet- injury. Even if a woman’s period has not returned, ter Health Channel. http://www.betterhealth.vic. she can still get pregnant. Here are some tips gov.au/bhcv2/bhcarticles.nsf/pages/Traumatic_ to help with and protection from brain_injury_and_sexual_issues sexually transmitted disease. Disclaimer ƒƒ Do research to help figure out what method This information is not meant to replace the of birth control and protection from sexually advice from a medical professional. You should transmitted disease are best for you. The fol- consult your health care provider regarding spe- lowing website has some helpful information: cific medical concerns or treatment. http://www.plannedparenthood.org Source ƒƒ Because of changes in thinking abilities, it may be harder for you to remember to use protec- Our content is based on research evidence tion or to remember to take it with you. whenever available and represents the consensus of expert opinion of the investigators on the TBI ƒƒ You can plan ahead by always carrying a Model Systems Directors. or other method of protecting yourself and your partner. Authorship ƒƒ For women who use birth control pills, or Sexuality after Traumatic Brain Injury was devel- a device that must be replaced, using a cal- oped by Angelle M. Sander, Ph.D. and Kacey Maes- endar or alarm on a smart phone can help tas, Ph.D., in collaboration with the investigators you remember to take the pills or change of the TBI Model Systems Collaborative Project the device. on Sexuality after TBI, and the Model Systems ƒƒ If you are unsure whether your partner has Knowledge Translation Center. Portions of this a sexually transmitted disease or has been document were adapted from Sexual Functioning intimate with others who have such disease, it and Satisfaction After Traumatic Brain Injury: An is safest to use a condom. Educational Manual (authors: Sander AM, Moess- ner AN, Kendall KS, Pappadis MR, Hammond FM, ƒƒ If you have engaged in any risky sexual behav- Cyborski CM). ior, one of the best things you can do for your- self is to get tested for sexually transmitted diseases – and get treated if you test positive.

Resources for further information Sexuality Is A Family Matter by Carolyn Rocchio in Family News And Views: A Monthly Publica- tion of the Brain Injury Association, 1993. http:// www.bianj.org/Websites/bianj/Images/Sexual- ity%20is%20a%20family%20matter.pdf Following Injury: Time for Enlightenment and Understanding: Suggestions

Traumatic Brain Injury Modelby System ConsumerCenter Information for Neuro Skills. http://www.neu- roskills.com/tbi/sex-suggestion.shtml

Sexuality after Traumatic Brain Injury Page 3 of 3