Burns

Addressing Sexuality after a Burn Injury:

Watkins, Cook, May, and Ehleben (1988) developed a series of psychological stages that an individual experiences while recovering from burn injuries:

First stage: Survival anxiety (1-2 weeks)
Second stage: Pain perception (6-8 weeks)
Third stage: Search for meaning
Fourth stage: Investment in recuperation
Fifth stage: Acceptance of losses
Sixth stage: Involvement in rehabilitation
Seventh stage: Reintegration of identity

According to Pandya, Corkill, and Goutos (2015), sexuality may be most appropriate to discuss with burn patients who are in a stage where they are invested in their rehabilitation and motivated to engage in self-care tasks independently. If the patient has a partner, the occupational therapist should include them in the process and discussion if the patient is comfortable (Ahmad, Masoodi, Akhter, & Khurram, 2013).

Potential Problems:

Anxiety and posttraumatic stress disorder are common in people with burn injuries, both of which are related to an overactivity of the sympathetic nervous system (Pandya et al., 2015). This can interfere with an individual's ability to become aroused or orgasm.
Negative body image and rejection of sexual activities. May be embarassed to reveal body parts to partners.
Hormonal changes following burns can impact sexual arousal and function
Medications commonly prescribed to patients with burn injuries, including antihypertensives and psychotropic medications can impact sexual function.
Burns and skin grafts over genitalia can cause a multitude of sexual problems. These may include inability to engage in traditional sexual intercourse, increased friction between bodies during sex, and reluctance to engage in sexual activity due to body image concerns.
Following burns, patients may have areas with altered, increased, or decreased sensation, which can impact sexual functioning.
Clients may have decreased range of motion and pain (Wibbenmeyer, 2018)
Unhealing wounds or scars that have not healed (Ahmad et al., 2013).
Itching and dry skin may impede the client from enjoying sexual experiences
Decreased libido
Fatigue

Strategies:

Activities to improve self-concept and self-esteem (Pandya et al., 2013)
Cognitive-behavioral therapy methods to address symptoms of anxiety and posttraumatic stress disorder
Explore other erogneous zones, especially if genital sensation or anatomy has been impacted (Connell, Coates, & Wood, 2014)
Prior to resuming sexual intercourse, engage in other forms of intimacy with partner, such as kissing or hugging
Partner can assist with massaging scars. This helps the patient become more comfortable with their partner seeing their new body, as well as gives the partner a better understanding of what sensations may cause pain.
Ensure skin is moisturized before engaging in sexual activity
Plan to engage in sexual activity during times of the day when the client has the most energy
If the client is prescribed pain medication, it may be helpful to take the medication 30-60 minutes prior to engaging in sex
Stretch before engaging in sex. The partner could also assist with this.
Find pleasurable positions that do not put pressure on healing grafts or other tender areas.

References

Ahmad, I., Masoodi, Z., Akhter, S., & Khurram, F. (2013). Aspects of sexual life in patients after burn: The most neglected part of postburn rehabilitation in the developing world. Journal of Burn Care and Research, 34(6), 333-341. Retrieved from https://doi.org/10.1097/BCR.0b013e3182779b6d

Connell, K. M., Coates, R., & Wood, F. M. (2014). Sexuality following trauma injury: A literature review. Burns & Trauma, 2, 61-70. Retrieved from https://doi.org/10.4103/2321-3868.130189

Pandya, A. A., Corkill, H. A. , & Goutos, I. (2015). Sexual function following burn injuries: Literature review. Journal of Burn Care Research, 36(6), 283-293. doi: 10.1097/BCR.0000000000000196

Wibbenmeyer, L. (2018, July). Intimacy after burns. Retrieved from https://uihc.org/health-topics/intimacy-after-burns