SUMMARY :
After traumatic brain injury, sexuality is not an easy matter to discuss either with the patient or
their partner: the body is suffering and the notion of pleasure is absent. Can the patient's body
still remain a source of pleasure for the "self" and of desire for the "other"? The persistence of
neuro-behavioural disturbances and the alteration of narcissistic and libidinal interests give the
patient's sexuality a different tone: affective adherence or indifference, emotional lability,
affective regression.
What adjustments can be made to the intimate relationship? Studies of cerebral
injury and sexuality highlight a "sex effect". How can a woman live her sexuality when she has lost
her power of seduction and a man his sense of dominant power? In a study of 50 heterosexual couples
(39 males and 11 females) where one partner had suffered severe brain injury, the following factors
were considered (pre and post accident) the patient's age and sex, the length of the relationship
before the accident, the couple's marital status (married or cohabiting), the social and professional
roles of each partner (whether preserved or not), the couple's past experience, the role of the
patient's parents after the accident.
The neuropsychological and psychoaffective disorders of the
patient were studied and monitored to evaluate the life-span of the relationship after the accident.
Semi-directive interviews led us to retain two specific issues regarding the sustainability of the
relationship: relational exchanges and the couple's sex life. Models of fusional and dissociated
couples were identified. Our psychological assessment, aimed at individual or couple oriented
treatment leads us to consider the disorganisation of intimate relationship of brain injury patients
as a manifest post traumatic symptom.