Changes to sexual functioning are common after traumatic brain injuries (TBIs), but rarely talked about by healthcare providers. New guidelines are trying to change that
Traumatic brain injuries often affect intimacy – in fact, more than half of people with traumatic brain injuries (TBIs) say their sexual functioning has been disrupted. Yet sexuality is often completely overlooked in rehabilitation.
This isn’t because healthcare professionals aren’t aware of the issue; 97% of them say that sexuality should be discussed during rehabilitation for TBIs. Yet only 36% say they have had those conversations with patients and their partners.
New guidelines, the INTIMASY-TBI Guideline (Intimacy and Sexuality after Moderate to Severe Traumatic Brain Injury), hope to change that.
“Many providers feel unqualified or uncomfortable because they lack the confidence, knowledge or skills to address this,” says Eleni Patsakos, lead author of the guidelines and a research analyst at KITE Research Institute, part of the Toronto Rehabilitation Institute and University Health Network. “These guidelines provide clinicians with a step-by-step guide on when and different ways to discuss intimacy, sexuality and relationships throughout the care continuum.”
She worked with Dr. Mark Bayley, a senior scientist at KITE and Program Medical Director and Physiatrist-in-chief at Toronto Rehabilitation Institute, and an expert panel of North American clinicians and researchers to develop the 12 recommendations. They cover training medical teams, educating patients on TBIs and intimacy, relationships and sexuality, offering individualized interventions, educating, assessing and managing the causes of sexual dysfunction, and giving written materials and relationship coaching to people with TBIs and their partners.
The recommendations include directing clients to programs like Couple CARE and Families4Families, which improve communication, coping skills, and relationship satisfaction. They also recommend considering in-person or virtual peer support programs in the community and ensuring that all multidisciplinary team members understand how TBI can affect intimacy and sexuality and how to approach the topic.
The guidelines advise starting to discuss intimacy early while people are still in inpatient rehab. That offers them a warning that this might be an issue for them and lets them know that help is available if they need it.
This step-by-step guide should help clinicians feel more comfortable treating intimacy and sexual health issues, says Patsakos. “Open discussions about intimacy and sexuality normalize these issues, helping patients feel less stigmatized and more comfortable seeking support,” she says. “And treating these issues can significantly improve patients’ emotional and psychological well-being.”