Sexuality and Intimacy After Burn Injury

Introduction

A burn injury can change the way your body looks, feels, and functions. In some cases, these changes in your appearance may be permanent. After a burn injury, the initial focus is on addressing your immediate, physical needs for survival. Once these needs are met and you are on a path to recovery, issues such as sexuality or intimacy may come up.

What Is Sexuality and Intimacy?

Sex and sexuality are important parts of everyday life. Sex refers to biological and physiological characteristics of your body, and is often used to refer to sexual intercourse. Sexuality refers to how you express yourself, your gender identity (the gender you feel you are), and your sexual identity (your desire for the opposite sex, same sex, or both).

Intimacy is a way to connect closely with oneself or another person on an emotional or physical level. Intimacy with oneself includes, for example, getting comfortable with one’s own body via masturbation. You may have different types of intimate relationships; not all intimate relationships are sexual.

Sexuality After Burn Injury

People have different sexual desires and use different ways to express them. Defining what is typical or common is hard. It is whatever gives you and your partner pleasure. It is important to have an open line of communication with your partner to deal with your sexuality.

It is normal to have doubts and fears during this time of healing. These feelings are a natural response to returning to a life of sexuality and intimacy. You are not the only one to feel this way after a burn injury. Talking about body image, sexuality, and intimacy can be hard to do. Sexuality and intimacy are possible regardless of your burn injury.

This factsheet includes information on how changes in your body after a burn injury may affect sexuality and intimacy, suggestions for how to adjust to the changes, and other resources that may help you.

Physical Effects of Burn Injury on Sexuality and Intimacy

Burn survivors may have physical problems or limitations that affect sexuality and intimacy. Here are some things you can do:

• Keep skin moisturized to lessen friction, blisters, or skin tears. You may need to try different positioning during sexual activity or different forms of intimacy. After a burn injury, newly healed skin may be fragile and prone to shearing.
• Good communication with your partner is important. Newly healed areas may be sensitive to touch. Areas with skin grafts may have little or no feeling. Areas with nerve damage may be more sensitive or may have no feeling. Communicating to your partner about your trigger points may be helpful. It is important to know that it may take time through trial and error to find what works for you and your partner.
• Consider trying different positioning or different forms of intimacy. Contractures or tightness that limits movement, amputations, surgeries, and general weakness may have a big impact on positioning during sexual activities.
• Talk to your doctor if you have lower energy or decreased desire. Most survivors of a severe burn injury have lower energy levels that may improve over time. Other issues that may affect stamina include changes in hormone levels, such as decreased testosterone or increased estrogen. Medicines – particularly those that treat depression and high blood pressure – can affect desire and stamina. They can also affect a man’s ability to get or keep an erection or to ejaculate. Do not stop taking any medicines suddenly because of side effects. Talk to your doctor about other medicines. Ask about blood tests to check hormone levels and nutrition status that may help your energy level and stamina after burn injury.

Psychological Effects of Burn Injury on Sexuality and Intimacy

Burn survivors may also have issues with sexuality and intimacy that relate to their mental, social, and emotional well-being. They may have reduced sexual desire and function. This may be due to the following:

• Body image effects: You may have changes in body image. Some individuals describe feeling:
  • Distress, shame, embarrassment, or anger. You may also feel inferior.
  • Abnormal.
  • Anxious about hiding or showing burns.
• Emotional effects: You may have changes in your emotional health. These may include changes in your ability to accept changes and manage your feelings as you work through challenges. These feelings may cause:
  • Fatigue.
  • Lack of sleep or changes in sleep patterns.
  • Stress and fear about having sex.
  • Mood changes.
  • Anxiety, depression, and sadness.
  • Feelings of sadness about the changes in your body.
  • Use of drugs or alcohol.
  • Boredom with your sexual routine.
• Role change effects: You may have changes in roles and relationships after a burn injury that can lead to:
  • A sense of not being needed, or not having control over your life.
  • Feeling like you have lost your place in your home, school, or workplace.
  • Low self-esteem due to relying on others to get through the day or due to the difficulty to fill other roles, such as being a mother, a father, a husband, a wife, or a breadwinner.
  • Ending a romantic relationship or a marriage in separation or divorce.

How can you adjust to the changes in your body after burn injury? How can you help your partner adjust to these changes?

• You can show your interest in sex in many ways. You may want to have your partner sit or lie next to you. Just touching and holding your partner can be fulfilling. It’s important to remember that you can touch, cuddle, and caress someone without needing to have an orgasm. Sometimes just feeling loved and secure without feeling the need to perform can be enough. Over time, you will become more confident and feel more comfortable with yourself and your partner.
• Take time to learn what you and your partner find enjoyable and exciting. The kinds of things you did before your burn injury may not work for you now. Try to be creative and open to finding new ways to explore sexual satisfaction.
• Be playful. Using humor when appropriate and having fun can make your romantic relationship more interesting and enjoyable for you and your partner.
• Keep the lines of communication open.
  • Think about how you feel and what you want to communicate. This will require self-awareness and self-exploration to understand what you want or need sexually after your injury.
  • Talk about your needs and wants together. Talking about sex can be hard. Talk about things in a way that makes you both feel comfortable and secure. It might be helpful to write about your needs. The goal is to work through issues and concerns together. Your health care provider may help you resolve physical problems and concerns. Don’t be afraid to ask for help.
  • Take time to listen to each other. Good communication takes work. Listen and be open to what your partner says. Listening to each other without judgment can help solve problems in ways that satisfy both of you. Pay attention to body language. Don’t assume that something will be uncomfortable; ask.
  • Be flexible. It may take time for you to become comfortable with each other again. You may have a few setbacks. For example, you may have issues with skin sensitivity, skin breakdown, or your energy level. You and your partner will learn to manage these issues as you continue to communicate, listen, and remain flexible.

