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ISSN 2691-8803
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Versions: Online (Open Access)
Year first Published: 2019
Language: English

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Changes In Partnership And Sexuality In Persons With Acquired Brain Injury (ABI)

Simona Tičar, Eva Ristič^*
Center KORAK for individuals with acquired braininjury, Kidričeva cesta 53, 4000 Kranj, Slovenia

Received Date: August 18, 2022; Accepted Date: August 26, 2022; Published Date: September 09, 2022
^*Corresponding author: Eva Ristič, Center KORAK for individuals with acquired braininjury, Kidričeva cesta 53, 4000 Kranj, Slovenia. Email: eva.ristic@center-korak.si

Citation: Tičar S, Ristič E (2022) Changes In Partnership And Sexuality In Persons With Acquired Brain Injury (ABI). Adv Pub Health Com Trop Med: APCTM-158.

DOI: 10.37722/APHCTM.2022404

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Introduction
      Partnership and sexuality after ABI are challenging. ABI affects physical, mental, emotional, behavioral, and social functioning [1]. Sexuality and partnership are parts of the holistic rehabilitation process.

      ABI-related deficits can shake the core of a partnership by affecting roles, responsibilities, trust, communication, emotional connections, and behavior toward each other [2]. ABI has a direct effect on sexual function or an indirect effect on motor, sensory, cognitive, behavioral, and emotional functions [3]. Changes in individuals with ABI also appear to affect the sexuality of their uninjured partner [4]. Hormonal changes affect the production of sex hormones [5].

Partnership Changes after ABI

• The relationship changes if the partner’spersonality has changed after ABI (Ahman, Yates 2017),
• Partners often take on therole of guardian for an injured partner (Rodger, Yurdakul, 1997 in Ahman, Yates 2017).
• Partnership reinforcements, family dynamics (Ahman, Yates 2017), and interaction of couples changes [2].
• Lack of inhibition results in socially inappropriate behavior (inappropriate touch in different situations and interactions), impulsivity, aggressive behavior, and hyper sexuality (Blacker by, 1994) [6].
• Changes in intimacy (asexual acts) - as emotional, physical, and mental closeness between two people, which is often accompanied by romantic emotions. Intimacy is asexual acts such as holding hands, caressing, kissing, and physical intimacy. Intimacy is affected if the victim has a lack of insight into their behavior or problems with anger management [2].
• Decreased satisfaction in the relationship, social-emotional abilities, and functioning are challenged (Abigail etc., 2007).

      The partners of people with ABI who have been in a long-term relationship (more than 15 years) accepted the changes of their partner and did not separate. The likelihood of marital separation or split between couples increases with time from injury. Between 5 to 6 years after the injury is the common period for the split to happen (Rodger and Yurdakul, 1997). A mature and responsible attitude of the injured partner contributes to the stability and survival of the relationship after PMP (Rodger, Yurdakul, 1997).

      The partners of people with ABI who have been in a long-term relationship (more than 15 years) accepted the changes of the injured person and did not break up. The probability of separation between partners increases with time from injury, with the turning point for relationship breakdown being approximately 5 to 6 years after injury (Rodger and Yurdakul, 1997). The mature and responsible attitude of the injured partner contributes to the stability and survival of the relationship after ABI (Rodger and Yurdakul, 1997). 

Changes in Sexuality after ABI

• The decreased desire for sex and less interest in sexual intercourse [7].
• Hypersexuality or hyposexuality [8], ejaculation disorders, anorgasmia, and decreased vaginal moisture [9].
• Loss of libido [9].
• Difficulty controlling sexual behavior, inappropriate comments, and sexual behavior.
• Problems with arousal.
• Difficulty in achieving or maintaining an erection [7, 10].
• Irregular menstrual cycles, difficulty conceiving, decreased amount of cervical mucosa, increased growth of hair on the face or body, worsening acne, changes in sex drive, and recurrent miscarriages [9].
• Lack of sexual desire in women, arousal, sexual pleasure, and orgasm (Strizzi et.al, 2015; Hibbard et. Al., 2000).
• Premature ejaculation [11] is the most common male sexual disorder.
• Reduced sexual/erotic thoughts or fantasies arousal, sexual behavior, and difficulty achieving orgasm in women (in Sander, 2012) [12].
• Disrupted sexual behavior - sexual content manipulation, genital exposure, and public masturbation. Sexual behavior may occur in appropriate contexts [13].
• Sexual dysfunction following ABI is associated with symptoms of depression (in Sander etc., 2012) [12] and anxiety. 

