Day 29 TBI Challenge for CHANGE for Veterans
29th Mar 2011 | Posted in: PTSD, TBI, Traumatic Brain Injury, Veterans 0

Day 29 SEX and TBI

Remember!! The 31 Day TBI Challenge for CHANGE during March, Brain Injury Awareness Month, consists of just two parts:

1.) Please learn something new about TBI every day. We will be posting an article daily on our Facebook and website pages to make it easy for you to learn. Today’s article is below.

2.) Help facilitate CHANGE by partnering with The Arms Forces by assisting us in continuing our efforts for invisibly wounded veterans by collecting your CHANGE daily and at the end of March donating the money to The Arms Forces. (contact information below) Create a jar and label it:

“The Arms Forces CHANGE for TBI” and put it out where you and others will see it. When someone asks you what it is all about, share with them a bit about what you have learned about TBI. Share stories of the people you will learn about through our posts on Facebook and how their lives have been forever changed by their injuries.

If collecting change every day is not your thing then be a part of the CHANGE by making a donation to The Arms Forces through our website or by mailing a check to the address below.

Day 29  SEX and TBI

SEX and TBI……I saved this one for day 29 because I know that we are getting to the end of our 31 Days of learning about TBI and you might be losing interest!  What perks interest more than that three letter word, SEX?   A little humor for today, but the subject of sex and TBI is a serious one.  Recently, I was asked to do a radio show with a “Sexuality Tutor” about this topic and welcomed the opportunity to discuss what many don’t address about traumatic brain injury.

Sex, though we think originates in other parts of our body, which we won’t get into today in this article, originates in the BRAIN!  As we discussed in one of our previous articles, all of our bodily functions are controlled by the “hard drive” in bodies, our brain. Our sexual functions are no different.  We have learned about sexuality so much more in the last twenty years.  Most of us have a greater understanding that our emotions control whether or not we have a fulfilling, lasting sexual experience.  This article is not about moral decisions on whether or not you should have sex with someone, when, where or any other judgment call.  This article is about the natural physical and mental process that humans were created to have; sexual relations.

So, what happens when the brain, the MOS, main operating system of our bodies has been physically altered by a TBI?  What are the consequences to the sexual experience due to the emotional changes in a TBI survivor? And, how do the environmental changes within the relationships that exist with a TBI survivor and his/her sexual partner, such as going from spouse to caretaker, affect sexual desire and intimacy?

If a TBI is so severe that a person cannot physically be aroused or perform in a sexual relationship, that is a much greater challenge and one that we won’t talk about today, due to the length of such a discussion. Today, we will address those survivors who have made it through the major recovery processes and are ready to begin their sexual life once again.

Cognitive difficulties linger on, to some extent, after the major recovery in most TBIs.  Things like memory, judgment and responsiveness, processing speeds and skills and insight are some cognitive issues that might remain impaired. Responsiveness is sometimes characterized by impulsiveness – acting before thinking through the consequences of behaviors – including the patient’s sexual responsiveness. As a result, normal sexual thoughts and feelings are not censored or inhibited as in a non-injured person. This extends to remarks and actions that reflect sexual thoughts and are inappropriate to the immediate circumstances, such as touching and repeated sexual references.

One can imagine how this might affect the partner’s response to the injured partner.  Many times people with TBI take things literally.  Joking and sarcasm about their sexual abilities, or their behavior is not a good way to create a change in the behavior that might be socially unacceptable.  It is better to identity the inappropriate behavior, explain why this behavior is inappropriate and provide them with an alternative behavior such as “Next time, it might be better if you said this rather than….”  Unfortunately, rarely is sexual therapy ever included in TBI rehabilitation programs.  Not surprising, since most therapy programs do not include the necessary cognitive rehabilitation, so to include sexual therapy, well, it just isn’t going to happen anytime soon.  That is one reason I bring information to you through The Arms Forces organization.

We are all pretty much aware that sexuality is greatly influenced by our self-esteem and self-perception, or the way we view ourselves in relation to our environment and other individuals.  Changes in appearance, thinking skills and or physical changes related to brain injury alter an individual’s self-perception and result in changes in their sexual thoughts and desires. Self-esteem issues are so important to brain injury and are not being addressed with all areas of recovery, let alone sexual recovery.  Low self-esteem lowers our “hope factor” that we have control over our own life and the ability within us to make positive changes in our lives. The power of HOPE is under-utilized in most rehabilitation programs for TBI.

