Sexuality and Brain Injury Flashcards
Brain injury can reduce sexuality
Fatigue
Brain injury can reduce all drives, including sexual drive
This is a neurobiological problem, not a reflection of feelings, perceived attractiveness, or value of relationship
Brain Injury can affect diverse neural circuits
Can impact feelings of pleasure that lead to orgasm
Medications can impact ability to orgasm
Causes can be multifactorial
sexuality and pain
Pain is common with movement
Neuro injury can change movement patterns and comfort levels
Adaptive positioning aids may be helpful
sexuality and self perception
Over 50% of men and women have associated loss of confidence and esteem, and depression
This change is both:
Neurobiological
Reaction to injury/disability and change in life roles
Therapy and medication may be of benefit
decreased ability to satisfy partner
Sexual intimacy involves a dynamic exchange between partners
May not be able to remember the patterns of interaction or may not be able to process those in the moment due to the complex physical and mental energy that is being expended
disinhibition / hypersexuality
Not as common as loss of interest
Troubling symptom related to frontal lobe injury
May result in inpatient treatment for safety of the individual and community
Brain based condition; not character flaw
Supportive counseling for spouse
bowel/ bladder issues
In severe brain injury, neurological control of bowel and bladder (B&B) can be affected
Learn how to time voiding and manage equipment
Utilize a caregiver other than sexual partner for B&B to preserve elements of sexual attraction and erotic energy within the relationship
cognitive deficits and sexual deficits
Brain injury can impact ability to imagine sexual activity
Further reduces drive and interest
Counseling recommended
mTBI and sexuality research shows
15% continue to have cognitive or psychological difficulties
Aware of loss of functioning
“Feel different”
premorbid sex and intimacy issues
Men and women may have experienced preinjury sexual trauma or violation
Can be re-triggered by experience of brain injury
brain injury locations impacting sexuality
frontal lobe, limbic system, temporal lobe
primary causes of sexual dysfunction
neuroendocrine issues
hypothalamus and pituitary damage
neuroendocrine issues
Changes in the neuroendocrine (hormone-regulated) system occur frequently following brain injury
Hypothalamus and Pituitary Damage
Pathology studies indicate pituitary damage in 40-62% of persons with TBI and hypothalamic lesions in 42%
Changes in neurochemistry and hormone levels affect all aspects of sexual drive, experience, and reproduction (i.e., menstrual irregularities)
secondary causes of sexual dysfunction
physical, cognitive, emotional, other (marital, social isolation, etc)
physical causes of sexual dysfunction
Spasticity Hemiparesis Ataxia Decreased balance Movement disorders Sensory deficits
cognitive causes of sexual dysfunction
Attention and concentration Initiation (motivation to act on a plan or drive) Social communication abilities Impaired awareness Memory loss Executive dysfunction
emotional causes of sexual dysfunction
Emotional and Behavioral Changes Impacting Sexuality:
Depression (14-61% of persons with brain injury)
Child-like or dependency behaviors
Self-centeredness
Apathy; decreased initiation
Disinhibition or difficulty with self-monitoring
Low self-esteem or poor body image
other potential causes of sexual dysfunction
Other Potential Contributors Impacting Sexuality: Marital or family dysfunction; Role changes Financial stress Parenting strain Decreased communication between partners Social isolation Medication side effects
reasons sexual deficits not addressed in tx
Persons served have difficulty bringing this problem to the team
Treatment team does not view it as priority in face of other rehab goals
Sexual function goals cut across all disciplines
LGBT issues and TBI
2%-15% of population is homosexual/bisexual
LGBT individuals with brain injury face unique challenges that are at times mismanaged or ignored in rehabilitation
Benign neglect: staff discomfort and inexperience in treating LGBT patients
Two factors that contribute to benign neglect:
Heterosexism: an ideological system that denies, denigrates, and stigmatizes any non-heterosexual form of behavior or lifestyle
Homophobia: negative or hostile attitude toward non-heterosexual people
heterosexism
an ideological system that denies, denegrates, and stigmatizes any non heterosexual form of behavior or lifestyle
homophobia
negative or hostile attitude toward non heterosexual people
LGBT issues in brain injury rehab
Sexual minorities and sexual subcultures are often superficially addressed in staff cultural awareness or diversity training
LGBT individuals have many of the same post-TBI sexuality concerns as their heterosexual counterparts
Family relationships may be faced with unique strains:
