How Dementia Affects Sex and Intimacy

Dementia affects more than just memory and thinking skills. It can also have significant impacts on a person's sexuality and intimacy. Understanding these effects is important for caregivers, healthcare professionals, and family members to provide appropriate support and care for individuals living with dementia.

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Did you know that the most common change in sexual behavior for individuals with dementia is actually apathy or an indifference to sexual activities? Many people believe that hypersexuality is the most common change in sexual behavior. However, when we look at the whole picture, hypersexuality is quite rare. Individuals with dementia may also experience a decrease in sexual interest. These changes will vary from person to person and are also influenced by the type of dementia a person has, the parts of the brain being impacted, as well as any medications the person may be taking. But, regardless of the change in sexual behavior, it is essential to recognize and address these changes with sensitivity and understanding.

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The reality is sexuality and intimacy are both basic human needs, even for people with dementia. Because of this, the need for human connection remains important throughout life until a person passes away. Therefore, even if engagement in sexual activity decreases as a person gets older or develops dementia, the importance of nonsexual forms of intimacy is still paramount. Physical touch, emotional closeness, and companionship play a crucial role in maintaining a sense of connection and well-being for individuals with dementia. Caregivers should focus on promoting nonsexual forms of intimacy to meet the individual's emotional needs. This could include things like hand holding, hugs, kisses, and massages.

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Now, with that being said, a diagnosis of dementia does not automatically mean a person with dementia can no longer consent to sexual activity. Many people with dementia can still consent to sex even with severe cognitive impairment. Consent is fluid, meaning that it can change over time and in different situations based on various factors such as cognition, context, communication and the ability to express "no" and "stop", partners involved, and individuals' feelings and boundaries. This is why it is so important to check that the person with dementia able to consent before each sexual act. Just because a person with dementia can consent to sexual activity today doesn't mean they can consent tomorrow and vice versa.

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Now, although, hypersexuality is pretty rare statistically speaking, it is still particularly distressing for caregivers who experience it with their partner with dementia. Inappropriate sexual behavior, such as public mastubation, disrobing, or making sexual advances towards others can catch caregivers off guard and introduce unique challenges. However, it's important to realize that not all seemingly sexual behaviors are actually sexual. There could be a completely nonsexual reason for the person's behavior such as needing to use the toilet, being hot and uncomfortable, or desiring general human contact. With that being said, regardless if a behavior is sexual or not, it is crucial to respond to such behaviors calmly, redirect the individual to a private area or engaging activity if necessary, maintain their dignity, and create a safe and supportive environment for sexual expression. Strategies for preventing and managing inappropriate sexual behavior should be implemented with compassion and the understanding that the goal should never be to eliminate all sexual expression, but rather to decrease sexual behavior to a point where it's safe and appropriate for the social context. Most inappropriate behaviors can be adequately managed with non-pharmacological approaches and pharmacological treatments should really be used as a last resort.

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Additionally, when navigating issues related to sex and intimacy, caregivers and family members should seek support from trusted friends/family, healthcare providers, counselors, or support groups to address their own feelings, concerns, and questions about intimacy and dementia care. Sex and intimacy may feel taboo to talk about, but it's completely normal and it's important that support is sought after when needed.

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To learn more about this important topic, watch our webinar on "Navigating Sexual Expression in Dementia Care" by grabbing a Paw Pass for the Treehouse. ‍

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During this webinar you will learn:

• Definitions and implications of sexuality, intimacy, and sexual expression within the context of dementia care.
• Common changes in sexual desire and behavior that may occur in individuals with dementia.
• The impact of dementia on intimate relationships and strategies for maintaining a positive connection with a partner who has dementia.
• How to identify and manage inappropriate sexual behavior in dementia, with an emphasis on non-pharmacological approaches.
• The risks associated with sexual activity in the context of dementia.
• Criteria and guidelines to consider when assessing the capacity for sexual consent in individuals with dementia.

If this information would be beneficial to your care journey, we hope to see you inside the Treehouse!

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