BINSA Information on Sexuality When a member of your family, or someone you know, sustains an injury to the brain it is a major shock for both them and you. When a person’s survival is paramount, and later when rehabilitation focuses on issues such as basic care and the activities of daily living, discussions about sexual functioning and performance often take a back seat. The person’s future as a sexual being can easily be ignored by professionals and the others caring for them. In addition, some people find the area of sexuality difficult to discuss. Sexuality and reproduction, though, are important parts of life and living and will certainly need attention as a part of the rehabilitation process. You may well have concerns and questions about any changes that result from the injury. For instance you may want to know about the return of sexual feelings, about how the person may act in sexual and social situations, displays of love and affection, or about any effects on the ability to have children. The professionals are there to help, so remember to ask any questions you might have, or ask to be referred to a specialist in the area. Groups like BINSA and SHINE can be useful for information and support. Changes In most cases of brain injury the person will have few or no changes in their physical ability to have children. Checking with the doctors who are caring for the person should clarify this quickly. Behavioural, emotional, and sensory changes are much more likely for the person following brain injury. There may also be changes in their ability to recognise and accept social responsibilities. Behaviour changes Acquired brain injury affects every person differently. Each person lives a unique life both before and after the injury. Behaviours, including sexual behaviours, are learned by interacting with friends, family, and others. When the brain is injured any part of this learning and the associated behaviours may change. Some old behaviours may no longer be present, some may be changed, and there may be new behaviours in place. Some of these changes may be unwelcome and can cause adjustment problems. If the person has previously played an important gender role, such as that of a mother or father, husband or wife, then their children, partner, or other concerned people may be able to assess fairly accurately the changes and how this role can continue. It is likely that some changes and adjustments will need to be made. Some expectations and cultural roles may be difficult to fulfil. Previous beliefs, opinions, and values may be thrown into confusion and there may be conflict with the current actions and expected future of the injured person. Family and friends often find that some of the changes make it difficult to know how to relate to this ‘new’ person. Open, honest discussion is the best way to solve these problems. Difficulties with inappropriate sexual language, gestures, or talk, may require outside help to resolve. Some of these behaviours may at times be embarrassing, awkward, or socially troublesome. Such behaviours may not be under the control of the person with ABI, and they may not even know that they are doing them. Patience and persistence will always pay off in the long run.
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Emotional changes Control of strong feelings is often affected after a brain injury and it may take some time for such feelings to be dealt with in an appropriate manner. An increase in impulsive behaviour is likely. The trauma that the family and friends experience due to unwanted changes is also strong in the person who is injured. While you may no longer be familiar with the person, imagine what it is like to be no longer familiar with yourself! Distress, pain, anger and withdrawal are all natural responses and all have effects on relationships and sexual feelings. Sensory changes In some cases of ABI sensations can become distorted, for example, heightened sexual sensation and overstimulation may be experienced. Learning or re-learning of sexual and social behaviour can therefore be adversely affected. Changes to senses, such as smell, can alter sexual reactions. Some medications and other treatments influence how a person feels in their own body and how they experience sexual feelings. These influences will also have an effect on the person’s behaviour. For instance some medications can reduce the capacity to become sexually aroused and in males may prevent erections. Getting help Talking to the doctor in charge about your concerns and worries is useful. You can ask whether the effects and changes are likely to be short or long term, whether they will be stronger or weaker at certain times of the day, whether they will change with fatigue or stress levels. The doctor can also advise you about the effects of alcohol and other recreational drugs on medication and behaviour. Understanding these effects and the behaviour changes they cause will help the person and their relatives and friends to manage and make the necessary adjustments. If one doctor cannot answer your questions then ask another one or seek help from a social worker, counsellor, or other professional.
Setting limits One of the difficult tasks when dealing with a person who has had a brain injury is knowing how much individual responsibility they can take for themselves and how much family and friends need to take. In general a person should be allowed to take as much responsibility as possible so that their chances of failure and of risk are equal to those of an uninjured person. It is worthwhile to discuss such areas as HIV and other sexually transmitted diseases, contraception and appropriate public behaviour. The limits needed for comfort and safety may conflict with the development of independence and family and cultural values. Professional help is available for such problems.
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Sexual needs The sexual needs of a person who has experienced a brain injury are part of their personality and vary a great deal from individual to individual. If they do not have a satisfying intimate relationship, other ways of fulfilling their sexual needs may be sought. Some of these ways may include the use of sex workers, pornography, or masturbation. These options can challenge the thinking and values of carers, friends and family. A discussion to clarify any differences and to help the injured person take others’ feelings and needs into account may be helped by the inclusion of a neutral person such as a social worker. Straight talk and the use of simple language will go a long way in understanding and dealing with such emotional issues. Sexual behaviour in residential facilities Early in the process of recovery and in cases of serious injury the person may have little control or awareness of their behaviour or of its effects on others. As memory is often affected, a person with a brain injury may be unable to remember how they used to act, how they acted yesterday, or what promises and arrangements they have made. If you are concerned about your relative’s sexual behaviour, ask the staff about any rules or policies that may exist. You can also ask about the usual responses of staff and whether any information or training is available. It is important to ensure that consistent messages about what is OK and what is not OK are given. Explaining your need for information and guidelines on the rehabilitation of your relative towards healthy sexual interactions may also help staff to focus on this important health issue. The case records may contain valuable information about behaviour and staff attitudes. You may need to ask to see the case notes and request clarification of terms that you do not understand or question statements with which you disagree. Long term adult residents may need resources to help with satisfying sexual needs, including privacy. Checking the guidelines of the organisation will help you to ensure that the person has their needs and rights respected. Contact Brain Injury Network of South Australia Inc. (BINSA) 70 Light Square Adelaide SA 5000 Ph:
08 8217 7600 / 1300 733 049 (country callers)
Fax: 08 8211 8164 Email: info@binsa.org Shine SA Sexual Health Hotline: 1300 883 793 / 1800 188 171 (country callers) Monday to Friday, 9am-1pm Email: info@shinesa.org.au
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East/West Team GP Plus Health Care Centre 64c Woodville Road Woodville SA 5011 Ph:
08 8300 5300
Northern Team 43 Peachey Road Davoren Park SA 5113 Ph:
08 8256 0700
Southern Team 19-23 Beach Road Christies Beach SA 5165 Ph:
08 8186 8600
(Gay/Lesbian/Bisexual/Transgender (GLBT) Sexual Health Issues AIDS Council of South Australia 2 Eton Place Keswick SA 5035 Ph: 08 8334 1611 Fax: 08 8351 3652 TTY: 08 8362 0306 Email: information@acsa.org.au Gay Men’s Health 2 Eton Place Keswick SA 5035 Ph: 08 8334 1606 Fax: 08 8351 3652 Email: gmhealth@gmhealth.org.au Gay and Lesbian Community Services of South Australia Ph: 08 8193 0800 (7pm to 10pm every night) Email: glcs@glcssa.org.au
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O’Brien Street General Practice Five GPs operate in the practice which provides services to a number of specialist groups including the GLBT community. 17 O’Brien Street Adelaide SA 5000 Ph: 08 8231 4026 Fax: 08 8231 1211 Email: mark@obrienstreetpractice.com.au
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