People with TBI are as varied in their sexual knowledge and experience as are the rest of the community. Some will have sound knowledge and broad experience from before the injury that helps them deal with post-injury sexual issues. Their confidence in their ability to have sexual relationships is likely to be affected if they have lost some social sensitivity, or have developed sexual dyscontrol as part of a general pattern of disinhibition, or have suffered loss of self-esteem and changed body image. In these circumstances they will need help to deal with their losses.

Other individuals will have had very little information and less experience before their head injury. If they are still young, they will need to be given appropriate sex education in accordance with their family’s values, as well as follow-up opportunities to develop psychosocial and sexual skills.

All people, including those with TBI, are entitled to have basic needs in human relationships and sexuality met.

1. Development of self-awareness and self-esteem

• Sense of oneself as a unique individual, who is an acceptable person, after a head injury.
• Development of personal beliefs and values.
• Awareness of own feelings and an understanding that everyone has them (anger, love, embarrassment, hate, confusion, loneliness, guilt, fear, etc.)
• Being able to express feelings in acceptable ways and to change them if required.

2. Body awareness

• Development of a positive body image after a head injury.
• Sense of ownership of, right to, or control over, one’s body.
• Information about how the body works, including sexual and reproductive parts.

3. Awareness of others

• Awareness of others, including their difference and sameness to us.
• Awareness of the way we affect others via our actions and feelings, and development of responsibility for our own actions.

4. Relationships

• Understanding of what relationships are, different kinds of relationships, different kinds of behaviour involved in them.
• Understanding of, and skills involved in, making and maintaining relationships.

5. Awareness of social custom/rules/values

• What is considered acceptable behaviour in the general community, and variations in relation to particular communities where appropriate.
• Specific awareness of appropriate physical touching in relationships and of one’s own body.
• Discussion about different values people hold, particularly in areas of sexual morality.

6. Self assertion

• Developing confidence in interacting with others and asserting one’s own views and needs. This results in:
  – less vulnerability to exploitation
  – less compliance
  – greater responsibility for self
  – problem-solving and negotiating skills
  – understanding the consequence of one’s actions.

7. Awareness of self as a sexual being

• Understanding that sexuality is a normal and healthy part of life and that we have choices about its expression.
• Understanding the differences between love and sexual desire (they are not the same thing) and appropriate ways of expressing them.
• Accurate, non-judgmental information about sex, including possible consequences, such as pregnancy and sexually transmitted diseases including HIV.
• Issues of rights and responsibilities and issues connected to sex and different kinds of relationships.

Adapted from Sexuality: Rights and Choices produced by Philomena Horsley and Sylvia Azzopardi for the Family Planning Association of Victoria, 1990