Traumatic Brain Injury

How or When to Address Sexuality:

  • May need to be addressed early in rehabilitation in reference to sexually inappropriate behaviors (Pritchard, Kordes, & Hoffman, 2012)
    • Sexually inappropriate behaviors are most likely to occur during Ranchos Los Amigos Levels IV and V
    • By Ranchos Los Amigos Level VI these behaviors are likely to be reduced
  • Once a client is at a Ranchos Los Amigos Level where s/he can function independently, such as Level VII or higher, sexual activity may be a topic in rehabilitation.
  • Therapists should speak openly and honestly with clients about their injury and the effects of their injury to continue to develop self-awareness.
  • If the client has a partner, the partner should be included in discussions surrounding sexuality and should also be educated on the effects the injury will have on the client's sexual activities and behaviors.

Barriers:

  • Decreased libido (Bivona et al., 2016)
  • Emotional and behavioral dysregulation negatively influencing quality of romantic relationships (Bivona et al., 2016)
  • Inappropriate physical or verbal sexual behavior (Turner, Schottle, Krueger, & Briken, 2015)
  • Issues with ejaculation and erection
  • Low self-esteem and depressive symptoms
  • Fatigue (See Fatigue)
  • Hormone disregulation could cause issues with sexual activity
  • Increased stress following injury may interfere with sexual functioning (Sander, Maesta, Pappadis, Hammond, & Hanks, 2016)
  • Partner may take on a caregiving role, which decreases feelings of sexual intimacy (Sander et al., 2016)
  • Decreased range of motion (See Limited ROM)
  • Feelings of pain (See Sensation and Pain)
  • Hyposexuality or hypersexuality (Pritchard et al., 2012)
  • Deficits in motor and praxis skills can decrease ability to maintain postures, position, and engage in rhythmical movements
  • Altered sensation (See Sensation and Pain)
  • Deficits in executive processing and abstract thought may impact client's ability to engage in appropriate sexual activity
  • Vaginismus, which is a strong muscular contraction of the vagina, may make penetrative sex painful or difficult
  • Decreased cognition, which may impact ability to consent. (See Intellectual Disability for guidelines on determining an individual's competence to consent).
  • Men may experience erectile dysfunction
  • Decreased memory may affect preparation and protection for sexual activity

Strategies:

  • Sensory re-education training may be helpful in improving function (Pritchard et al., 2012)
  • Pain during sex may be minimized by engaging in less strenuous positions, including the sidelying position
  • Partner could help stretch and massage the client prior to engaging in sexual activity to improve mobility
  • Client could take a warm bath prior to engaging in sexual activity to reduce spasms and improve ROM
  • Female clients may benefit from use of external lubrication to aid vaginal dryness
  • Vaginismus could be improved by use of dilators prior to penetrative sex
  • Encourage client to discuss erectile dysfunction with physician to determine if there are any medication adjustments that could be made
  • Clients may benefit from making checklists for items to be completed prior to sexual activity, such as taking medications or obtaining contraceptives
  • Use of a behavior plan may be helpful in managing oversexual behavior
  • Social skills training, including videotaped social interactions, to develop skills for engaging in relationships
  • Educate partners that sexual drive and personality are impacted by TBI to alleviate any guilt or anxiety they may feel about this


References

Bivona, U., Antonucci, G., Contrada, M., Rizza, F., Leoni, F., Zasler, N. D., & Formisano, R. (2016). A biopsychosocial analysis of sexuality in adult males and their partners after severe traumatic brain injury. Brain Injury, 30(9), 1082-1095. Retrieved from https://doi.org/10.3109/02699052.2016.1165867

Pritchard, V., Kordes, T. L., & Hofmann, A. (2012). Stroke and spasticity. In B. Hattjar (Ed.), Sexuality and occupational therapy. Bethesda, MA: American Occupational Therapy Association.

Turner, D., Schottle, D., Krueger, R., & Briken, P. (2015). Sexual behavior and its correlates after traumatic brain injury. Current Opinion in Psychiatry, 28(2), 180-187. doi: 10.1097/YCO.0000000000000144

Sander, A. M., Maesta, K. L., Pappadis, M. R., Hammond, F. M., & Hanks, R. A. (2016). Archives of Physical Medicine and Rehabilitation, 97(5), 753-759. Retrieved from https://doi.org/10.1016/j.apmr.2016.01.009