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After a brain injury, a person undergoes physical, cognitive, emotional and employment changes. All these changes directly affect the sufferer’s relationships. Feeling of isolation, sense of loss of social support, change of roles, and caregiver duties are some of the immediate effects.

Marital Changes

50% of marriages dissolve within 2 years of an injury. Some studies even found rates as high as 64% to 78% within 1-15 years post-injury.

Marital quality is mainly impacted due to negative personality traits like bad temper, mood swings, and fatigue.  

It is natural for a partner and the person experiencing TBI to undergo a period of grief and mourning at the loss of the relationship that once existed. A couples’ relationship can be altered due to loss of connectivity, loss of future and commitment instability

Intimacy & Sexuality After TBI

TBI victims are unable to express affection, share pleasurable experiences, communicate, and sense of being attracted and attractive. Our brains control our sexuality and sexual response. 

The physical changes due to a TBI include changes in hormone levels, changes in desire and arousal, and reproductive changes in men and women. Medication side effects can also play a role in reducing intimacy and sexual desires.

Psychological changes impacting sexuality include anxiety, depression, social isolation, and altered physical image, lack of self-confidence, and fear of rejection.

Neuroendocrine Dysfunction

The pathophysiology of the TBI can impact sexuality. The neurochemical responses from the brain to the spinal cord, and changes in cognitive functioning make it difficult for a TBI victim to express intimacy.

Intimacy can also be affected by inappropriate sexual behavior, impulsivity, and lack of boundaries.

So how do we overcome these barriers to re-establish healthy intimacy after a brain injury?

A counselor or psychotherapist can provide counseling regarding intimate relationships. The survivor’s capacity for consent is essential where intimate relationships are concerned. Evaluation is needed to assess if the survivor can cognitively understand and consent to a sexual relationship, even if it is with their spouse. 

Working with a neuropsychologist may be required to assess and establish the capacity to consent. Support groups can help reestablish communication. Enjoyable social activities, employment, and volunteer participation can increase feelings of social integration and connectedness.

Changing the relationship environment:
Establish a positive environment at home, look for progress in recovery instead of focusing on the changing relationship. A positive attitude can help curb inappropriate behaviors as couples find time to do fun activities together.

Inappropriate behaviors need to be managed and professional help may be required to set boundaries, redirect sexual behavior to a private place, and find a way to have appropriate sexual expression. 

Communication and advocacy are key for establishing boundaries, whether it is physical, emotional or in an intellectual context. Healthy boundaries help raise self-confidence and self-image. 

Spending productive time together can be an inexpensive way that can make a huge difference in re-establishing the connection. Consider scheduling a date on the calendar to take a walk, watch a movie together, or play a game of cards as a doctor’s appointment. Something that should not be ignored or rescheduled.