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Intimate Relationships & Sexuality After a Stroke or Brain Injury

Intimate Relationships & Sexuality After a Stroke or Brain Injury. West Park Healthcare Centre Neurological Rehabilitation Service. Outline. What does intimacy & sexuality mean to you? Impact of Stroke and Brain Injury on intimate relationships and sexuality Strategies Who can help

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Intimate Relationships & Sexuality After a Stroke or Brain Injury

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  1. Intimate Relationships & Sexuality After a Stroke or Brain Injury West Park Healthcare Centre Neurological Rehabilitation Service

  2. Outline • What does intimacy & sexuality mean to you? • Impact of Stroke and Brain Injury on intimate relationships and sexuality • Strategies • Who can help • Helpful resources

  3. Attractiveness Self confidence Closeness Compatibility Pleasure Passion Enjoying activities with someone Intercourse Love Marriage Reproduction What does intimacy & sexuality mean to you?

  4. What is sexuality? • Sexuality & intimacy is a central aspect of being human • Different for everyone • Includes sex, gender identity and roles, sexual orientation, pleasure, intimacy and reproduction • Experienced and expressed in our thoughts, behaviours, beliefs, attitudes, values, practices, roles and relationships

  5. The location of your injury matters

  6. Effects of Brain Injury on Intimate Relationships & Sexuality Intimate Relationships & Sexuality

  7. Medical & Physical Issues • Medications • Physical Limitations • Fatigue • Pain and Sensitivity • Arousal and Erectile Dysfunction • Incontinence • Medical & Physical Issues

  8. Medications • Medical & Physical Issues Some medications can cause decreased sexual desire and interest It is important to continue to take your medications, please speak with the doctor or pharmacist if you have questions. • Anti-hypertensive (lower your blood pressure): treating hypertension may improve erectile function • Antidepressants • Anti-seizure medications • Opioids: hydromorphone, morphine • NSAIDs – Advil, naproxen • Sleep medication: lorazepam, zopiclone

  9. Physical Changes • The following can impact your activity level after a stroke or brain injury: • Muscle stiffness • Muscle weakness • Loss of muscle tone • Spasticity • Decreased endurance • Medical & Physical Issues

  10. Fatigue • People with stroke and brain injury fatigue more quickly • This fatigue may not be helped by sleep or rest • This type of fatigue can last days to months & can persist for years • Fatigue affects sexual life in people with stroke and brain injury more than those without a brain injury • Medical & Physical Issues

  11. Pain and Sensitivity • Medical & Physical Issues • You may experience decreased or increased sensation in your body • When you have pain you may be less likely to participate in daily activities • Pain and sensitivity, anywhere in your body, may affect your sexual health

  12. Arousal and Erectile Dysfunction • Medical & Physical Issues • The part of your brain that controls sexual desire and arousal can be impacted after a stroke or brain injury • The most common sexual changes following stroke or brain injury include lower sex drive, changes with arousal and erectile dysfunction

  13. Psychological Effects • Psychological Effects • Change of Emotions • Sense of loss • Decrease in confidence • Depression • Cognitive changes

  14. Psychological • Effects Emotional Reactions After Stroke or Brain Injury • Anger • Anxiety • Embarrassment • Guilt • Loneliness • Grief and Loss • Sadness • Don’t feel like themselves How you feel can impact your relationships with loved ones.

  15. Sense of Loss and Changes in Self Confidence • Psychological • Effects • Decrease in confidence level • Isolated or frustrated • Body image changes • Feeling of unattractiveness or not feeling like yourself

  16. Depression • Psychological • Effects • Depression is common after stroke or brain injury • Symptoms: • lack of energy, changes in sleep, decreased appetite, irritability • Depression can also affect your relationship with your partner, including changes in your sexual activity. • Treatment can include talking with your healthcare provider and/or starting medications • Speak with your healthcare team if you have concerns you may be depressed

