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CBIS > Sexuality and Brain Injury > Flashcards

Sexuality and Brain Injury Flashcards

1
Q

Brain injury can reduce sexuality

A

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

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2
Q

sexuality and pain

A

Pain is common with movement

Neuro injury can change movement patterns and comfort levels

Adaptive positioning aids may be helpful

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3
Q

sexuality and self perception

A

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

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4
Q

decreased ability to satisfy partner

A

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

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5
Q

disinhibition / hypersexuality

A

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

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6
Q

bowel/ bladder issues

A

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

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7
Q

cognitive deficits and sexual deficits

A

Brain injury can impact ability to imagine sexual activity

Further reduces drive and interest
Counseling recommended

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8
Q

mTBI and sexuality research shows

A

15% continue to have cognitive or psychological difficulties

Aware of loss of functioning
“Feel different”

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9
Q

premorbid sex and intimacy issues

A

Men and women may have experienced preinjury sexual trauma or violation

Can be re-triggered by experience of brain injury

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10
Q

brain injury locations impacting sexuality

A

frontal lobe, limbic system, temporal lobe

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11
Q

primary causes of sexual dysfunction

A

neuroendocrine issues

hypothalamus and pituitary damage

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12
Q

neuroendocrine issues

A

Changes in the neuroendocrine (hormone-regulated) system occur frequently following brain injury

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13
Q

Hypothalamus and Pituitary Damage

A

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)

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14
Q

secondary causes of sexual dysfunction

A

physical, cognitive, emotional, other (marital, social isolation, etc)

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15
Q

physical causes of sexual dysfunction

A 
Spasticity
Hemiparesis
Ataxia
Decreased balance
Movement disorders
Sensory deficits
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16
Q

cognitive causes of sexual dysfunction

A 
Attention and concentration 
Initiation (motivation to act on a plan or drive)
Social communication abilities
Impaired awareness
Memory loss
Executive dysfunction
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17
Q

emotional causes of sexual dysfunction

A

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

18
Q

other potential causes of sexual dysfunction

A 
Other Potential Contributors Impacting Sexuality:
Marital or family dysfunction;
Role changes
Financial stress
Parenting strain
Decreased communication between partners
Social isolation
Medication side effects
19
Q

reasons sexual deficits not addressed in tx

A

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

20
Q

LGBT issues and TBI

A

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

21
Q

heterosexism

A

an ideological system that denies, denegrates, and stigmatizes any non heterosexual form of behavior or lifestyle

22
Q

homophobia

A

negative or hostile attitude toward non heterosexual people

23
Q

LGBT issues in brain injury rehab

A

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

24
Q

intimacy and TBI

A

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

25
Q

psychological intimacy

A

self esteem, awareness, respect, loyalty, openness, commitment and intellectual compatibility

26
Q

emotional intimacy

A

abilities to share emotional needs, communicate affection, share mutual empathy and listen

27
Q

operational intimacy

A

sharing responsibilities decisions, role expectations, and parenting

28
Q

shared intimacy

A

activities, hobbies, traditions, friends, family and community

29
Q

sexual addiction and TBI

A

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

30
Q

sex education, prevention, sexual abuse, exploitation and risk

A

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
31
Q

adolescent sexuality and TBI

A

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

32
Q

adolescent sex education

A

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

33
Q

sexuality intervention for adults & adolescents with TBI

A 
permission
affirmation
limited information
specific suggestions 
intensive therapy 
(PALISSIT)
34
Q

permission in PALISSIT

A

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

35
Q

affirmation in PALISSIT

A

A – for Affirmation

Receiving acceptance and support for wherever the adolescent is in their sexual development

36
Q

limited information in PALISSIT

A

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

37
Q

specific suggestions in PALISSIT

A

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

38
Q

Intensive therapy in PALISSIT

A

IT – for Intensive Therapy

individual, couple or family, to address identified intensive needs

39
Q

women and sexual challenges

A

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

40
Q

women and relationship/ disability issues

A

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

CBIS (30 decks)

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