6.6 Take home messages

• Common changes to sexuality after TBI include lower sex drive, decreased frequency, erectile problems, and orgasmic problems, these can be due to both primary and secondary causes.

• Influences and values from family, culture, personal experiences and professional training can all influence your clinical decision making in terms of finding solutions to sexuality related problems for patients with TBI.

• People with a disability are entitled to the same rights as are enjoyed by every other citizen. It is the responsibility of service providers to enforce and protect these rights.

• Isolation and myths about the sexuality, or lack of it, of people with disabilities have deprived many people of information, skills or opportunities and made it difficult for them to exercise their rights and responsibilities in sexual functioning.

• All people, including those with TBI, are entitled to have basic needs in human relationships and sexuality met. There are many strategies to help with this.

• It is important to match verbal and non-verbal communication to get a message across effectively.

• There may be times when we feel distressed in response to a client sexual issue. It is normal to feel emotional discomfort to socially and sexually inappropriate behaviour. There are strategies for dealing with these feelings.

• Questions on sexuality can be incorporated into a patient interview to help identify issues.

• There are a range of treatment strategies that can be used to assist with physical impairments, erectile problems, low sex drive, problems with orgasms, masturbation problems and catheters.

• People after TBI have sexual needs that should be met. Even when a person's sexual needs are met, they may still behave in sexually disinhibited ways.

• The level of sexual drive only rarely increases after TBI - more usually it remains the same or decreases. Problems with disinhibition are far more common than problems with increased drive ('hypersexuality').

• Sexually disinhibited behaviour is normally part of a broader pattern of disinhibited behaviour

• Workers and family members often misunderstand sexually disinhibited behaviour as a derivative problem (sexual frustration or increased drive).

• Sexually disinhibited behaviour will not be extinguished by the person having more access to sexual activity.

• Sexually disinhibited behaviour is best managed through the consistent use of simple behavioural techniques. Setting professional boundaries and giving verbal feedback are important.