Relationships and intimacy

Relationships & Intimacy

If you have had a brain injury and are in a relationship with a spouse, partner, boyfriend or girlfriend, this page is written for you. If you are single or dating at the moment, we hope you will also find it useful. To avoid repeating the phrase ‘spouse, partner, boyfriend or girlfriend’, we use the term ‘partner’ to cover them all. We suggest both you and your partner read this section to get the most out of it.

Many couples have difficulties after a brain injury. You and your partner have probably been through a lot and have overcome many challenges. Adjusting to life after a brain injury can often feel like being on an unplanned journey without a map! It is not surprising that many relationships come under pressure.

In this section, we explain the common reasons for relationships and intimacy difficulties after a brain injury, we suggest things that may help and where to get further support.

Professional advice can be helpful to some people. We also provide a list of professionals, organisations and websites that offer services and further advice if you need it.

Effects of a brain injury

A brain injury can affect you in many different ways

The different ways that your brain injury affects you, can influence how you feel. How you feel is likely to have a knock-on effect on your relationship. For practical suggestions on living with the effects of a brain injury, see I have a brain injury.

Important elements of a healthy intimate relationship

Open, honest and respectful communication is considered to be the lifeblood of a healthy relationship. For more on communicating, see Changes in how you communicate below.

Changes in roles and responsibilities

How a brain injury may affect your roles and responsibilities

It is important to bear in mind how your brain injury is affecting your partner as well as you. If the roles in your relationship have changed since your injury, you both need time to adjust. If you had to give up work or you cannot do as much around the house now, this can put extra pressure on your partner as well as being difficult for you.

It is common to feel insecure about what your role is now and even to feel resentful if your partner’s life seems to be going on as normal but yours has changed. Bear in mind that your partner has probably been affected a lot by your brain injury but they may be trying not to show it.

Doing enjoyable activities with your partner triggers beneficial chemical messages in your brains. This can reduce feelings of stress and make you both feel more content.

Roles and responsibilities – what you and your partner can do

• Bear in mind that it takes time to accept new life situations. Try to be patient with yourself and your partner. Give each other time to adjust.
• Try to take each day as it comes and avoid worrying about things that may not even happen in the future.
• Tell each other how you are feeling about any changes in your roles even if it you find it hard.
• Focus on the things and people that help you to stay strong as a couple. This might be keeping in touch with supportive family members, meeting up with friends or doing activities you enjoy together.
• If there are things such as work you have had to give up, try not to dwell on them. Focus on what you can do and on the ways you are contributing.
• If you or your partner are finding things difficult or if any problems you had before, are worse now, try the communication tips that follow or consider getting counselling (see Help and Information below for contact details).

Changes in how you communicate

Communicating

A brain injury can affect how we communicate, whether we have a speech and language difficulty or not. We express ourselves and respond to other people by using body language as well as speech. Gestures, facial expressions and touching are all important. A brain injury can bring stress into a relationship. When we are feeling stressed, we all react in different ways. Some people become quieter; others become more talkative or even become aggressive.

Common problems that affect communication after a brain injury

• Finding it hard to express, or control, your emotions.
• Finding it hard to keep up with conversations.
• Speech and language difficulties or hearing loss.
• Dominating conversations – for example, talking a lot about things that bother you or interest you.
• Not thinking to tell your partner you care.
• Speaking without thinking and causing your partner embarrassment without meaning to.
• Having rows over small things because you often feel frustrated, tired or irritable.

• Try not to bottle up your feelings. Remember to ask your partner what they are feeling as well.
• If fatigue or irritability affect you, take frequent rests and try the tips in the sections Fatigue and Sleep and Anger, irritability and mood swings pages.
• Memory – it is not worth using energy arguing over something you can’t remember clearly. Let it go. If memory difficulties are affecting you, assistance from a psychologist may help. Our Living with changes in your memory page has practical tips to try.
• Remember to talk about things that don’t relate to your brain injury.
• If there is something important to discuss, write down the points you want to make. Pick a time and place when you are both relaxed if you can. Afterwards, write down what you have agreed.
• For advice on talking about sex, see below.

If you have a speech and language difficulty:

• Try to talk somewhere quiet, take your time and keep up comfortable eye contact with your partner.

Problems after a brain injury and what you can do

How a brain injury can affect your sex life

Sexual difficulties are quite common after a brain injury. The reasons can be physical, hormonal, emotional, psychological, related to medications or a combination of these. Problems can happen with the way our body and brain work during sexual arousal, sexual activity (including intercourse) and climax (orgasm).

