Changed relationships due to changed intimacy and sexuality

A topic that is still too often underexposed is the potential for altered intimacy or sexuality after a brain injury.

This may significantly change your relationship.
Your brain is you. Damage to the brain and brain areas may have significant consequences and
may alter your 'individuality', your personal awareness.
But even a healthy partner can have changed in her or his experience of relationships, intimacy and sexuality. Every person is different, and every injury is different.

Nevertheless, we want to provide information about what may have changed due to a brain injury.

Possible manifestations of a different response in the person with a brain injury

The desire for sex or intimacy disappears.
There is an insatiable desire for sex.
There is sexual disinhibition.
There is excessive fatigue (brain fatigue, neurofatigue, it is different from physical fatigue!).
There is overstimulation (cognitive/sensory overload).
There is reduced/inability to maintain divided attention, which prevents the person from switching between their own feelings and those of others and can therefore appear less affective.
There is reduced empathy.
Old character traits are intensified after the brain injury.
The person with a brain injury no longer has a sense of who their partner is.
The person with brain injury experiences him- or herself as a burden or is ashamed, which can reduce the need for cuddling or sex.
The sexual desire may be diminished, but the need for intimacy and cuddling has become more important.
There is foul language when discussing intimacy/sex and when it comes to intimacy and the intimacy is lost as a result.
There is physical disability or pain, etc.
There is nsufficient or excessive hormone production by brain areas such as the pituitary gland.
There is damage to the hypothalamus.

Some people with brain injuries become more gentle. Others become rougher or somewhat less inhibited sexually. Others become more irritable, meaning they get irritated more easily.

This, of course, has a huge impact on sexual relationships. People can also be too tired due to neurofatigue, or in excessive pain, or have a decreased libido or lack of desire due to hormonal changes in the brain.

No unwillingness, but inability

It is important to understand that the person with brain injury didn't choose to have brain injury.

This makes it easier to see the underlying cause. Is it the inability to do or think two things simultaneously? The ability to divide attention may simply be broken.

People with brain injuries may have difficulty dividing their attention, which can make them appear more self-focused in their needs during a sexual relationship. The reason for this is that they are unable to also focus on the other person.

These are, so to speak, the mitigating factors of a changed sexual relationship.

Relationship under pressure?

Yet, the very realization that the person with a brain injury can't do anything about it often makes the "healthy" partner feel guilty, and he or shee avoid talking about the changes.

Starting the conversation and acknowledging the shared losses marks the beginning of grieving together.

"What have we lost?"

"How can we move forward?"

Read more about the changed relationship.

The "healthy" partner may also experience altered feelings about intimacy and sexuality

The confrontation with (near) death has changed everything.
"caring for", and the resulting shift in role can be influential.
Physical changes can diminish desires for sex and intimacy.
Aversion to the new situation.
Unable to cope with the changed life.
The personality has changed so drastically that the person with the brain injury no longer resembles the person you once chose.
Inability to cope with altered behavior, mood swings, aggression, constantly talking about the same topic, the other person's apathy, coarse language, demanding behavior, etc.

Sex and intimacy

Everyone will agree that intimacy isn't just about sexual acts or "the act." When the sexual desire disappears, the need for intimacy, a kiss or a cuddle or feeling secure together wil become more important. There are different ways to be together.

Try to discuss it together, where possible, and don't be shy about seeking advice.

A general practitioner or a (neuro)psychologist may be a good first step.

It is important that the person offering advice is aware of the potential consequences of a brain injury, especially because you can't simply advise people to do more of this or less of that.

Especially with injuries to the right hemisphere or the forehead, the partner's behavior and personality may change significantly.

If the caregiver isn't aware of this, she or he may recommend goals that are unattainable.

When objective knowledge about brain injury is provided, expectations may also be adjusted. Inability is not unwillingness.

Even with some disinhibitions, agreements or friendly solutions can be devised, such as mutual agreements where the partner is "protected" and brought back to reality.

Another possibility is a "delay": wrapping something around the hand that is being physically active. This forces the hand to free itself first, which may already reduce the impulse.

Behavioral Problems

If the person with a brain injury has real behavioral problems we are talking about other issues, such as masturbating in public, verbally sexually aggressive or disinhibited behavior.
The person may have an insatiable sexual urge or become physically aggressive with anyone.

She or he may have lost the gentle side of intimacy and use harsh words against any kind of partner contact.
In that case, consulting a behavioral therapist, a neuropsychologist, a behavioral neurologist or neuropsychiatrist is an option to consider.

Changed relationship

A brain injury in one of the partners has a huge impact on the relationship. Caring for, working, and taking care of the children may take up a significant amount of energy. In this process, the partner is often overlooked.
Much-needed intimacy may be compromised.

"Whether people stay together after a brain injury doesn't depend on how long they were together, nor on how good their relationship was before the other person became ill," says Jenny Palm, a Dutch educational psychologist/clinical psychologist/neuropsychologist.

Interim solutions are often sought between staying together and leaving. Many couples find a solution in a separate bedroom or renovate their home so that the partner with a brain injury can live alone, but the healthy partner is able to care for her or him.

Children of a parent with brain injury

Siblings and children of parents with brain injury

Consequences for the family / partner

More information

https://pmc.ncbi.nlm.nih.gov/articles/PMC1028946/

https://www.sciencedirect.com/science/article/pii/S221026121630219X

https://msktc.org/tbi/factsheets/sexuality-after-traumatic-brain-injury

https://pubmed.ncbi.nlm.nih.gov/3746322/

https://www.tandfonline.com/doi/full/10.1080/02699052.2022.2145358

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/brain-injury-and-sexual-issues

https://biausa.org/public-affairs/media/sexuality-is-a-family-matter

https://www.headway.org.uk/media/12070/sex-and-sexuality-after-brain-injury-publication.pdf