Occupational Therapy Approaches to Brain Injury and Sexuality

60% of people with brain injury report difficulties with sexual health. 75% demonstrate hyposexual difficulties, while 25% demonstrate hypersexual behaviors. Since there is often no guidance on how to navigate these symptoms or address the sexual goals of patients, staff can often be at a loss for what to do. 

The most important thing when considering assessment and intervention is that it has to match the Rancho Los Amigos Level of the patient.  

1. If a patient is not responsive to stimulus and nonverbal, they can’t consent to sexual activity and furthermore the stimulation and arousal, for example from a partner, would be contraindicated to their need for calming input. 
2. If a patient is at a stage where they are engaging in familiar occupations, masturbation could likely be a familiar occupation for them just like brushing their teeth. 
3. If a patient is at a stage where they are able to achieve new learning, the education has to be conveyed in a way that is accessible to them.

Below are a couple of common difficulties and strategies to best approach them. 

Challenge: Impulsivity or agitation regarding uncertainty of when sex will happen

Strategy: schedule sex so the person knows when to expect it and can prepare for it (partner would have to consent to this plan)

Challenge: Client is masturbating in the dayroom 

Strategy: provide education for patient to masturbate in private spaces, establish a behavior plan for reinforcement, educate on social skills and considerations of others

Challenge: Client is masturbating in their private room and the nursing staff is upset about it 

Strategy: Educate nursing staff that masturbation is an ADL and, similar to going to the bathroom, people do that in the privacy of their room. Suggest the nursing staff could view it the same as accidentally walking in on a patient while they’re going to the bathroom, which is a fairly normal occurrence.  Additionally, advocate for clients who are a certain Rancho Level and above to be able to request 30 minutes of privacy which is designated by a sign on the door. 

Challenge: poor body image and self-esteem

Strategy: Work on confidence building exercises, challenging negative self-talk, exploring body image exercises. 

Challenge: low desire

Strategy: Educate on how changes from brain injury can be a damper on sexual desire, exploring sexual accelerators (turn ons) and sexual breaks (turn offs) with clients. Consider reviewing The Institute’s blog on sensory processing for more strategies on exploring and communicating preferences.