TBI fatigue, decreased mobility, low confidence, feeling unattractive for physical and mental reasons, difficulty communicating, pain, depression, sadness, loss of initiative or motivation, apathy or loss of pleasure in living all can factor in to a decline in all relationships in a survivor’s life, but especially their intimate relationships.  Though a TBI survivor may be one who seems pre-occupied with sexual remarks and behavior these do not necessarily transfer over to a sexual experience.  These new behaviors can be frightening and confusing to those who were sexually involved with the person before the injury.  In reality, most sexual drive does not change in people who have sustained a brain injury.  The ability to control their thoughts or actions may have changed, but the desire remains the same.  The frontal lobe of the brain is what helps all of us “hold back” our urges and allows us to inhibit ourselves appropriately. If there was damage to this area, then inhibition might be altered.

Sexual changes in arousal and performance after TBI are more often a result of interpersonal difficulties than physical change in the survivor’s physical abilities.  Again, we are talking about those without major physical disabilities that interfere with sexual performance.  Sexual counseling remains the exception rather than the rule in multidisciplinary rehabilitation programs.  Actually, it is a subject matter that is rarely even brought up with TBI surviors.

Unless the hypothalamic-pituitary function of the brain has been disrupted, sexual responses such as erection, vaginal lubrication, ejaculation, orgasm and fertility are not altered as a direct consequence of brain injury. The interpersonal difficulties are the main area of concern with sexuality in most brain injuries. It would seem that a spouse that was a real pain, crabby and not nice to be around then has a brain injury and turns into this nice, soft-spoken, gentle person would always be an immediate good thing.  But, even this type of situation can cause great stress on a relationship.  You are going along in life and got things worked out to accept things and then BAM, one day, the game changes.  Of course sexual relations are going to change too!

Going from being a loving spouse with a bit of equality between the roles of each person to being a caretaker is naturally going to affect the way the two people in the relationship relate to each other and the intimacy between them.  Imagine reminding a person which drawer his underwear is in and to call the doctor and to take the meds and to turn off the stove and then ravish each other with sexual attention.  It does take some work to go from one role to the other.  This is another reason that caretakers need a break.  A wife needs time to be a wife; a husband needs to be a husband.  Many of the studies that are done dealing with the impact of TBI on family and marital relationships fail to address the sexual problems.  The Arms Forces organization believes it is an important topic to be addressed and we recognize the affect it can have on the families of veterans with TBI.  I talk with so many spouses who are spending most of their lives being a caretaker and very little being a spouse.  No wonder relationships and families are being torn apart from traumatic brain injury.  The Arms Forces strives to be able to give even a little respite for the spouse and offer some direction, comfort and hope to those who are caring for our veterans with TBI.

Medicines also play a role in sexuality and those issues need to be addressed with the primary care doctors, sooner than later.  The interaction of drugs, along with the emotional difficulties of a survivor and any physical issues should be part of a successful recovery program.

Sex…oh how we sometimes snicker, or we avoid the topic because we think it is for only behind closed doors, but our sexual functions in our body are just as natural as our respiratory, circulatory and other systems.  For many, sexuality is a spiritual connection. If we had a problem with our heart, we wouldn’t think twice about going to see a cardiologist. If we had problems breathing, we would have our lungs checked.  If traumatic brain injury has entered your life either as a survivor or a loved one of a survivor, address your sexual needs and difficulties as you would any other problem with your body.  Our health depends on good emotional health as well as good physical health. Sexual health is part of our emotional and physical make up.

A good, fulfilling sexual life after TBI is very possible.  Relationships, though some believe always fail after TBI, which statistically is not true, can be nurturing and successful for both parties. Love can transcend all difficulties and grow even more deeply in the face of adversity.  Studies prove that to be a fact!  Perseverance and reaching out and getting the right help are the keys to having a life that is fulfilling and has passion and purpose.

The Arms Forces is here for you to help empower you to have a more fulfilled life after TBI!

With open arms,

Pam Hays

Founder/President and severe TBI survivor

The Arms Forces

PO Box 981

Maumee, OH 43537

419-491-1555 –email

Leave a Reply