Sex after Brain Injury: What does this look like for me?

May 30, 2019

= Authors =

Gabi Kaplan, Student Occupational Therapist

Jenni Diamond, OT Reg. (Ont.)

Evan Cole Lewis, MD


 Sexual Function following a Brain Injury

Sustaining a brain injury can lead to a variety of physical, cognitive, emotional, and behavioural issues that can change your sexual functioning and intimacy experiences.


Women & men may experience sexual issues differently


For instance, following a brain injury, you may be experiencing (1,2):

  • Decreased or increased desire to have sex
  • Decreased arousal
  • Decreased quality of sex
  • Difficulty or inability to reach climax/orgasm
  • Inadequate energy for sex

Women and men may experience sexual issues differently (2).


Some of the most commonly reported issues following a brain injury are (2):

Women Men
Difficulties with initiation and arousal Difficulties initiating sex
Difficulties with orgasm, or reduced sensation Difficulties reaching orgasm, or less intense orgasm
Difficulties with lubrication, leading to vaginal dryness Getting and maintaining an erection
Painful sex Premature ejaculation
Discomfort in positioning Body positioning and movement
Changes in menstruation
Inability to masturbate


These changes in sexual function might be due to (1,2,5):

  • Disruption of normal brain functions
  • Hormonal changes
  • Autonomic dysfunction (see explanation below)
  • Medication side effects
  • Fatigue
  • Movement and balance issues
  • Self-esteem issues
  • Changes in thinking
  • Emotional changes
  • Changes in relationships


Autonomic Dysfunction and Concussions

Following a concussion (also known as a mild traumatic brain injury), you might be experiencing similar sexual functioning issues that are listed above. One plausible reason for your changes in sexuality may be due to autonomic dysfunction, which can occur after a mild traumatic brain injury (mTBI) or concussion (3).


… one plausible reason for your changes in sexuality may be due to autonomic dysfunction…


Our autonomic nervous system is involved in influencing certain involuntary bodily functions, such as our:

  • Heart rate
  • Blood pressure
  • Digestion
  • Urination
  • Sexual arousal & orgasm

In fact, innervation of sexual organs is primarily mediated by the autonomic nervous system (4). So when this system is not properly functioning, your sexual response can be impacted.


What can I do to improve sexual functioning and intimacy?

  1. Communicate with your partner

Don’t assume your partner knows exactly what you are going through. Try your best to be as open as possible when speaking about all aspects of your brain injury, including your sexual issues.


  1. Plan and prepare for sexual activities (1,2)
  • Plan sexual activities for when you have the most energy and are less tired
  • Limit distractions in the environment (for example, set up a quiet room with limited background noise)
  • Create a relaxing and sensual environment (for example, light candles or have a warm bath together beforehand)
  • Stay hydrated before and after sex


  1. Pay attention to your body position during sex (1,2)

When having sex, position yourself so that you are not causing pain or dizziness. If you are having balance issues, position yourself to avoid falling or exacerbating the symptoms.


  1. Try new things to increase arousal and/or comfort (1,2)

If you are having difficulties getting aroused, try watching movies or reading books/magazines with sexual content. Additionally, try initiating sexual activity with foreplay, which can help psychologically and physically prepare you for sex. If penetration causes pain due to vaginal dryness, consider using a lubricant.


… your doctor, nurse practitioner, occupational therapist or psychotherapist… may be able to help you in identifying the underlying issue, manage your symptoms, and help develop a solution.


  1. Speak with your healthcare provider and seek advice (1,2)

This might include your doctor, nurse practitioner, occupational therapist or psychotherapist. They may be able to help you in identifying the underlying issue, manage your symptoms, and help develop a solution. Often, speaking about sex and sexual issues makes people feel uncomfortable or embarrassed. Try to remember that sexual activity is a normal aspect of our everyday lives. In addition to speaking to healthcare professionals, you may choose to talk to close friends or family members.



  1. Model Systems Knowledge Translation Center (2011). Sexuality after traumatic brain injury. Retrieved from:
  2. Ahmad, T. & Yeates, G. (2017). Sex and sexuality after brain injury. Headway: the brain injury association. Retrieved from:
  3. Esterov, D., & Greenwald, B. D. (2017). Autonomic Dysfunction after Mild Traumatic Brain Injury. Brain sciences, 7(8), 100. doi:10.3390/brainsci7080100
  4. Kaplan, H. I. & Sadock B. J. (1995). Comprehensive Textbook of Psychiatry. 1(6) 1296
  5. Purves D, Augustine GJ, Fitzpatrick D, et al., (2001). Autonomic Regulation of Sexual Function. Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates. Retrieved from: