What is sex or intimacy really?

Normally, with a healthy body and mind, sex can be fabulous, exciting and joy. It really is the ultimate enjoyment of each other and a very concrete expression of one's love for each other. In my humble opinion, great sex is a fine mixture of friendship, compassion, humor and respect for each other. A fully compassionate acceptance of one another, of one another's body, is the basis for a true making love to each other.

Of course you can have intercourse with another person much more based on lust, such as in a one-night stand with someone you really don't know that much. But that is not the kind of making love I am talking about here. That kind is shallow, a real connection is never really made, well at least it is very temporary. However, who am I to judge? When it is mutually accepted and willingly sought, there is not much wrong with it.

But the really great type of sex, is the kind in which two people know each other very well and can accept each other as they are. Their love for each other is expressed in intimacy, how soft or wild that may be. It is this kind of making love that can be hurt the most after brain injury.

Brain injury can seriously reduce your sexual skills

For really intimate sex you'll need compassion, especially empathy and consideration. A touch of gentleness, humor would be nice as well. For example, I and my girlfriend can lay naked against each other, legs intertwined, but we never have to do the 'deed' itself (intercourse, I mean). We can caress each other, touch each other's arms, legs, fingers, lips, kiss each other, but we can do this while talking about daily life. Actually, we do talk quite often when we are making love (well not at the same time), about our ideas of other children, our future together, and other things we care about. Usually, we laugh a lot as well. It's a very relaxing experience and we feel the warmth for each other.

Unfortunately, brain injury can change this and usually it does. The most heard complaint of a healthy partner after making love with someone with a brain injury is that the intimacy is much less, or even gone. As if someone is less attentive, less caring after his or her injury. And yes, that is indeed true. Most brain injured patients are more focused on themselves, have less attention to divide between themselves and their partners, and are much more easily tired. So they tend to be heading just too quickly towards an orgasm or lust for themselves. And in this process they seem to notice less the needs of the healthy partner.

Especially when their body is changed due to their head injury. After a stroke, it happens that one side of the body is more paralyzed so it is much more difficult to even have intercourse with each other. Usually, you both need to find other positions or some other ways to please each other. And that kind of change requires flexibility, patience and communication between each other. And these skills can be hindered by a brain injury.

Even worse, someone can become less empathic, less compassionate, and much easier irritated with less patience. Sex can be tiresome, sometimes a bit painful, so it requires delicate flexibility and constant communication and monitoring each others needs. These skills require much attention and a full control over one's emotions. That's just two things brain injury has usually damaged.

Is there any hope for improving your sex life after brain injury?

Yes, certainly. But it depends on how serious personality changes have taken place after brain damage. There are stories in the literature (see also my page about personality changes after brain injury) about pseudo-psychopathic behavior when someone has become much more impulsive, less patient and much less empathic. Then making love turns into a nasty experience, and some women even described it as 'being raped'. In such cases the prognosis is not good: usually the relationship ends, in most cases the woman leaves her husband.

But most of the time, there is hope. Hope that with some tips and counseling, a couple can make love to each other in a fantastic way, even with the effects of a brain injury. When a relationship has a nice quality before the brain injury, counseling is possible and usually accepted. Then there is a good chance to change each other's behavior in bed, just to achieve what I have called 'great sex'. However, in my experience, most hard work has to come from the healthy partner. Just because a brain injured person has more trouble to change him- or herself: less flexible, much easier exhausted or irritated. So the sad news is that the healthy partner becomes the therapist in the first couple of months. When they are lucky, making love becomes great and a new balance is created between the two loved ones.

Sex still is a taboo, especially with 'handicapped' people

But it certainly is not easy to achieve this. Sex still is sort of a taboo, even professionals don't talk about it easily. Especially not with handicapped people, as if it does not belong to them at all. There is only one way to solve this: get rid of your shame and reservations about this topic and just mention it when you are talking about the relationship, in a standard asking way. When people don't want to talk about it, they will say so. When they want to, they will. And the key to any chance of improvement of your sex life is when you are willing to talk about it. Usually, patients who want to improve their sex life after their brain damage, are very relieved at least someone has put this difficult topic on the table. Well, actually, I am just as relieved myself, having crossed this rather difficult border. Usually, we talk about it with a lot of humor, eases the tension, and smooths the talking. And when talking starts, anything is possible. There are very simple tricks and tips to give, to enjoy it in a different manner. As long as you can and want to enjoy someone else's body. 

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