• Doubting your own attractiveness and having performance anxiety – ‘Will my partner still find me attractive?’ ‘Will I be able to satisfy them?’
  – Tell your partner your worries so they understand what you are feeling. If things don’t go well the first time you are sexually intimate, don’t give up. Talk about it and see what you can both do differently next time. Remember, there are professionals who can help also (contact details in Help and Information).
• Not feeling as emotionally close to each other as you did.
  – Plan some positive changes you think may help (see Changes in how you communicate above for ideas).
  – Give yourselves a couple of weeks to see if things improve. If they do not, you could consider going to individual or couples counselling (see Help and Information below).
• Less interest in sex – this is the most common effect of a brain injury on sexuality. Try lying together or sensual massage as a way of keeping some intimacy. Seeing a registered Sex Therapist may be beneficial.
• Overly high sex drive, not being able to control sexual impulses or acting inappropriately – for example, talking explicitly, or touching sexually, in public. Get advice from your GP, a Clinical Psychologist or a registered Sex Therapist. A type of talk therapy called Cognitive Behavioural Therapy, or sometimes medication, may help.
• Personal hygiene – it can be harder to keep this up after a brain injury if your mood, memory, motivation or mobility are affected. Try sticking to a regular routine of showering and personal care every day.
• Poor bladder or bowel control or fear of being incontinent – get advice from your GP or therapist.
• Muscle or joint pain – having a hot shower, massage or doing stretches prior to having sex can help relax you and reduce the pain. Use body positions during sex that put the least strain on any painful areas.
• Weakness, paralysis, or reduced mobility or feeling
  – Try a firm mattress. A larger bed might also help. It is possible to get double-sized hospital beds.
  – Ask your partner if they will take a more active role.
  – Lie on your back or the affected side if pain allows.
  – An Occupational Therapist (OT) can advise you on making movement in, and around, your bed easier.
• Sexual dysfunction – this includes not having orgasms, pain, erectile or ejaculation problems in men or vaginal dryness in women. If these or similar difficulties are affecting you, get medical advice.
• Hormones – a brain injury can affect hormones that are important for becoming aroused, for sexual activity and for orgasm. Hormonal difficulties can occur quite some time after an injury. See your GP.
• Medication, alcohol and recreational drugs can affect sexual function. This includes some medications for seizures, high blood pressure, antidepressants and tranquillisers. Ask your doctor.

Talking about sex

A lot of people find it embarrassing to talk about sexual difficulties. Some tips to make talking easier are:

• Choose a time and place when you are both relaxed. Choose only one or two things to focus on.
• Remember to talk about positive things as well.
• Tell your partner your worries. A lot of people worry about not being attractive, not being able to perform, being rejected or even splitting up. If talking to your partner is too hard, try speaking to your GP, another professional or a close friend first.
• Listen to your partner. Try to take on board things they are worried about.

Sex – what you can do

• Relax. Use extra pillows if that helps. Have the room at a comfortable temperature.
• If you are easily distracted, remember to turn your phones to silent and try to keep the room peaceful.
• Ask your partner what they want. Without realising it, many people become more self-centered after a brain injury. It is important to make sure your partner, as well as you, is getting what they want from sex.
• Be patient. If things are not going well during sexual intimacy, tell each other. It can feel embarrassing but talking can make a difference. Keeping your sense of humour can really help too!
• Get professional advice. If your difficulties are only occasional, there is probably nothing to worry about. However, if any issues are persistent or are bothering you, talk to your GP, nurse or a registered Sex Therapist (see Help and Information for contact details).
• If you cannot have sex. Having sex, or a close physical relationship, can help keep intimacy alive. However not all couples can. You can help stay intimate by having sensual experiences such as a romantic dinner, fantasising, massage, kissing or hugging. Seeing a Sex Therapist may be helpful (see Help and Information below for contact details).

The Sexual Wellbeing Service in the National Rehabilitation Hospital (NRH), Dun Laoghaire, offers specialist sex therapy, counselling and advice to people affected by a brain injury.
NRH t: 01 235 5288 w: www.nrh.ie

To find a registered Sex Therapist in Ireland and for links on disability and sexuality, visit www.cosrt.org.uk or phone The College of Relationship and Sexual Therapists UK. t: 0044 208 543 2707

Headway offers community-based brain injury counselling, psychotherapy and rehabilitation in Cork, Dublin, Kerry and Limerick. Contact us nationwide for additional booklets, support or information.
t: 1800 400 478

Public Psychologists or Counsellors – your GP or Public Health Nurse can refer you.
HSE t: 1800 700 700 w: www.hse.ie

Family Resource Centres provide low-cost or free counselling.
t: 01 4200 580 w: www.familyresource.ie

Accredited Private Counsellors and Psychotherapists
w: www.counsellingdirectory.ie 

w: Irish Association of Humanistic & Integrative Psychotherapy (IAHIP) – Home

Registered Private Psychologists – Psychological Society of Ireland
t: 01 472 0105 w: www.psychologicalsociety.ie

Public Occupational Therapists are available through a referral from your GP to your local Health Centre.
HSE t: 1800 700 700 w: www.hse.ie

Private Occupational Therapists
t: 01 874 8136 w: www.aoti.ie