Sexual Changes - Fact Sheet
Acquired Brain Injury can have a number of
consequences for an individual's sexual functioning. Talking about
sex can be embarrassing, but it is important for the person with
brain injury and their loved ones to discuss the various
The rehabilitation stage
Impulsivity, disinhibition and lack of awareness may lead to
rehabilitation staff getting unwanted sexual attention from the
brain injury survivor. The medical team, family and friends need to
have a common response to inappropriate sexual behaviour that will
assist the person to regain control over very basic impulses when
placed in close proximity to a person of the opposite sex. This
behaviour can particularly be a problem for males from their late
teens to mid-twenties when their sexual urges are strongest. Some
of this behaviour may include fantasising, lewd verbal responses,
disrobing and/or masturbating in public, impulsiveness, and
Understanding from the family
Families and partners can have trouble understanding these
sexual changes and can react negatively. A good understanding
should be gained of how impulsivity, disinhibition and lack of
awareness have caused sexual changes.
The brain injury survivor must be encouraged to take control over
aspects of their life, when there is a reasonable expectation for
responsible behaviour. When sexual behaviour is inappropriate,
steps need to be taken to learn better ways for managing or
compensating for the lapses in social skills. All members of the
family should work to become comfortable in discussing sexual
issues, and assist in implementing behavioural modification
techniques to manage behaviours.
Sexual changes are common after a brain injury. Although we are
all sexual in nature, there is a great deal of stigma to sexual
behaviour in the wrong place or time. Some of the more common
changes include the following:
- Loss of libido or sexual drive
- Inability to achieve or maintain erection
- Inability to orgasm
- Premature ejaculation
- Pain and discomfort during sex
- Hypersexuality (increased desire for sex)
- Sexual disinhibition e.g. talking excessively about sex or
- Reduced sexual responsiveness or desire for intimacy.
Such changes may be a direct result of damage occurring to
particular brain structures underlying sexual functioning. Other
biological causes of sexual dysfunction may include damage to
genital organs, muscles and bones, spinal cord and peripheral nerve
damage, medical conditions, hormonal disturbance and side effects
of medication and drugs. In addition to the direct effects of brain
injury and other biological causes, changes in sexual functioning
may occur more indirectly due to a variety of physical and
- Low motivation
- Diabetes or Hypertension (high blood pressure) can reduce
- Stress and Anxiety
- Emotional reactions e.g. anger, embarrassment, shame and fear
- Personality changes e.g. aggression
- Cognitive problems e.g. distractibility, perceptual disorders
and memory problems
- Communication deficits e.g. Aphasia or missing social cues
- A loss of self-confidence regarding personal
- Poor social skills and impaired self-control
- Social avoidance and isolation.
- Relationship breakdown
Seeking professional advice can be an embarrassing and sensitive
issue for many people as sex is usually a very personal and private
aspect of life. People are often more likely to discuss sexual
problems with their general practitioner during a visit for other
health reasons. Assessment of sexual problems can be a vital first
step in learning to manage or discover treatment options.
Assessment may involve an interview, questionnaires, physical
examination, and neurological and medical tests. In addition to a
general practitioner, psychologists and psychiatrists may be
involved in the assessment and treatment of sexual problems.
Management of Sexual changes
Partners "and family members"
Partners and family members play a significant role in
influencing the person's adjustment to physical and psychosocial
changes that affect their sex life. Partners and family members may
consider the following forms of coping:
- Developing greater understanding by seeking information on how
to support the person
- Learning different techniques and compensatory strategies e.g.
different ways of giving and receiving pleasure with the
- Altering expectations and negotiating about how often, how long
and the type of sexual activity the person can achieve
- Being assertive and sensitively communicating personal
- Making changes to lifestyle and routines that improve quality
Jill's husband Paul experienced a number of personality changes
after his brain injury. In particular Paul's behaviour was
childlike and immature and he became overly dependent upon Jill. In
many ways Jill felt like she had become Paul's mother rather than
his wife, friend and lover. The impact upon their sexual
relationship was significant. Jill read some information about the
effects of brain injury, organised some regular respite care and
learned some behaviour management strategies for encouraging Paul
to be more independent. As a result of Jill's increased
understanding, some lifestyle changes and new skills, she and Paul
now spend more quality time together and their sexual relationship
Another important issue is the increased vulnerability that people
may experience due to cognitive Impairment and emotional distress.
In particular, the person may not sense when they are at risk, know
how to cope with unwanted sexual advances or understand the
consequences of their actions. Family members and friends need to
be aware of these issues and discuss any concerns with a
professional. Some people may not feel that it is possible to
discuss these issues directly with the person with a brain injury.
In such cases, a friend or another family member may be a more
appropriate person to recommend self-protection strategies or
remind the person about general safety issues.
Children's social and sexual functioning
Acquired brain injury can also affect children's social and
sexual functioning whereby development may be arrested or they
appear to revert to a previous level of development. In less common
situations a child may develop physical and behavioural changes
earlier than their peers, which are often referred to as
'precocious puberty'. Families and schools may vary greatly in
their approaches to educating children about sexual issues and
behavioural management. It is recommended that parents and teachers
consider resources available in the community e.g. family planning
and sexual health clinics and support from professionals
specialising in acquired brain injury.
A family member may need to be told that masturbation is an
appropriate way to deal with sexual urges, but in the privacy of
their own room. It is important to establish ground rules to
protect the rights and privacy of others, so when, where and how
need to be discussed.
In some cases, a partner or spouse may continue in a caring role
but no longer wish to maintain a sexual relationship. In these
cases, it needs to be stated clearly and consistently that
masturbation will be the only option to sexual urges.
Treatment for sexual problems
Professionals can help individuals cope with a variety of
physical and psychosocial changes. Following assessment, specific
treatment of sexual problems may involve education, learning new
skills and behavioural techniques, physical rehabilitation, aids
and medical treatment. Specific forms of treatment may include
psychological support, medical and surgical approaches.
A psychologist or social worker can provide sexual and marital
counselling to couples to enhance their understanding of sexual
changes, communication skills, problem-solving, conflict resolution
and caring behaviours. Professionals may also provide literature,
audio-visual aids and advice on sexual positions, techniques and
aids. A psychiatrist may prescribe medication for either
psychological or physical problems.
Medical and surgical approaches
The medical management of sexual problems is usually most
applicable for musculoskeletal, neurochemical and vascular
disorders. Some examples include hormonal replacement, new
medication e.g. anti-spasticity drugs or a change of current
medication, neurosurgical and orthopaedic procedures.
Where to get help
- Your doctor
- Brain Injury Association of Queensland 1800 673 074 or (07)
- BrainLink Tel. 1800 677 579
- Brain Foundation Tel. 1300 886 660
- Acquired Brain Injury Unit, PA Hospital (07) 3240 2111
- Acquired Brain Injury Outreach Service (07) 5574 4311
- Open Minds (07) 3891 3711
Things to remember
Brain disorders such as traumatic brain injury can
alter the way a person experiences and expresses their sexuality.
Common problems can include reduced sex drive, difficulties with
sexual functioning (such as erectile problems) and behaving
sexually at inappropriate times.
Talking about sex can be embarrassing, but it is important for
the person with brain injury and their loved ones to discuss the
various issues and seek professional advice.