“When a client discloses that they have a sexual health concern, we need to make sure that we respond in a positive way so that the issue can be addressed effectively. We need to make a response that comprises three elements. This can be called a ‘Very Normal Response’.

Validate

We need to validate the client’s concerns.
We can do this by saying “It is important that we address the issue that you have raised.”

Normalise

We need to normalise the issue.
We can do this by saying “Many people with brain injuries have had the same problem.”

Refer

If we do not have the knowledge or skills to address the issue, we need to organise a referral for the person.
We can do this by saying “I do not have the expertise to help you with this issue. But I would like to find someone that can. Would you be happy for me to do this? Would you feel more comfortable speaking with a man or a woman?”

Interviewing about sexuality – possible questions to ask

The following is a set of general interview questions that a person with TBI could be asked about their sexuality to help identify problems to be solved.

Have you noticed any changes in your sexuality since the brain injury?

Is sexuality an important issue for you at this time?

If you are not having sex, do you think ...

– erotic magazines
– sex videos
– sex workers
– masturbation
– phone sex lines
... will help to meet your sexual needs?

If you have been sexually active with another person/other people:

– was it good or not so good?
– why?
– did you take any safe sex precautions, eg. contraception?
– did you experience erectile difficulties?
– difficulties with ejaculation?
– problems with orgasm?
– was intercourse painful?

Have you noticed a change in your sex drive?

Do you think you are as sexually attractive as before the injury?

What sort of rules/values do you think are important in sexual relationships?

Where do you think sex should be placed in a relationship?

Since the injury, have you been taken advantage of or abused sexually?

Have you had any interactions with your family about sexuality issues?

What issues do you think arise for staff in relation to your sexuality? Have you had any interactions with your staff about sexuality issues?

If, during some interaction with a client, they say that they have a sexual concern, how would you respond to this situation? what sort of a response could you make? what other action might you take?