Bring Back That Loving Feeling - Sexuality and Relationships After Brain Injury

Transcription

1 Bring Back That Loving Feeling - Sexuality and Relationships After Brain Injury Caron Gan Holland Bloorview Kids Rehabilitation Hospital Jon Lehti Survivor/Musician 1

2 What I hope you will get out of today s talk... Enhanced insight into the effects of ABI on sexuality and intimacy Increased comfort in addressing sexuality issues with clients & families Introduction to biopsychosocial model of assessment and intervention New ways of integrating sexual issues into clinical practice 3 Warm-up Sexual health - important part of rehabilitation Comfortable answering questions Comfortable initiating discussions Feel knowledgeable about ABI & sexuality Comfortable addressing a range of sexual practices and beliefs (i.e. homosexuality, sex workers, sex toys, pornography) Regularly assess clients sexual health needs 4 2

3 Why Talk About Sexuality An extremely important area of our lives Sexuality changes are common after a brain injury An area of our lives that is often not talked about or addressed in rehab Societal attitudes towards sexual issues for people with disabilities 5 Our Brains - The Ultimate Sex Organ! 6 3

4 Neuroanatomy of Sexuality Sensory awareness Sexual motivation Orgasm, initiation/ inhibition Emotional processing and modulation of motor response Emotion Emotion (Rees, Fowler & Maas, 2007) Hormonal responses involved in reproduction, sexual desire, lubrication, ejaculation 8 4

5 Sexual Problems After TBI RTC Study Compared 322 individuals with TBI and 264 with no disability (ND) Ages (mean age 38 years) Equal number females & males TBI group - average 9 years post -injury (Hibbard et al, 2000) 9 Sexual Difficulties Experienced by Males after TBI 20% 18% 16% Percentage of Respondents 14% 12% 10% 8% 6% 4% 2% TBI Controls 0% Energy for sex Sex drive Sexual initiation Sexual arousal Pain (Hibbard and Gordon, 2000) 10 5

6 Sexual Difficulties Experienced by Males after TBI 14% 12% Percentage of Respondents 10% 8% 6% 4% 2% TBI Controls 0% Ability to masturbate Ability to achieve orgasm Ability to obtain erection Ability to sustain erection (Hibbard and Gordon, 2000) 11 Sexual Difficulties Experienced by Males after TBI 18% 16% Percentage of Respondents 14% 12% 10% 8% 6% 4% TBI Controls 2% 0% Difficulty w ith positioning Difficulty w ith body movement Decreased sensation (Hibbard and Gordon, 2000) 12 6

7 Predictors of Sexual Problems in Men Being depressed Being older and having a TBI 13 Sexual Difficulties Experienced by Females after TBI 40% 35% Percentage of Respondents 30% 25% 20% 15% 10% 5% TBI Controls 0% Energy for sex Sex drive Sexual initiation Sexual arousal Pain (Hibbard and Gordon, 2000) 14 7

8 20% 18% Sexual Difficulties Experienced by Females after TBI Percentage of Respondents 16% 14% 12% 10% 8% 6% 4% 2% TBI Controls 0% Ability to masturbate Ability to achieve orgasm Vaginal lubrication Vaginal bleeding with sex (Hibbard and Gordon, 2000) 15 Sexual Difficulties Experienced by Females after TBI Percentage of Respondents 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% TBI Controls 0% Difficulty w ith positioning Difficulty w ith body movement Decreased sensation (Hibbard and Gordon, 2000) 16 8

9 Predictors of Sexual Problems in Females Being depressed Having endocrine/hormonal problems Being older and having a TBI 17 Sexuality after traumatic brain injury: A critical review Alexander Moreno, M.Sc. 1, Juan Carlos Arango Lasprilla, Ph.D. 2, Caron Gan, RN, MScN 3 & Michelle McKerral, Ph.D. 1 1 Centre for Interdisciplinary Research in Rehabilitation-Centre de Réadaptation Lucie-Bruneau, and Department of Psychology, Université de Montréal, Montréal, Québec, Canada 2 Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, U.S.A. 3 Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada NeuroRehabilitation (in press) 18 9

10 Is there a difference between male and female brains?? 19 Biopsychosocial Model of Sexuality Neuropsychological & Psychological Effects Sexuality Relationship Changes Medical & Physical Issues 20 10

11 Neuropsychological and Psychological Factors adjustment & loss issues cognitive changes depression & anxiety personality changes behavior (apathy disinhibition) language & communication 21 Medical/Physical Issues sensory changes motor function changes in oral function hormonal changes urogenital problems fatigue reduced endurance seizures medication effects alcohol use normal aging pain 22 11

12 Medication Side Effects Anticonvulsants impotence, libido, ejaculatory difficulties, arousal problems, effect on oral contraceptives SSRI s libido, orgasmic, erectile & ejaculatory difficulties Stimulants libido, impotence, orgasmic & ejaculatory difficulties Antipsychotics anorgasmia, priapism, painful ejaculation Antihypertensives - libido & sexual response 23 Relationship Factors 24 12

13 Relationship Issues loss decreased affection communication difficulties caregiver strain role changes decreased intimacy changed personality behavior

14 Dimensions of Intimacy Spiritual Emotional Sexual Work Communication Intellectual Recreational Aesthetic Creative 27 Unique Issues of Spouses Decline in sexual functioning Loss of companionship Caregiver strain When will our sex life get back to normal? Increased dependency Diminished intimacy Loss of partnership married to a stranger 28 14

15 COMMUNICATION About Sexuality Issues Frequency and types of activities Need for more emotional intimacy More non-sexual touching Negotiating positions and initiation Reduced focus on intercourse Not being taken for granted Reassurance that you are loved 29 How s Your Day I really need to ask dear It s an overwhelming task dear Thought I d put the thought to music How s Your Day You know you really have to answer Give me a second chance here I don t wanna lose it Everywhere I go right now And everything I see Everyone I know right now Is waiting there for me I really need to note this 30 15

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17 The Power of Touch Triggers release of oxytocin, the cuddle hormone Induces pleasure, calm, and contentment Arouses, soothes, and comforts Reduces release of stress hormones 33 You just need two things to be able to cuddle - affection and a willing partner 34 17

18 Goals of Couple Counselling COMMUNICATION Improve relationship Information Alternatives Redefine sexuality Restore we-ness How can I show her I love her? 35 Bring back that loving feeling 36 18

19 37 Caron Gan, RN, MScN, AAMFT Clinical Fellow & Approved Supervisor Registered Marriage and Family Therapist Family Support Service Holland Bloorview Kids Rehabilitation Hospital 150 Kilgour Road Toronto, Ontario M4G 1R8 Phone: , extension 3514 Fax: