Let’s talk about sex!

Talking about sex after a brain injury can feel awkward or uncomfortable, but it’s important to address because intimacy is a key part of any relationship. After a brain injury, both physical and emotional changes can affect how sex feels and how it’s experienced, for both the person with the injury and their partner.

It’s normal for things to change, but that doesn’t mean the connection between you and your partner has to disappear. Open communication, understanding, and a little creativity can help you both navigate this new chapter. Whether it’s talking about what feels good, finding new ways to connect, or just being patient with each other, it’s all part of building a fulfilling relationship again. Let’s explore some ways to work through these challenges together, with respect, support, and love.

Let’s start with the human sexual response cycle to understand the five stages involved. Understanding these stages can help identify any potential challenges. Desire is when you start to feel that want for sexual activity, often sparked by attraction, fantasies, or just thinking about being close to someone. Then comes arousal, where your body starts to get ready for intimacy—your heart rate goes up, muscles tense, and blood flow increases, leading to erections for men and vaginal lubrication for women. As things progress, you hit the plateau phase, where the physical changes grow stronger and the sexual tension builds. The next step is orgasm, where that buildup of tension is released in a burst of intense pleasure, and for men, ejaculation. The feeling of satisfaction can be different for everyone. Finally, after the climax, the body enters resolution, slowly returning to a relaxed state. Men usually need a bit of time before they can get aroused again, while some women can go right back into the cycle.

How brain injuries can affect sexual functioning?

After a brain injury, sexual functioning can change in different ways for each person. For some, there’s a decreased desire, sex may not seem as interesting anymore, and they might not initiate or think about it as much, which can make partners feel unwanted. On the other hand, some people experience an increase in sexual desire, which might lead to more frequent urges or even inappropriate behaviour, putting extra pressure on their partner. Physical arousal can also become a challenge, even if there’s still interest in sex, men may struggle with erections, and women might find it hard to get enough lubrication, which can cause discomfort. Reaching orgasm can also be tough for some, leading to frustration and less motivation to engage in sexual activity at all.

Why do sexual changes occur after brain injury?

Sexual changes after a brain injury can happen for several reasons, often due to the brain damage itself, physical limitations, cognitive challenges, or even shifts in relationships. Here’s a breakdown of the main causes:

Brain damage: Injury to areas of the brain, like the frontal and temporal lobes, that control sexual functioning can either reduce or increase interest in sex.
Chemical imbalance: After a brain injury, changes in neurotransmitters (the chemicals that help regulate sexual functioning) can affect libido and arousal.
Hormonal disruptions: TBI can interfere with hormone production, affecting menstruation, fertility, and sexual drive in women, as well as sperm production and arousal in men.
Medication side effects: Drugs prescribed for seizures, depression, or sleep issues can lower sexual desire, arousal, and performance.
Fatigue: Physical and mental exhaustion after a brain injury can reduce stamina and focus, making it harder to engage in sexual activity.
Movement issues: Conditions like spasticity, weakness, or balance problems can make sex uncomfortable or difficult.
Cognitive changes: Impaired attention, memory, or planning can affect intimacy and create misunderstandings.
Emotional shifts: Mood swings, depression, or irritability can change sexual desire or make it harder to connect emotionally with a partner.
Social communication challenges: After a brain injury, it may be harder to express and understand thoughts and feelings. The person may struggle with reading non-verbal cues like body language or eye contact, leading to confusion in social and intimate interactions.
Loss of self-esteem: Changes in appearance or abilities can lead to reduced confidence, making it harder to feel attractive or connect with others.
Decreased social contacts: After TBI, people often experience isolation due to changes in work, school, or friendships, leading to fewer opportunities for intimacy and connection.
Headaches: Frequent headaches, whether mild or severe, can reduce sexual desire and energy.
Bowel/bladder control issues: Difficulty controlling urination or bowel movements can be embarrassing, causing some to avoid sexual activity.
Other medical problems: Conditions like diabetes, heart disease, hormonal imbalances, or neurological disorders can affect sexual functioning.
Alcohol and drug use: While they might initially seem to help with relaxation, alcohol and drugs can lower sexual interest and performance.

What if they’re ready but I’m not?!

