Sexual problems are quite common after brain injury

Sexual Problems after brain injury

Sexual problems are quite common after brain injury. The most common problem is
a loss of interest in sex. This may be due to the direct effect of the injury on areas of
the brain involved in sexual function or medication used in its management. More
often it is due to a loss of confidence. A third possibility is that the problem stems
from a change in the relationship, which in itself may arise from personality changes
following brain injury. A brain injury not only affects the person directly concerned
but also all those close to them. The stresses and strains produced can be bad for
relationships in many different ways.

It is actually quite rare for the brain injury to have a direct physical effect on sexual
function. It is often possible to distinguish between ‘organic’ and emotional or
psychological causes for sexual problems. Organic in this context means due to
damage to your body. Apparently “physical” problems such as the inability to gain an
erection can be caused by organic damage or emotional or psychological problems
or a combination of both. The brain has a direct influence on sexual function and
certain parts in particular are responsible for aspects of sexual behaviour. It is
important to consult your doctor as there are a number of tests available to detect
physical damage. Many of the drugs commonly prescribed after brain injury can have
the side effect of preventing erections in men and effective vaginal lubrication in
women. In general it is estimated that 25% of all erectile difficulties, for example, are
caused by prescribed medication.

Prescribed Drugs which can affect sexual function

These include anti-epiletic drugs such as carbamazepine (Tegretol) or sodium
valproate (Epilim). Anti-depressants can have the effect of making erections difficult
as can major and minor tranquillisers. Anti-cholinergic drugs such as procyclidine,
often prescribed in association with major tranquillisers to prevent side effects, also
affect sexual function. Medication for high blood pressure (commonly prescribed
following cerebral haemorrhage) can have this effect.

For men, one way of telling whether the problem has a neurological or organic basis
is this: if you still have nocturnal or early morning erections and you are still able to
obtain a response to self stimulation the chances are that the problem is caused by a
loss of confidence, especially if all the investigations are normal.

A problem caused by loss of confidence is good news in one sense in that it is
always possible to overcome a lack of confidence. On the other hand it is not always
easy to do this without assistance and may require specialist help. If a problem is
caused directly by damage to the brain or the nervous system there may be a
medical solution but this is not always the case. Even so, it is usually possible for the
person to lead a sexually active and fulfilling life.

Personal relationships

Problems may develop in more general aspects of a personal relationship after a
brain injury. Perhaps the most common concern is the fact that the injured person
may fail to express their feelings of affection or may do this in a clumsy and non-
reassuring way. The injured person may become irritable and frustrated. They may
become depressed. They may lose their motivation, not just for sex but more
The Brain Injury Rehabilitation Trust (BIRT) is a division of The Disabilities Trust, Registered Charity No 800797

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generally. They may find it hard to express their feelings and they may forget to
reassure their partners that they still care for them. They may feel suspicious of their
partner. They may doubt their own attractiveness as a result of the injury and fear
their partner will no longer find them attractive or will be attracted by others. Such
fears are usually ‘better out than in’ although frequent expressions of these doubts
and fears can be wearing for the partner. From the partner’s point of view the person
with the brain injury often seems to have changed a great deal. They may seem to
be grumpy, uncaring and difficult. The partner has also been through a hugely
distressing experience – the initial sudden shock of the accident or illness, the
extreme anxiety of the early hours, days or even weeks in the hospital when they
may not have been sure the person was going to survive (Some will have been
involved in the same accident and suffered their own injuries, perhaps even a head
injury.) This may have been followed by a period of sitting at the bedside of an
unresponsive or confused loved one. Then, after all this, the person comes home
and can seem like a stranger because of some of the changes that brain injury can
produce.
So far we have assumed that the person with a brain injury is in an ongoing sexual
relationship. Where this is not the case the post-injury problem is frequently at the
level of dating and developing such a relationship. This can be extremely difficult
after a brain injury, especially when the person has lost some of their social skills.


Ways in which physical problems can affect your sex life:

Physical problems such as high muscle tone, poor balance, poor control of fine
movement and tremor (ataxia) all make sexual activity more difficult. Poor control
over swallowing and consequent drooling has an obvious impact. Loss of sensation
or feeling in area of the body may affect sexual enjoyment as can becoming over-
sensitive in areas of the body. The loss of the sense of taste and smell, which are
particularly common following traumatic brain injury, may affect sexual arousal and
satisfaction.

