By Rachael Larkin, Clinical Lead (Brain Injury Group)
As “Pride Month” draws to a close, I reflect on how being a member and ally of the LGBTQ+ community overlaps my professional work.
The word “pride” actually originated as an acronym that stood for Personal Rights in Defense and Education, an organization started in 1966 to fight for equal rights of LGBTQ+ persons in California, but the defining meaning of pride is ‘the consciousness of one’s own dignity’.
As I have experienced in my practice, brain injuries are a life altering event and can impact all areas of daily life; our sense of being and our relationships with loved ones, coupled with navigating physical and mental changes presents challenges to a person’s sense of dignity.
To ensure a holistic approach to rehabilitation, the changes to physical, emotional, cognitive and behavioral areas need to be supported, that includes the ongoing psychosocial and sexual elements that are important to a brain injury survivor.
Taboo Talk
Evidence has shown individuals with TBI have noted a low frequency of conversation with their health professionals in relation to their sexual and reproductive health concerns, and are usually derived from a reactive approach.
Although conversations around this topic can cause discomfort for some, it is important to ensure that consideration is given to a persons specific sexual and reproductive health issues pre and post injury, which left unexplored can impact rehabilitation goals, outcomes and their ongoing lived experience.
From capacity to consent, to care support and information sharing, the thread of persons sexuality and preferences are core to their presentation in the world. Those experiencing a disability and changes to their sexuality and function are often passively exposed to discrimination and outdated practices held by individuals and institutions positioned to support them. Often without any way to challenge or change the environment they are now exposed to.
Those that have experienced disturbance to the functioning of the frontal and temporal lobes are more likely to have their sexual health impacted, encompassing personality
changes, information processing, speech disturbance, and coordination difficulties to emotional lability, not to mention disinhibition or hypersexuality.
A significant proportion of TBI participants also reported decreased self-confidence, reduced sex appeal, higher levels of depression, side effects of medication, decreased communication levels and relationship quality with their sexual partner plus impacting choices around becoming/continuing as a parent.
Although women are statistically less likely to experience a brain injury than men, they, and those of the LGBTQ+ community often face the worst long term outcomes and face more social and financial barriers as a result.
Rainbows after the Storm
Although Pride is promoted in the month of June, the remaining 11 months still need to focus on accessibility and support, ensuring strategies and practices are put in place to meet the needs of this growing area of population.
Thankfully there are a flourishing number of services to assist those under the rainbow and disability umbrella and is an emerging area of research and practice. With professionals like Beaver Meadows a Disability and Sex Advocate, and Dr Giles Yeates, a neuropsychologist exploring relationships after brain injury sharing their work.
For further information or advice please contact Brain Injury Group Click Here
Glossaries
ParaPride – an organisation specifically set up to be a voice for those impacted by disability and identify as a LGBTQ+ is helping ‘fly the flag’
Regard – a social inclusion and activism resource
Resources
Dyer, K., & das Nair, R. (2013). Talking about sex after traumatic brain injury: perceptions and experiences of multidisciplinary rehabilitation professionals. Disability and Rehabilitation, 36(17), 1431–1438. https://doi.org/10.3109/09638288.2013.859747
Haag H.L., Caringal M., Sokoloff S., Kontos P., Yoshida K., Colantonio A. Being a woman with acquired brain injury: challenges and implications for practice. Arch Phys Med Rehabil. 2016;97 S64-70
Dombrowski, L. K., Petrick, J. D., & Strauss, D. (2000). Rehabilitation treatment of sexuality issues due to acquired brain injury. Rehabilitation Psychology, 45(3), 299–309. https://doi.org/10.1037/0090-5550.45.3.299
Mapou, R. L. (1990). Traumatic brain injury rehabilitation with gay and lesbian individuals. The Journal of Head Trauma Rehabilitation, 5(2), 67–72
Redoute J, Stoleru S, Gregoire MC, Costes N, Cinotti L, Lavenne F, et al. Brain processing of visual sexual stimuli in human males. Hum Brain Mapping. 2000;11:162–77.
Whittle, C., & Butler, C. (2018). Sexuality in the lives of people with intellectual disabilities: A meta-ethnographic synthesis of qualitative studies. Research in developmental disabilities, 75(2), 68-81.
Wilson, N., Macdonald, J., Hayman, B., Bright, A., Frawley, P., & Gallego, G. (2016). A narrative review of the literature about people with intellectual disability who identify as lesbian, gay, bisexual, transgender, intersex or questioning. Journal of Intellectual Disabilities, 22(2), 171-196.