It’s totally okay if your partner with a brain injury is ready to have sex, but you’re not quite feeling it. These situations can be tricky, but it’s important to be honest and communicate how you’re feeling, what your needs are and your boundaries. Let them know that you care, but right now, you may need more time or space. Be gentle and understanding – your partner might be eager, but they also need to hear that it’s not about them; it’s just how you’re feeling in the moment.

You can also suggest other ways to stay connected, like cuddling, talking, or simply being close, so they don’t feel rejected. Emotional connection, touch and intimacy – without pressure – can help both of you rediscover closeness. It’s about finding a balance where both of you feel heard and respected, and it’s okay to say no if you’re not ready. What matters most is that you maintain open, compassionate communication as a couple, keeping the emotional bond strong, even when physical intimacy isn’t on the table. When the timing is right and things unfold naturally, be prepared for some trial and error.

Improving sexual health

Let’s talk about ways to navigate and improve your sex life with a partner after brain injury – it’s all about finding what works best for you both in a safe, respectful way.

Get a comprehensive medical check-up: A thorough exam can identify any causes of sexual difficulties and guide treatment. Get comfortable with discussing sexual issues and any health concerns with your doctor. Blood tests for hormone levels and review of medications for side effects on sexual function may be needed.

Create a non-distracting environment: You can enhance focus during intimacy by reducing distractions like TV or loud music. It’s also a good idea to plan ahead to avoid feeling rushed and create a relaxed atmosphere with dim lighting and quiet surroundings.

Change positions: After a brain injury, some positions might not feel comfortable anymore. It’s okay to experiment! Talk openly with your partner about what feels good and works for both of you. For example, side-by-side or standing positions might be better, and using pillows for support can help reduce discomfort. Honest communication makes all the difference.

Manage fatigue: You can schedule sexual activity during times of day when your partners energy levels are highest, often mornings or early afternoons. Shorter sessions may help conserve energy.

Memory problems: Consider using a calendar to track dates and create reminders. You can make reminders playful or romantic, like leaving notes or emails. If the person forgets recent intimacy, gently remind them with humor or romantic details. Plan scheduled time for romantic encounters to maintain connection.

Impaired fantasy or imagination: You could engage with erotic content, such as movies, books, or images, to spark arousal and develop fantasies. This is completely valid as long as it’s done responsibly and in ways that don’t harm others or break any laws.

Erectile dysfunction: There are options available such as vacuum pumps, penile rings, or medications (consult a doctor about compatibility with other prescriptions).

Female sexual difficulties: Consider the use of lubricants or erotic content to aid arousal. Experiment with different positions or self-exploration to identify pleasurable sensations and improve satisfaction.

Self-exploration: If you don’t have a partner, or prefer solo intimacy, masturbation can be a healthy way to feel sexually satisfied. It’s also a chance to explore what feels good to you now, which can help in future relationships. If you try this, make sure it’s done privately and respectfully, keeping others’ boundaries in mind.

Online relationships: The internet opens doors to connecting with others, including romantic or sexual relationships. Online chatting and dating can feel freeing, especially if physical limitations make in-person connections harder. However, be cautious—don’t share personal details too soon, and always meet in public if you decide to take things offline. Bring a friend for safety, and remember that not everyone online is who they claim to be.

Sex Therapy

Sex therapy isn’t anything weird or taboo—it’s simply working with a licensed professional who knows a lot about human sexuality. They’ll help you address sexual challenges and discover ways to make intimacy more fulfilling. Therapy often includes your partner and may involve helpful exercises to try at home. It’s also a great way to tackle emotional or relationship struggles that might affect your sex life.

Rights in sexuality and relationships

Everyone, including people with brain injuries, has the right to enjoy a fulfilling sex life. However, it’s important to be aware of your rights to stay safe and avoid harm.

You have the right to have your sexual needs and preferences respected.
Your privacy and confidentiality, including in your relationships, should always be protected.
You have the right to engage in a sexual relationship with someone, as long as both are above the legal age of consent.
You can choose to stop having sex with anyone at any time.
You have the right to receive clear information about:
- Social skills and relationships
- Sexual health topics like contraception, hygiene, and STD prevention
- Your legal responsibilities and rights regarding sexual relationships
- How to avoid sexual exploitation or abuse
You have the right to marry or live with anyone you choose and to have children.
You can say no to anything that makes you uncomfortable, whether physically or sexually.
If you believe your rights have been violated, you have the right to file a complaint.