Sexuality and Traumatic Brain Injury
Trudel, Tina, Tepper, Mitchell, Barton, Barbara, Elias, Eileen, Weider, Katie, The Exceptional Parent
The following article is the tenth in a multi-part series on traumatic brain injury (TBI). This series is published by the Traumatic Brain Injury-Resource Optimization Center (TBI-ROC) and its Advisory Group, which is facilitated by JBS International, Inc. The TBI-ROC aims to be a recognized source and leader for advancing national attention to the myriad of policy, research, practice, and service needs supporting both civilian and military individuals who incur TBI and their families.
Sexuality is a life affirming gift that has long been a source of concern and conflict for adolescents and young adults with disabilities. This challenge is faced every day by parents of youth with traumatic brain injury (TBI). TBI potentially impacts behavioral, cognitive and physical functioning, all of which play a critical role in the development of intimate relationships and the experience of satisfying sexual expression. Brain injuries can directly impact sexuality through changes in neurochemistry and the endocrine system. Brain regions identified as vital participants in the brain's sexual underpinnings include the frontal system, limbic structures and temporal lobes (see TBI-ROC series article: Understanding Brain Injury: An Introduction). Research studies on adults with TBI report numerous findings regarding sexuality including:
* Issues with adaptive equipment or bowel/bladder care
* Changes in role and relationships
* Problems with mood, self-confidence and body-image
* Reduced sexual energy, desire and drive
* Diminished sensation and delayed or absent orgasm
* Difficulty with positioning and movement
* Adverse impact of pain and deconditioning
* Decreased ability to satisfy a partner
* Lack of inhibition or hypersexuality
The primary challenges to healthy sexual functioning after TBI are often due to the secondary causes of dysfunction, those aspects of activity that are impacted by damage to various brain regions or circuits. Physically, TBI related sexual dysfunction may involve spasticity, paralysis, ataxia (tremor), movement disorders, poor coordination, sensory changes and bowel/bladder issues. Cognitive TBI symptoms that impact sexuality include attention/concentration deficits, problems with goal setting and initiation, limited social communication abilities, impaired awareness and reduced executive functions (planning, organizing, abstract thinking, etc.). Emotional and behavioral changes common to TBI also affect sexuality, such as mood, self-centeredness, apathy, low self-esteem and difficulty with self-monitoring. In fact, sexuality is among the most complex human activities that requires integration of many high level skills. Yet for all its complexity and importance, sexuality after TBI is often ignored or minimized in rehabilitation treatment, especially for youth. This can be related to a number of factors including religious and cultural traditions, staff discomfort with the topic and that sexuality as a multi-faceted behavior does not 'belong' to any particular professional discipline. None are acceptable excuses for lack of professional attention.
For youth or young adults with TBI, sexuality does not occur in a vacuum. Therefore, interventions in this arena include global elements such as alleviating depression and other common post-TBI psychological conditions, maximizing integration back into home and community life, alleviating depression and other common post-TBI psychological conditions and promoting physical recovery and health. A current example worth highlighting is that of young adult service members returning home from Iraq and/or Afghanistan with both blast-related TBI and Post traumatic Stress Disorder (PTSD). Many of these young men and women joined the military early in their sexual development, as young adults with varying degrees of maturity and relationship experiences. Aside from the previously mentioned challenges posed by TBI, the added effects of Post Traumatic Stress Disorder (PTSD) can create distress, panic, emotional disconnection or complete avoidance of sexual intimacy. …