How do you keep your romance alive if your partner is your caregiver?

Be patient. Try to keep the caregiver role separate from that of a lover. This will make it easier for you and your partner to appreciate each other when you want to be intimate and allow you to keep the passion in your relationship. Here are some other suggestions:

• Be as self-sufficient as you can. Do as much of your self-care and other daily living activities as possible. This will help to lessen the care you need from your partner. It will also help to bring your relationship closer to how it was before your burn injury.
• Set aside time to have fun and go on a date where you can enjoy romance without caregiving. Keeping these roles separate will help you to avoid confusion and mix-up of the different roles.
• Show your appreciation for each other. Burn care can be stressful for both the patient and the caregiver.
• If you can, hire a caregiver. Ask a family member or friend to help with some of the daily caregiving duties. If you don’t have help, see if you qualify for intervention programs that can assist you. Contact your state vocational rehabilitation agency or your church. If you are a veteran, contact the Department of Veterans Affairs.

If you are single:

• You can still have a sex life.
• If you start a new relationship, it may be hard to tell a new partner about your burn scars, and that’s okay.
• You may feel anxious about hidden scars being discovered. Take your time and when you are ready, have an open and honest talk with your partner.
• Fear of rejection in a romantic relationship may affect your self-esteem. It is important to have friends who support you and listen to you.

Whether you are single or currently in a relationship - Remember the following:

• Focus on your own needs, wishes, and desires.
• Explore and communicate what gives you and your partner pleasure.
• Your sexuality is about how you feel, and your feelings may change.
• You can change your mind about how you feel, find new things that are enjoyable, and relate to your partner in new ways.
• You can aim to feel good about who you are and how you choose to experience your sexuality and intimacy.
• It’s common for sex to not be on your or your partner’s mind, especially in the early stages of your recovery. Some people do not want to have sex or need to have sex and that’s okay too.

Where can you go with questions?

Talk to your health care provider about how the burn injury may have changed your body, your energy level, or your sense of touch. This factsheet is a starting point to help you and your partner understand that it is normal to worry about how your body may have changed after a burn injury. Each person is unique; some of your issues may be unique, too.

• Doctors who specialize in sexuality and physical and emotional trauma can help with your fears or problems. They can also give you correct information and talk openly with you. They can also make sure that you get the therapy, treatment, and information you need to help with any concerns you have about sexuality and intimacy. Your local burn center doctors can help you locate or refer you to the specialists.
• Your occupational therapist or physical therapist can be helpful as well. Occupational therapists can give you tips for how to position your body during sexual activity without causing harm or injury. Reach out to a counselor, psychologist, social worker, or sex therapist. They help people and couples identify and work through problems. They can also help you find resources.

Helpful Resources

• Your local burn center may have aftercare resources as well as events and programs to support you during recovery. For example, they may have peer support volunteers, burn survivor support groups, or survivor retreats.
• The Phoenix Society for Burn Survivors (https://www.phoenix-society.org/) has many resources in various formats. These include weekly chat sessions, online learning programs, workshops, and an Annual World Burn Congress.
• Factsheets and multimedia resources from the Model Systems Knowledge Translation Center on various topics related to burn injury such as Understanding and Improving Body Image after Burn Injury, Social Interactions after Burn Injury, and Sexuality and Intimacy after Burn Injury. Learn more at: https://msktc.org/burn.
• Find a provider who is familiar with sexuality topics and sexual concerns on the following websites:
  • Society for Sex Therapy and Research (STAR) – STAR is a community of professionals who have clinical and research interests in human sexual concerns. Use the link www.sstarnet.org/find-a-therapist.
  • American Association of Sexuality Educators, Counselors and Therapists (AASECT) - Search for a sexuality counselor or sex therapist in your area. Use the link www.aasect.org/referral-directory.
• Disability rights and activities organizations offer resources for sexuality for specific disabilities.

References

Alexander, M., Hicks, T., Aisen, M., & Klebine, P (2015). Sexuality and sexual functioning after spinal cord injury. Washington, D.C.: Model Systems Knowledge Translation Center.

Rimmer, R., & Rutter, C. (2015). Intimacy and sexuality after burn injury. Phoenix Burn Support Magazine, 2, 14–15.

Authorship

Sexuality and Intimacy After Burn Injury was developed by Radha Holavanahalli, PhD; Karen Kowalske, MD (North Texas Burn Rehabilitation Model System; UT Southwestern Medical Center, Dallas, TX); Ruth Rimmer, PhD, CLCP (Arizona Burn Center College of Medicine-Phoenix), and Cindy Rutter, BSN, MFTI, (Burn Survivor), in collaboration with the Model Systems Knowledge Translation Center.

Source: Our health information content is based on research evidence and/or professional consensus and has been reviewed and approved by an editorial team of experts from the Burn Model Systems.

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. The contents of this factsheet were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DP0082). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.

Copyright © 2021 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.