Sexual Health and Intimacy

A decrease in the level of sexual interest is a common concern. The reasons for this are many and may include:

Physical changes such as:

• Difficulty getting an erection, vaginal dryness
• Loss of body movement
• Loss of sensation
• Spasticity
• Pain
• Fatigue
• Difficulty communicating

Emotional / behavioural changes – that may affect the expression of sexuality such as:

• Fear and anxiety
• Depression
• Changes in body image and self esteem
• Behavioural disinhibition
• Changes in role
• Social isolation

Medical conditions such as:

• Thyroid problems, vascular disease, diabetes, hormonal changes
• Potential side effects of some medications

Some of these changes may be temporary and improve over time.  There may be some treatment options for you.  Discuss your concerns with your doctor or sexual health clinician.

Share your concerns and feelings with your partner. Talking with each other may help clarify misunderstandings as well as create chances to work on your intimate relationship.

You may have difficulty moving, balancing and positioning your body, legs, arms and hands for sexual activity. Pain and discomfort may also be a concern.

• Be creative and stay open to new ideas
• Stretching and range of motion exercises may help decrease spasticity
• Taking anti-spasticity medication prior to sexual activity may help. Talk to your doctor about this.
• A physiotherapist, occupational therapist or sexual health clinician can explore different positions and techniques with you and your partner
• Try new positions, and explore using pillows and adaptive devices. The Sexual Device Manual gives ideas for positions and devices.

The short answer is “yes”

Try to avoid an unplanned/unwanted pregnancy

• You may choose to change your method of contraception. Think about your ability to remember, hand function and physical ability. Discuss this with your doctor.
• Everyone is vulnerable to STD’s and HIV infection. Always use condoms with casual partners and partners when you don’t know their sexual history
• For information on contraception and safer sex practices contact:
  BC Options for Sexual Health at www.optbc.org or 1-800-SEX-SENSE (1-800-739-7367)

• Pay attention to your appearance (clothing, hair, shaving) and personal hygiene
• Join support groups, find ways to help others, volunteer, join a hobby or interest group or take a course. Attend a service club or church. The bottom line is, you need to get out of the house to meet people.
• Get ideas from family and friends

• We all have thoughts in our head that we don’t share with people around us. For example, if we see an attractive person walking down the street we don’t say, “I like your butt”. For some persons with a brain injury keeping these thoughts private is difficult.
• In some cases after a brain injury, the person’s understanding of appropriate sexual behaviour can be affected. This can be very confusing and upsetting for the family.
• Giving constructive feedback to the person may help
• If the behaviour continues, you can try education, counselling, setting boundaries and medical help.
• Getting feedback from others and being aware that you have trouble with this is the first step
• If this is a problem you are experiencing as a brain injury survivor, you will have to work hard to watch what you say. A psychologist or occupational therapist can help you find ways to do this.

• Your partner may take on more of a care giving role after your brain injury.  It can be time consuming, physically tiring and emotionally draining.
• Your partner may feel differently towards you emotionally
• Having the help of a paid caregiver helps your partner focus on your relationship
• Find simple ways to work on your relationship: Go on a weekly date, set aside an hour each day to focus on intimacy
• If you need more help, consider counselling. A good therapist can help clarify concerns and increase communication between you and your partner

In your journey to sexual rediscovery it can be helpful to understand that life behaviours of a sexually healthy person include:

• Appreciating one’s own body
• Affirming one’s own sexual orientation and respecting others
• Making informed choices
• Identifying and living according to one’s values
• Taking responsibility for one’s own behaviours
• Enjoying and expressing one’s sexuality throughout life
  (Adapted from the Sexuality Information and Education Council of US)