Understanding Intimacy and Sexuality After Burn Injury

Written by Ruth b. Rimmer, PhD, CLCP, and Cindy Rutter, BSN, MFTI on September 04, 2019

Intimacy + Sexuality

The aftermath of a burn injury can affect many aspects of a person’s life. Several areas that often create challenges and result in frustration after a burn injury are related to intimacy and sexual function.

Individual burn survivors are different and so too are their burn injuries. The ways in which people respond to the changes in their bodies and emotional states can vary. Due to these differences, as a burn survivor you will need to make your own observations and evaluate your particular circumstances to better understand and deal with changes you may be experiencing in the area of sexual function and intimacy and how best to deal with your concerns.

A variety of sexual issues can arise after a significant burn injury and they apply to all types of relationships. These include but are not limited to a diminished sex drive due to extreme fatigue, chronic pain, and itching.

Physical impairment, sensitive skin, lack of sensation, depression, anxiety, and body image issues can also contribute to a feeling of insecurity and uncertainty in sexuality. A change in roles within a couple when one partner becomes the caregiver for the other can also affect a couple’s intimacy.

Starting the Conversation

Talking about sexuality and intimacy is difficult for many people. It can be challenging not only for burn survivors and their partners, but also for burn care physicians, nurses, and therapists. Therefore you, as the survivor, may have to initiate conversations regarding your ability to engage in sex, as unfortunately this is an area of burn aftercare that to date has not been addressed very well.

Issues Following a Burn Injury

After a burn injury, your skin may look and feel very different. Changes in appearance may result, and this will likely bring about questions and concerns. Depending on where you are in your recovery journey, the way you look and the things you are able to do might also have changed.

Sometimes a burn affects how your sex organs or other erotic zones work or feel. Such changes can result in frustration, anger, and disappointment, all of which often place pressure and strain on a relationship. Individuals with burn injuries may begin to question whether they will be able to maintain their current relationship or develop new ones.

The Importance of Intimacy

Intimacy with another person involves mixing one’s life with another’s and a sharing of heart and soul. Being intimate involves more than just engaging in sex. Your interests, ideas, and behavior play a greater role in defining you than your appearance or your ability to have sex. A relationship is influenced by many things, including common interests, the way you deal with personal likes and dislikes, and how you treat each other.

The most important thing in an intimate relationship is communication. You will need to talk to a partner about your feelings or disclose that you have scars from a burn injury. Be open about how the burn has affected your sexual desire and function and how it makes you feel. Always know that individuals who have sustained burn injuries can and do have romantic relationships, marry, have active sex lives, and have children.

The Role of Sexuality

Sexuality is the quality or state of being sexual. Sexuality is not only the act of intercourse but also associated feelings and actions that go along with it. Every human being has a desire to be held, touched, caressed, and loved. Sexuality is an important quality-of-life issue and includes how you feel about yourself as a human, as well as how you relate to others. Sexuality is integral and inseparable from body image and self esteem.

Sexuality is a form of communication, a way of expressing part of one’s personality to another. Sexuality spans the biological, psychological, emotional, spiritual, and social dimensions of lives; it begins with us and extends to our relationships with others.

Relationships After Loss and Trauma

Changes in self-image and self-esteem can be common feelings following a serious or severe burn injury. Relationships are key to supporting healing after loss and trauma. First and foremost you, the survivor, must have a relationship with yourself. Know who you are and what you want. You are in control of what you feel about yourself. Our relationship with our self includes how we feel about who we are as people, as sexual beings, and how we feel about our bodies and behaviors.

Relationships are developed slowly between individuals sharing their experiences and insights and learning to appreciate each other for who they truly are as unique human beings. It comes down to “Will I be rejected?” and ultimately “Will I reject myself?” and “Do I love and accept myself enough to trust that others can do the same?” In the end, it is the confidence and connection to self and spirit in intimacy that is attractive and draws others to us. 

Once healing starts, the following quality-of-life issues may arise:

  • Will my life ever be normal (if there is a normal)?

  • Will my relationships with others be different?

  • Will my significant other still want to be with me?

  • Will anyone be attracted to me with the way I now look?

  • Will anyone ever want to touch me?

You may experience the following obstacles to sexual arousal and desire post-injury:

  • Emotions—Depression, anxiety and stress can reduce sex drive.

  • Medications—Some medications can greatly reduce libido.

  • Relationship problems—A couple with communication breakdown is less likely to engage sexually.

  • Decreased confidence—You may feel less self-assured or attractive after the burn injury, which may make you less likely to feel sexual.

  • Other illnesses—Conditions, such as diabetes and hypertension (high blood pressure), can reduce libido.

  • Altered skin integrity

  • Hypersensitivity/hyposensitivity

  • Change in texture of skin

  • Change in color and appearance of skin

  • Fear of rejection

  • Variations in energy levels

  • Mobility issues

  • Pain

  • Amputations

Resuming Sex Soon After a Burn Injury

Before resuming sex, talk with your doctor. Be led by their guidance, but common recommendations include the following:

  • Discuss your expectations, doubts, worries, and feelings with your healthcare provider. If you have a partner, try talking openly and honestly with each other about your expectations and doubts. Encourage your partner to ask your health care provider questions as well.

  • Try not to put too much pressure on yourself, especially after a recent injury or reconstructive surgery. Ask your doctor what you can and cannot do.

  • Focus on pleasure. It may be necessary to change your former method of sex for a while.

  • Concentrate on enhancing the romance in your relationship. This may include showing appreciation for one another, offering affection (such as kissing and cuddling), and celebrating special occasions, such as birthdays and anniversaries.

Also consider the following helpful suggestions:

  • Go slow and take “baby steps.”

  • Make it as fun as possible.

  • Try to find some humor in this trying time. Humor can be very healing.

  • Try, try, and try again. Practice can make perfect.

  • Remember, communication is essential! 

You should discuss any sexual difficulties you experience after your burn injury with your medical team. General suggestions for doing so include the following:

  • Seek professional help should you experience depression, anger, and/or anxiety.

  • If you suspect your sex drive is diminished due to medication, ask your doctor if a different medication without this side effect is available.

  • If you are experiencing erectile problems, discuss treatment options, which may include counseling and/or medication, with your physician.

Your healthcare provider should be able to give you information and advice to resolve your concerns or direct you to someone who can. If your issues with sexuality and intimacy do not resolve, you may want to seek the counsel of a mental health professional who is familiar with burn injury, specializes in helping people deal with depression and anxiety, and is also comfortable discussing sexual difficulties.

Cindy Rutter has been an advocate for Phoenix Society for Burn Survivors and involved in the burn community for more than 30 years. She recently completed her masters degree to become a marriage and family therapist. Cindy has been a burn survivor for 57 years and is the former nurse manager of the burn unit in San Diego.

Ruth Rimmer is Director of Psycho/Social and Prevention Research at the Arizona Burn Center and President of Care Plans for Life, LLC. She received her PhD in life span developmental psychology from  Arizona State University and is certified in life care planning and gerontology. Dr. Rimmer has been working in the field of burn care for more than 21 years and specializes in research associated with the psycho/social and rehabilitation needs of burn survivors. She is also interested in burn prevention and works in research and development in this area as well.