Synapse - reconnecting lives

Surging hormones and the wish for a successful social life fuel a teenager's interest in sex.

For parents, adolescence can be challenging. For young people, it is exciting and potentially risky, and a brain injury can increase these risks.

For example, where judgement, planning skills, social skills and self-esteem are all affected, a young person is at higher risk of unplanned pregnancy, sexually transmitted disease and sexual assault. These young people may be vulnerable to being exploited and manipulated, and sexual activity may be a response to feeling isolated. Impulsiveness can further increase the risk.

Reduced self-esteem and self-confidence, and decreased social skills, can affect a young person's ability to develop relationships and be accepted by others. In addition, some people with a brain injury lose the normal inhibitions we place on our behaviour. They may do and say inappropriate things - for example, use sexually explicit language or masturbate in public - and this inevitably affects the way others relate to them.

Physical disability following a traumatic brain injury can affect a young person's ability to engage in sexual or self-pleasuring activity, and an injury during adolescence-a time when acceptance by peers is so important-can have a devastating effect on self-image and self-esteem.

Sex education & guidance

To negotiate these years safely and successfully, all young people need to learn about their sexuality. They need to know how to avoid risks to their health and their social and emotional development, and find positive and healthy ways to express their sexuality.

The risks involved in sexual behaviour have changed over time. Unplanned pregnancies have decreased-but the risks of sexually transmitted disease, including HIV/AIDS, are real. Attitudes towards homosexuality are more positive-but young people can still feel shame, guilt and regret about their sexuality.

Having information is a good first step. It doesn't prevent all problems-adolescents aren't always able to put theory into practice. However, research shows that teenagers who receive appropriate sex education tend to delay first intercourse, use contraception and avoid pregnancy. Of course, family input is crucial, too.

Like their peers, young people with a brain injury need:

• Informal education, at all ages, on sex and self care such as having their questions answered by trusted adults
• Formal sex education, such as that provided by schools.

Young people often need extra time to absorb information and learn self-care - for example, managing monthly periods for a young woman. And a young person with a brain injury who thinks concretely may need to practice skills in a variety of specific situations - it may be very difficult for them to generalize from one situation to others.

Young people with a brain injury are also more likely to need very firm, clear guidelines about what's appropriate. A degree of tolerance is needed - if they do or say inappropriate things, shaming or punishment doesn't help. The issue needs to be dealt with quietly and firmly, without condemning the person.

Sometimes a trusted adult or young person outside the immediate family is in a better position to provide information, support and advice.

Good relationships and social skills, and good self-esteem, provide a strong foundation for a safe passage through the turmoil of adolescence, and this needs to be the central focus in assisting and supporting young people with a brain injury. It also helps to address the biggest concern of many parents: that their child may not have satisfying social relationships or be able to find a partner.

For an extensive catalogue of information and services relating to relationships, sex, sexuality and sexual health when someone has a disability, contact your local Family Planning Association.

When young people are sexually active

Young people with a brain injury  who are sexually active may be at risk because of poor judgement, planning and follow-through, and/or of social awareness and skills. For example:

• They may be less likely to use 'safe sex' methods to prevent infection or unwanted pregnancy
• They may be more likely to deny symptoms of infection.
• If they have an infection, they may delay seeking treatment or not complete a course of treatment, especially if symptoms decrease.
• They may not inform their sexual partners about any diagnosed infection they have.

Even when they see a health professional, diagnosis may not be correct, and relevant health and education issues may not be discussed. This may be because the young person has difficulty communicating or because the health professional is unfamiliar with the effects of a traumatic brain injury.

These are difficult issues for parents to address at the same time as respecting their young person's privacy. You may be able to go with your young person to the doctor, or get a friend to go, or rehearse with the young person what they will say to the doctor.