Ways in which communication problems can affect your sex life:

Brain injury can lead to speech and communication problems in a number of ways.
Injury may result in dysphasia (difficulty expressing one’s thoughts in words) which
can make it difficult to develop a relationship or express love and affection.
Dysarthria (difficulty articulating speech) can make you sound strange or
permanently drunk. Some people have communication difficulties such as poor turn-
taking in conversation or sensitivity to others’ needs and these may hinder one’s
ability to form or sustain relationships. All of these make getting on with people in
general more difficult but have a particularly strong impact on sexual relationships.


Ways in which cognitive problems can affect your sex life:

Cognitive impairment in general can have profound effects on one’s sexual
relationships. These include poor concentration and being easily distracted,
memory deficits (for example some people forget they have only just had sex and
may pester their partner for more). Or you may forget significant occasions you have
shared with your partner – perhaps even getting married! For others the main
The Brain Injury Rehabilitation Trust (BIRT) is a division of The Disabilities Trust, Registered Charity No 800797

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problem may be initiating activity including sexual activity. Or you may have difficulty
in general in forming and maintaining relationships.

Sometimes partners feel that the person with the brain injury has changed as a
person since their injury. This can be very difficult for them as it may feel “like living
with a stranger”. But of course it is also extremely upsetting for the person with the
injury as one may feel there is nothing one can do about this. It is probably just
important to accept how one’s partner feels as a result of all the stress thay have
been under and give them time to see that whatever changes may have taken place,
you are still there inside your body.

Other ways in which brain injury can affect your sex life:

It is not uncommon for people recovering from traumatic brain injury to become
suspicious or even paranoid (a particularly strong and unshakable feeling of
suspicion). Sometimes these suspicions may have a sexual content or focus.

After a brain injury it can be very difficult to motivate oneself to maintain one’s
previous standards of personal care. For example, this may mean one takes a
shower or bath less frequently or forgets to clean one’s teeth. More subtle effects
can be losing the ability to monitor one’s appearance or make judgments about dress
sense and colour co-ordination.

More general difficulties in motivation may occur following brain injury. These may
take the form of general drowsiness or tiredness. Or one may have problems in
forming intentions or plans or in initiating and implementing these. Lack of
confidence, anxiety and depression may also reduce motivation.


What is known as disinhibited behaviour may occur. This means the person may
become less diplomatic or may inadvertently offend people by saying or doing
something inappropriate. For example a young man may express his interest in a
young woman he has only just met in a very clear and even openly sexual manner.
This of course, may put off potential or current partners.

Summary
In the immediate aftermath of a traumatic brain injury sexuality is not high on the
agenda. Survival through the acute stages is far more important but, with gradual
recovery, the emergence of a possibly changed personality brings with it possible
changes in sexual desire, performance and expressions of sexual behaviour.
Sexuality is usually an important part of an individual’s previous personality and a
sympathetic understanding of problems encountered is a vital part of rehabilitation of
the whole person. If in doubt, ask. Your rehabilitation specialist will be able to advise,
or arrange further assistance


Michael Oddy and Ian Fussey


Further reading:

Sexuality and the Person with Traumatic Brain Injury: A Guide for Families:
The Brain Injury Rehabilitation Trust (BIRT) is a division of The Disabilities Trust, Registered Charity No 800797

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Ernest R., MD Griffith, Sally, MSW ACSW Lemberg
F.A. Davis
Hardcover - March 31, 1993


Personal and Sexual Relationships following Brain Injury
Anthony Coughlan, Margaret Morgan
Headway
Paperback - November 2002

Useful addresses:

Outsiders Club, BCM Box, Outsiders, London, WC1N3XX, Telephone 020 7354 8291
This organization provides a telephone helpline/ info service and help meeting new
people.
The web address is: WWW.OUTSIDERS.ORG.UK.

The Brain Injury Rehabilitation Trust (BIRT) is a division of The Disabilities Trust, Registered Charity No 800797

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