Sexual Problems Are Affected By

• Body changes, gender identity, self-image, depression, and anxiety [14], Tyerman, Humphrey, 1984).
• Reduced self-confidence, deterioration of mood, the elevation of anxiety, and communication problems (dysphasia -difficulty to express thoughts in words), which can make it difficult for a person to express love and affection or develop a relationship [3].
• Medications (antidepressants) can cause erectile dysfunction [3]. Impaired cognitive functions, including impaired control of behavior, communication, social judgment, and egocentrism affect the ability to have quality interpersonal relationships [4].
• Physical impairment - spasticity, poor balance, poor control of fine movement, and tremors (ataxia).
• Poor control of swallowing and consequent salivation, reduced sensitivity or. Hypersensitivity affects sexual pleasure [3].
• Loss of taste and smell correlates to a decrease in sexual arousal and pleasure.
• Limited opportunities for intimate contacts [4].
• Decreased ability to become physically aroused andexperience orgasm [4].
• People aged 46–55 report the greatest reduction in the quality and frequency of their sexual experiences [4].

Method 

Participants: The case study involved 16 people (25% women and 75% men) who suffered a traumatic or non-traumatic brain injury. Allare involved in the process of long-term and comprehensive rehabilitation at Center KORAK for individuals with acquired brain injury. Before publishing research, individuals signed written consent forms. 

Measures: Diagnostic-oriented open type of interview The structure of the questionnaire was adjusted according to the cognitive and emotional characteristics of people with ABI. The frequency of interviews depended on the ability of people with ABI. GRISS questionnaire (Rust and Golombok, 1986a). Partnership Assessment Form (RRF) (David, 1996; in Bele, 2011) [15].

Procedure: The survey was conducted in January 2022. After obtaining the consent of the participants, we applied a questionnaire. The results were processed with the SPSS program. We researched the areas in more detail with a diagnostic-oriented interview [16-23].

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Results

 Table 1: Diagnostic interview findings.

  

RRF	M	SD
Enjoyment	4,14	0,967
Success	4,17	1,266
Reciprocity	4,11	1,173
Respect	4,25	1,164
Spl. Satisfaction	4,16	1,112

 Table 2. Results on the scale of the Partnership Assessment Form (RRF). 

      In present case study, the quantitative results do not match the qualitative results. Qualitative results were based on answers disclosed during the interviews. Possible misunderstandings of delicate questions included in the questionnaire are not excluded. Relationships after ABI are challenging, yet despite the difficulties, people after ABI are very happy in the partnerships. The questionnaire was answered by 75% of the participants that are in currently in partnership. People with ABI are on average very happy with their partner and feel worthy and unique with their partner. On average, they are happy in a relationship that meets their needs.

 Table 3: Average raw results on the GRISS questionnaire.

       Individuals with ABI have intimacy issues in the areas of sensuality, dissatisfaction, and premature ejaculation. On average, women are most dissatisfied with the duration of foreplay, sexual intercourse, and orgasm.

Figure 1: Male GRISS profile.

       58.33% of people with ABI generally report dissatisfaction (with ≥5), 50% report impotence problems, 50% report premature ejaculation problems, and 58.33% report irregular sex. All participants report problems with cuddling.

Picture 2: Female GRISS profile.

      60% of participants have problems with dissatisfaction and vaginismus. 100% of them have problems with sensuality and affection. In the survey, all men and women (100%) perceive the most problems with intimate contact.

 Table 5: Identification of problems in the field of partnership and sexuality based on a diagnostic interview and questionnaires in the process of long-term rehabilitation after ABI.

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Conclusion

 Table 6: Interventions.

      In the process of rehabilitation after ABI, areas of partnership and sexuality are among the most demanding, both for people with ABI, professionals, and researchers. We estimate that people with ABI lack insight into their abilities or conceal their inabilities in the areas of sexuality and partnership. It is observed that men more often conceal their abilities and competencies in the field of sexuality and partnership due to ego states and social roles. The research concludes the development period does not affect partnership and/or sexuality. In participants of this study, achieving developmental tasks in the development period was impacted by ABI.\

      A good, therapeutic, supportive work alliance that cultivates a high level of trust from individuals with ABI was and is required. Psychologist who processes, researches, and interprets these most sensitive topics, respecting the dignity of fellow humans, while obtaining information in qualitative research, helps individuals with their rehabilitation journey.

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