Differing ideological views
An LGBT young adult is injured and his or her family of origin is not aware of their sexual or gender orientation or relationships
intimacy and TBI
Aspects of intimacy that an individual brings into the relationship include:
Knowledge of self
Self-acceptance
Awareness of one’s strengths and weaknesses
The ability to experience and share wide-ranging emotions
Feeling worthy of happiness and pleasure
Seeking to choose experiences of this nature
Any of these can change as a result of brain injury
psychological intimacy
self esteem, awareness, respect, loyalty, openness, commitment and intellectual compatibility
emotional intimacy
abilities to share emotional needs, communicate affection, share mutual empathy and listen
operational intimacy
sharing responsibilities decisions, role expectations, and parenting
shared intimacy
activities, hobbies, traditions, friends, family and community
sexual addiction and TBI
Internet based sexual addiction: growing concern for people with and without disability
The rapid rise in internet sexual addictions is related to the Triple A of the addiction scenario:
Accessibility
Affordability
Anonymity
sex education, prevention, sexual abuse, exploitation and risk
Sexuality has real risks that must be considered and balanced with the right to live a fulfilling life
Persons with disabilities, especially cognitive impairments, experience higher rates of sexual abuse of all types – molestation, rape, and various forms of exploitation
Competence for sexual consent must balance protection from harm with promotion of rights
Consideration must include: Overall cognitive functioning Safety skills Sexual knowledge Understanding of consequences Overarching ability to make safe and healthy choices
adolescent sexuality and TBI
The primary challenges to healthy sexual functioning after TBI among adolescents are also often due to the secondary causes of dysfunction (damage to the brain)
Sexuality after TBI is often ignored or minimized in rehabilitation, especially for youth
adolescent sex education
Research demonstrates that non-disabled youth receive much of their sex education (accurate or otherwise) from siblings or friends
Youth with TBI do not receive the same level of peer interaction to learn sexual information and cultural guidelines and are far more reliant on parents and professionals to fill this void
Accurate, meaningful, and developmentally-appropriate information about relationships and sex is critical
sexuality intervention for adults & adolescents with TBI
permission affirmation limited information specific suggestions intensive therapy (PALISSIT)
permission in PALISSIT
P – for Permission
Which includes discussing the importance of sexuality, how self-esteem and self-concept relate to sexuality, information about changes in sexuality from TBI and through development, and the importance of being able to discuss sexuality openly with family and professionals
affirmation in PALISSIT
A – for Affirmation
Receiving acceptance and support for wherever the adolescent is in their sexual development
limited information in PALISSIT
LI – for Limited Information
Reviewing the more detailed impact of the TBI on sexual experience (both primary and secondary causes), as well as the challenges that TBI may pose in forming or maintaining a relationship within which sexual intimacy may occur
specific suggestions in PALISSIT
SS – for Specific Suggestions
Which typically involve professional interface, such as medical examinations (hormone levels, urology or gynecology, etc.), therapeutic activities to address educational gaps, safe practice habits, interpersonal strategies and social skill issues, and environmental modifications, as well as alternative sexual activities or positions
Intensive therapy in PALISSIT
IT – for Intensive Therapy
individual, couple or family, to address identified intensive needs
women and sexual challenges
Findings from general outcome studies demonstrate that women with TBI experience changes in sexuality and greater relationship difficulties
Sexual difficulties documented in a large sample of women included:
Problems with arousal
Reduced desire
Pain during sexual activities
These difficulties were reported at a higher rate than those reported for non-disabled women
women and relationship/ disability issues
Women with disabilities are stereotyped as asexual
Lower rates of marriage
Reduced opportunities for dating related to:
Visible disability deterred dating
Potential partners mistakenly assumed women with certain disabilities were disinterested or incapable of sex
The social pressure against dating a woman with disability
Women with disabilities displayed low self-esteem and self-defeating behaviors
Limited mobility or access to transportation impeded dates
Cognitive or communication problems made the complexities of dating extremely difficult
