Sexual functioning following Traumatic Brain Injury

Sexual functioning following Traumatic Brain Injury

TBI can change the way a person experiences and expresses their sexuality. Talking about sexual functioning with healthcare professionals and others can be embarrassing and uncomfortable, but it’s important to remember that sexuality is a normal part of life and that everyone is entitled to express their sexuality. Things can be done to help manage, treat, and resolve many of the changes in sexual functioning that can arise following TBI.

What are the ways that sexual functioning can change after TBI?

TBI can affect a person’s sexual functioning in a number of ways, including:

• Decreased desire. It is common for people to have less desire or interest in sex following TBI.
• Increased desire. For others, their interest in sex may be increased after TBI. For example, they may want to have sex more often or may have difficulty controlling their sexual behaviours (e.g., make inappropriate sexual comments or advances).
• Decreased arousal. Some people may still have an interest in sex following their TBI but may have trouble becoming sexually aroused. For example, men may have difficulty getting or keeping an erection while women may have decreased vaginal lubrication (moisture in the vagina).
• Difficulty or inability to reach orgasm/climax. Both men and women may experience difficulties reaching orgasm (climax) when engaging in sexual activities.
• Reduced frequency of sex. Some people find that don’t have sex as often as they did before their TBI.
• Reproductive changes. Following TBI, people may experience changes that may affect their ability to have a baby. For example, women may experience irregular menstrual cycles (periods). In some cases, periods may stop (amenorrhea) for weeks or months after injury. They may also have trouble getting pregnant. Men may have decreased sperm production and may have difficulty getting a woman pregnant.

What causes changes in sexual functioning after TBI?

There are many reasons why a person may experience sexual problems after their TBI. Some are directly related to damage that has occurred in the brain. Others are related to changes in physical and thinking abilities, and relationships.

Possible causes of changes in sexual functioning include:

• Damage to the brain. TBI may have resulted in damage to parts of the brain that control sexual functioning and arousal.
• Hormonal changes. Damage to the brain can affect the way our bodies produce hormones, including those that play an important role in sexual functioning (e.g. testosterone, oestrogen, and progesterone). For example, lower testosterone levels in men can cause problems in achieving and erection or ejaculating too soon. Low levels of oestrogen can lead to decreased genital sensitivity in women.
• Increased stress levels. After TBI, many people experience increased stress related to changes in their health, employment, financial, housing, or relationships. This can affect their desire to engage in sexual intimacy.
• Medication side effects. Many medications prescribed to people after TBI have negative side effects on sexual functioning.
• Fatigue/tiredness. Many people with TBI find that they tire easily. Feeling physically or mentally tired can affect your interest in sex and your sexual activity.
• Physical limitations. Problems with movement due to spasticity (tightness of muscles), physical pain, weakness, poor balance or coordination can make it difficult for people to have sex or engage in sexual activities.
• Self-esteem problems. TBI can affect the way that people feel about themselves. Some people may feel less confident in their attractiveness and/or nervous about their ability to have sex after their injury. These can affect their ability to enjoy and engage in sexual activities.
• Changes in thinking and communication abilities. Sexual functioning may also be affected by changes and difficulties with communication and thinking skills such as attention, memory, planning, reasoning, and imagining.
• Emotional changes. Feelings of sadness, nervousness and irritability are commonly experienced by people recovering from TBI. These can all have a negative effect on their sexual functioning, including their desire for sex.
• Changes in relationships and social life. Some people may lose relationships after TBI or have trouble meeting new people. This can make it difficult to find a sexual partner.

Who can I talk to for help?

Many people, including health professionals, may feel embarrassed or uncomfortable talking about concerns relating to sexual functioning. You may assume that your doctor will bring up the subject, but this doesn’t always happen. You may also think there is no point in talking about sexuality because you might not realise that there are things that can be done to help.

Sexuality is a normal part of being human, and problems with sexual functioning can often be addressed just like any other medical problem. Speaking to your GP is a good place to start. If you do not feel comfortable discussing this topic with your doctor, it is important to find a healthcare professional who you do feel comfortable speaking with.

Other healthcare professionals who may be able to help include:

• Physiotherapist
• Occupational Therapist
• Psychologist
• Sex therapist
• Couples (Marriage) therapist
• Medical specialists, such as rehabilitation specialist, endocrinologist, urologist (men), gynaecologist (women).

Learn more about these and other healthcare professionals here. 

Is there anything I can do to help with resuming sex after TBI?

In addition to talking to your doctor or healthcare professional/s and following their advice, there are a number of things that you can consider doing to help improve sexual functioning after a TBI. Some general suggestions include:

• Getting a comprehensive medical exam. Ask your doctor to check your hormone levels and whether any medications you are on may be affecting your sexual functioning. They may refer you to a medical specialist (i.e. endocrinologist, urologist (men) and gynaecologist (women)) if further investigation is needed.
• Talking to your partner and planning sexual activities around times when you are feeling less tired.
• When having sex, positing your self so that you can move without being in pain, losing your balance or feeling dizzy. This may mean having sex in a different way or unfamiliar position. Discuss this with your partner.
• There are sexual aids that have been designed for people with disability. Talk to your healthcare professional.
• Consider your environment. Remove things that might be distracting or pose a hazard while having sex. For example, having sex in a quiet environment free of any background noise (e.g. television, radio) may be helpful for people who find they are easily overwhelmed by light and sound after their TBI.
• Concentrating on other aspects of your relationship. Boosting the romance, remembering to appreciate and compliment each other, offering lots of affection (such as kissing or cuddling) and celebrating special occasions such as birthdays and anniversaries can all help bring couples closer together.
• Increase your social network by joining a club or other social organisations. This can help create new opportunities to meet new people and form intimate relationships.

Importance of safe sex

Practising safe sex to look after your health is important, even after a TBI. Safe sex helps to prevent unplanned pregnancies and offers protection against sexually transmitted diseases. A woman can still become pregnant, even if her period has not returned. Some tips to help with birth control and protection from sexually transmitted diseases include:

• Speak to your doctor to figure out what method of birth control and protection from sexually transmitted disease is best for you.
• Changes in thinking abilities may make it harder for you to remember to use protection or take it with you.

Strategies to help overcome this include:

• Always carrying a condom with you
• For women, using calendars, alarms or smartphone apps to remind you to take oral contraception (the pill) or change your device.
• Always using a condom if you are unsure whether your partner has a sexually transmitted disease or has been intimate with other others who have a sexually transmitted disease.
• Get tested for sexually transmitted diseases if you have engaged in risky sexual behaviours. Seek treatment if you test positive.

July 2023