Brain Injury and Sexuality

Spring 2020 Disability RAPP: The Intersection of Disability and Sexuality

Brain Injury and Sexuality

By Beth A. Fisher, OTR/L

This article contains sensitive material which may not be appropriate for all readers.

“Normal sex isn’t a thing, so you don’t need to know what normal sex is.” Kathryn Ellis, OTR/L and Certified Sexuality Counselor

People with brain injury (along with other people with disabilities) are still sexual beings with sexual needs and desires. However, people with brain injuries may have difficulty in meeting their sexual and relational needs for a variety of physical, cognitive, and social reasons. Understanding the root of some of those problems is important in order to find solutions and to ultimately experience sexual fulfillment.

It is often said that the brain is the most important sexual organ. So then, it should come as no surprise that any injury to the brain will likely affect one’s sexual functioning in some way. How a person is affected sexually after brain injury varies. Increased desire may also be coupled with impulsivity and may manifest as inappropriate remarks or repeated attempts to establish sexual relationships with unreciprocal partners. Decreased desire may be a result of the fatigue that often accompanies brain injury while the brain tries to repair damaged neural networks.

Additionally, physical changes such as hemiparesis (the inability to move parts of the body on one side), increased muscle tone, and impaired sensation can make intimacy uncomfortable, painful, difficult, or potentially dangerous. Communication and mobility challenges that often occur because of brain injury can impede social relationships, limiting a person’s access to others they would consider as sexual partners. Hormonal changes (in

addition to those caused directly by brain injury) are often a result of medications taken to combat the causes or secondary effects of brain injury such as high blood pressure or depression.

So, with all these negative sexual side effects as a result of brain injury, is there hope? Yes, there is! However, because the topic of sex is often taboo or not discussed, people may avoid talking about their experience with their sexual partners, their therapists, or their doctors. Partners can learn to let pleasure be the goal of sexual expression. Therapists can assist with scheduling a time for intimacy when the person is less fatigued. Doctors can adjust medications to reduce or eliminate some of the sexual side effects. Normal sex, though not a “real” thing, may be defined as the way a person had sex before brain injury, or how they perceive others to experience sexual pleasure. People with brain injury should know that sexual pleasure is different for everyone. In addition to the help people can receive from their counselors, therapists, and doctors, online forums such as the British site Enhance the UK
( can provide information as well as the social support that a person with a brain injury may need to begin their journey to sexual satisfaction.

Beth A. Fisher, MS, OTR/L, CAPS, Fit to Garden Program Developer

Spring 2020 Disability RAPP: The Intersection of Disability and Sexuality


Welcome to the newly renamed and redesigned Disability RAPP. The themes explored in each issue, like this issues’ focus on the intersection of disability and sexuality, inform us and empower us to break barriers and challenge traditional ideas of what it means to live with a disability. We updated the Disability RAPP design to be more accessible in both its print and digital formats.

Certain content contains sensitive material which may not be appropriate for all readers.

DRC-NH, in collaboration with the UNH Institute on Disability and the New Hampshire Council on Developmental Disabilities, distribute a quarterly RAP sheet to educate community members and policy makers about the latest research, policy, practice, and advocacy issues affecting individuals with disabilities and their families.


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