"Changing Attitudes and Changing Practice" with Dr. Farris

I recently attended a webinar by Dr. Farris on Sexuality and Intimacy After Brain Injury with the Brain Injury Association of America. It was a great presentation that shed light on some important points that we as OTs should be making sure to address and incorporate into our practice.  

Consider the Partner

When it comes to addressing sexuality and intimacy with a client after brain injury it’s important to consider the impact on the partner, too. How has this injury impacted the couple? What is the partner’s comfort level with addressing sex and intimacy?

Studies have shown that, often, the client is typically comfortable with discussing changes in their sexual function with their healthcare providers and many individuals who did not receive sexual counseling within the first year after an injury wish they would have.

The impact of a brain injury doesn’t stop with the person directly affected. It’s not uncommon for the couple to have deal with connective instability and frustration when it comes to intimacy. So let’s not forget about the partner and invite them to discuss their feelings too.

Wondering where to start? Dr. Farris recommends:

• Building trust in this new normal within their relationship by starting with small acts of intimacy and affection. Move slowly toward more complex actions
• Be forgiving of the changes, and acknowledge there’s a need for sex and intimacy
• Don't feel guilty for having the desire or need for sex and intimacy

Changes to Sexual Expression, Intimacy and Self- Image

The unfortunate effects of a brain injury can result in:

• Changes to appearance from scars or contractures
• Muscle weakness
• Decreased range of motion and endurance
• Changes to sensory and/or motor function
• Difficulty with communication and expression of wants and needs
• Changes in sexual response including desire, arousal and orgasm
• Hormonal imbalances, which ultimately affect reproductive health

Dealing with any of these struggles can understandably lead to depression and lower self-esteem.

What I found interesting is that these changes can also be influenced by hormonal imbalances. For example, due to high cortisol levels and pituitary dysfunction a period of amenorrhea post TBI is common in women. Studies have shown that individuals assigned female at birth may experience a period of decreased desire, arousal, and greater dysfunction in areas of sexual cognition/fantasy, when compared to male cohorts. 

Culture, Religion, and Spirituality

As OTs we're well versed in understanding the role of these client factors during the recovery process.  It’s important to consider exploring with your client the influence of their cultures, religion, and spirituality on their sexual identity and beliefs.  You can't be expect to know this in advance, but asking your client about what is meaningful to them and why is a great place to start to make sure you're holistically considering their client factors.  

Make sure to consider how your own culture, religion, and spirituality has influenced your attitudes about sex and what is meaningful to you, so you can understand these attitudes are your norms & beliefs, but not other people's beliefs.  Dive in deeper with my favorite CEU "Guided Self-Reflection of Sexuality Values, Beliefs, Attitudes, & Biases."

Dr. Farris beautifully empowered us to consider our obligation to address our own issues and misconceptions related to sex & sexuality so that we can better serve our clients...

“Our duty as healthcare professionals is to take action to

overcome barriers, misperceptions and discomfort in

addressing sexuality in order to provide comprehensive holistic

care to our patients!” – Dr. Farris

Farris, K. (2022, February 22). Sexuality and Intimacy After Brain Injury: Changing Attitudes and Changing Practice [PowerPoint slides]. Shepherd Center.