Intimacy and sexual issues are an important part of life for people with dementia. Sex and affection is important. However problems may arise for people with dementia and their partners, including aggression or inappropriate behaviour. Carers may need support to deal with their own feelings as well.
The need for closeness is a very important and natural part of people's lives, including people with dementia. Intimacy is the giving and receiving of love and affection. It involves caring touch, empathic understanding, comfort in times of need and a feeling of safety in relationships.
Sexuality is the feeling of sexual desire and its expression through sexual activity. Like intimacy, it is a natural expression of human need. For many people, however, sexuality goes beyond the narrow concept of sexual intercourse. It is often bound up with many of the broader expressions of intimacy, including physical closeness, kissing and hugging.
How are intimacy and sexuality affected by dementia
People with dementia continue to need loving, safe relationships and caring touch. However, they will vary in their individual ways of giving and receiving affection, and the way in which their dementia affects that capacity. As a result of the condition, some people with dementia may become demanding and insensitive to the needs of others, and less able to provide caring support for their family and friends.
They may also experience changes in their expression of sexuality. Some people continue to desire sexual contact while others may lose interest in sexual activity. Others may display inappropriate sexual behaviour.
Partners may experience a range of feelings about continuing a sexual relationship with someone who has dementia. These may include feelings of rejection, distaste and guilt. It can be helpful to discuss these with a counsellor.
Changed sexual behaviour
It is important to remember that any strange or uncharacteristic behaviour is part of the illness and not directed in a personal way. The person with dementia may no longer know what to do with the sexual desire, or when or where to appropriately exercise the desire.
Increased sexual demands
Some partners find that a person's desire for sexual activity increases as a result of dementia. This can result in unreasonable and exhausting demands, often at odd times or in inappropriate places. Occasionally aggression may be shown if those needs are not met. A carer may have to keep safely out of the way until there is a mood change. Some partners complain of feeling like an object. Once the person with dementia has had sex or sexual contact, they may immediately forget what has occurred.
Diminishing sexual interest
Many people with dementia lose interest in a physical relationship and may become very withdrawn. They may accept physical contact from others, but not initiate affection. Carers may feel hurt and bewildered by the loss of interest.
Loss of inhibitions
People with dementia sometimes lose inhibitions and make advances to others, or undress or fondle themselves in public. Sexual advances are sometimes made because the person with dementia mistakes another person for their partner. Sometimes, an action which appears sexual - for example, a woman lifting her skirt - may be an indication of something else, such as the need to go to the toilet.
Managing inappropriate sexual behaviour
Suggestions for managing inappropriate sexual behaviour include:-
• Consider all possible reasons for the inappropriate behaviour. These could include needing to go to the toilet, discomfort or boredom.
• Gently discourage inappropriate behaviour.
• Try to remain focused on the person, not the behaviour.
• Aim to distract the person if possible or redirect them to another activity.
• Find ways to include different forms of touch in the everyday routine, so that the person gets some physical contact. Massage, holding hands and embracing are ways of continuing to provide loving touch.
Support for carers
Like all the challenges faced by families and carers of people with dementia, discussing this with an understanding person can help. Support and affection from friends and family can help many carers. Talking about problems in a carer support group can also help. Knowing that others have been through a similar experience may assist you to feel that you are not on your own.
For some a good friend is enough, while others find that their doctor or social worker is able to give them the time and understanding needed. There are many qualified counsellors who are used to talking with families about sexuality and dementia. Your doctor should be able to refer you to an appropriate counsellor.
Things to remember
• People with dementia continue to need loving, safe relationships and a caring touch.
• Strange behaviour is caused by the illness of dementia, not the person.
• A person with dementia may have increased or diminished sexual desire.