Kids Health Info

Brain Injury - Sexuality

  • Sexuality is a healthy and natural part of living. A child's sexuality reflects his/her personality and encompasses thoughts, feelings, values, physical development, actions and drives. It is more than sexual activity and behaviour. As a child progresses towards adolescence, their sexual development and growing maturity include the additional issues of physical and hormonal changes, relationships, body image, sexual characteristics and sexual preference.

    While issues of sexuality impact on a child from the time of birth to adulthood, it is during the transition period of adolescence that the impact of sexual development and disability can become a concern for children, families, school and community.

    Sexuality issues for young people with a brain injury

    Parents and teachers may be concerned the child's brain injury may impact on normal sexual development and behaviour. For some young people, the brain injury will have no effect or little impact.  It will not cause physical changes or interfere with the child's ability to learn about sexuality, or to make friends and develop relationships. However, for some children, the physical, cognitive, psychological, emotional and behavioural changes or difficulties following brain injury may impact on sexual development or behaviour.

    Physical considerations

    After a brain injury, some children with moderate to severe physical disabilities may have specific problems which will impact on their sexuality and possible sexual activity. Some severe physical problems could directly affect a young person's ability to engage in and enjoy normal sexual activities or to manage menstruation. The social impact of physical impairments can affect a young person's ability to be accepted by others and develop more socially mature relationships.  For many young people, this can result in reduced or poor self-image.

    Occasionally, after severe brain injury, puberty may begin earlier than would normally be expected (ie under the age of nine or 10 years). Development of sexual interest and growth spurts are part of this precocious (early) puberty. Managing these physical and emotional changes can cause problems for the child, family, peers and school.

    Ways to help

    • Assessment and appropriate counselling, focussing on physical disabilities and options for engaging in social and sexual activities.
    • Specialist advice regarding precocious puberty is recommended. Help from the child's paediatrician, social worker and occupational therapist regarding adjustment issues, sex education and menstruation management is available.

    Behavioural aspects

    Following a brain injury, some young people may behave in a disinhibited or sexually inappropriate way. Sexual innuendoes and comments and/or inappropriate touching may lead to peer rejection, ridicule or punishment at school. Sometimes this disinhibited behaviour, together with poor awareness and impaired social skills, may place a child in a vulnerable social situation where she/he could be the subject of exploitation or sexual abuse.

    Ways to help

    • Ensure the child has received and understands the key issues of sex education including protective behaviours.
    • Seek help from the rehabilitation team to determine appropriate intervention.
    • Discussions about the behaviour should occur between the young person, their family and school to gain a clear picture of the context of the behaviour, where and how it occurs and its consequences.
    • Reach agreement between parents, teachers and the young person about the approach to be taken to change the behaviour to ensure consistency between home and school.
    • Give clear explanations about which behaviours are not appropriate and why not. Outline consequences for unacceptable behaviour.

    Psychological considerations

    The ability for young people to develop relationships and learn appropriate social skills may be affected by physical and psychological impairments. They may feel less attractive and socially capable than their peers and these feelings can impact on their ability to develop and maintain relationships. It could also contribute to low self-esteem and lowered self-confidence. Together with problems of impaired memory, planning and organisation, decreased intellectual skills can also affect a young person's ability to learn about sexuality and appropriate behaviours.

    Ways to help

    • Look for ways to improve self-esteem in a variety of home, school and social situations.
    • Focus on the young person's strengths.
    • Consider whether sex education can be specifically tailored to the needs of the child with impaired memory, planning and organisational skills.
    • Link with rehabilitation and school programs offering social skills training to address: meeting other people, making friends, anger management and protective behaviours.
    • Contact the rehabilitation team to discuss any concerns about sexuality issues.

    More information

     

    Developed by the RCH Paediatric Rehabilitation Service, based on the Sexuality factsheet produced by the Brain Injury Service, The Children's Hospital at Westmead. First published April 2007. Updated November 2010.


Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.