  17. Cognitive Changes • Psychological • Effects • Poor concentration • Memory deficits • Difficulty remembering events or details • Difficulty with social skills and communication • Understanding social cues • Planning how to interact with others • Personality changes • Persistent behaviours or thoughts

  18. Relationship Changes • Relationship Changes • Relationship Changes • Communication difficulties

  19. Relationship changes • Relationship Changes Altered roles • Partner may now be a caregiver • Supporting a person with stroke or brain injury can be positive and rewarding for a partner Loss of equality in the relationship • May require more help with daily activities • Focus on previously enjoyed activities Decreased spontaneity • May need to put more planning into intimate activities • Sexual encounters may be “different” now

  20. Communication difficulties • Relationship Changes • You may have more trouble communicating your needs and wants • Talking about intimacy can be difficult because it is an emotional topic • Plan for the conversation by thinking about what you want to say to your partner • Your speech therapist can help you with expressing your thoughts

  21. Strategies • Connecting your partner/spouse • Effective Communication • Finding new relationships • Returning to sexual activity • Energy Conservation

  22. Connecting with your partner or spouse • Connect in ways that build intimacy • movie nights, cooking, playing games • rekindle old interests • Laughing, sharing stories

  23. Connecting with your partner • Five love languages • Words of affirmation • Giving gifts • Acts of service • Quality time • Physical touch (touching, kissing, hugging)

  24. Effective Communication • Talk to your partner • Share your feelings and concerns through writing, speaking and body language • Take time to ask and listen to your partner’s thoughts and feelings • Use ‘I’ statements • reduces blaming the other person • Calm and firm tone of voice

  25. Finding New Relationships • Plan to meet other people • consider what you like to do • Join an activity or hobby you like • Make yourself available • get out of the house, join a group • Take care of yourself • Dress up, focus on self-care • Develop qualities you admire in others • (humour, caring nature, smile, etc.)

  26. Returning to sexual activity Both partners need to consent to any sexual activity Following a stroke or brain injury, a person’s inhibition or judgment can be affected and this needs to be addressed prior to engaging in sexual activity

  27. Returning to sexual activity No one should be forced or pressured to engage in sexual activity Being ready to resume sexual activity will be different for each person in the relationship Having fears and anxiety regarding sexual health after an injury is normal Both partners should feel comfortable and should explore and discuss their concerns

  28. Sexual intimacy • Sexuality is more than sex! • Talking • Touching • Kissing • Cuddling • Massages • Masturbation • Take time to discuss and get creative, and discover new ways to sexually engage with your partner

  29. Energy Conservation • Planning • Time of day • Allow adequate time for intimacy • Prioritizing • Prioritize dedicated time for Intimacy • Limit strenuous activities throughout the day • Pacing • Take things at a slower comfortable pace that is best for you • Rest between activities • Positioning • Try different positions –allow your partner to take on a more active role, positions that reduce stress on the affected side, semi-reclined side lying. Use pillows to support weaker limbs.

  30. General Tips • Environment • Relaxing environment – music, dim lighting, candles • Incontinence - use the bathroom prior to sex and empty a catheter bag if applicable • Comfortable room temperature • Medication • Keep up with your medication as per your doctor’s advice • Other Tips • Avoid heavy meals or excessive alcohol • Be aware of signs of distress and take breaks as needed • Stay active to increase overall endurance increased mood

  31. Who can help? • Doctor • Nurse • Physiotherapist • Occupational Therapist • Pharmacist • Social Worker • Speech Language Pathologist • Psychologist

  32. Where else can you find help? • Book: The Ultimate Guide to Sex and Disability. https://www.corysilverberg.com/sex-and-disability • Barry McCarthy: Rekindling Desire • Barry McCarthy: Sexual Awareness • Pleasure ABLE: Sexual Device Manual for Persons with Disabilities http://www.dhrn.ca/files/sexualhealthmanual_lowres_2010_0208.pdf • Sexual Aids: www.mypleasure.com/education/disability/index.asp • Heart and Stroke Foundation – sex and intimacy

  33. Sexuality and Brain Injury

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