Sexy and they know it (or do they?): Sex and Dementia

Sexy and they know it (or do they Sex and DementiaCaregivers are often at a loss as to how to deal with the sexual changes that dementia can cause in a person, even – or especially – if the caregiver happens to be that person’s spouse. Fifteen years into the 21st century sex is still something of a taboo subject, but add aging and mental illness – which are often intertwined – and the result is almost anathema. The fact remains though that people with dementia have as much right as anyone else to enjoy a rewarding sexual life. Having said that, caregivers/spouses must realize that, among other things, and to paraphrase Comic Book Guy, for many of you, this will be much less breeding; for others, much, much more.

Sexual changes in a person with dementia

·         Increased interest in sex.

·         Reduced interest in sex.

·         More ability to perform.

·         Less ability to perform.

·         Changes in sexual manners.

·         Changes in inhibition – or lack thereof.

It isn’t uncommon at all for a husband and wife to notice some of these or other changes in their spouses without any apparent reason, and feel guilty or upset – for example if the person is no longer as interested in sexual activity as they used to be, the husband or wife may think it’s their fault or that their partner does not consider them attractive anymore (they might even suspect infidelity). In this sense, a diagnosis of dementia may come as a relief, though some might consider it the final nail in the coffin of their sexual life. However, this does not have to be the case. In fact, it could be quite the opposite; the person with dementia could accrue all the sexual energy of all The Golden Girls put together. Either way, it’s still possible to have a balanced sex life.

·         More interest in sex. Sex-crazed seniors are no laughing matter – as the 2009 movie Play the Game proved beyond the shadow of a doubt. As a matter of fact, an increased sexual drive may be a nice change of pace for a couple – just ask Mrs. Blackitt – but it can easily turn into an embarrassing and even violent situation. The person’s behavior during bathing, for instance, may be a little more than paid care workers bargain for, and make the family have to go without outside help. Moreover, the sexual demand may reach such a point that the partner may refrain from displays of affection for fear that the dementia patient will misconstrue them as sexual invitations. On the other hand, the person with dementia may also retaliate aggressively when faced with a lack of sexual compliance – either from their lawfully wedded husband or wife or from a stranger, and anyone in between. It’s best to let them down as easy as possible and suggest other activities that can meet the person’s intimacy needs. Failing that, talk to a doctor for advice, which may include medication but only when all other possibilities have been exhausted.

 

Dementia or not, no one should be forced to have sex against their will or be physically or verbally abused if they refuse. Safety always comes first, in sex and in everything else. Thus, if you feel at risk of violence, do not hesitate to get yourself and others to safety and get help if necessary.  

 

·         Less interest in sex. Conversely, some people with dementia are content to give up sex altogether, but the fact that they’ve become sexless does not mean they are loveless as well. They may still enjoy hugs, caresses, and cuddling. Think of it like that Nelson song, (Can't Live Without Your) Love And Affection – which while being a lovely ballad is as far removed from any sexual innuendo as a 90’s glam rock song can be. It is essential to respect the person’s decision while trying to find different ways to preserve intimacy.

 

·         Other changes. The amount of sexual activity may remain level before and after dementia, but other changes may occur during intercourse, such as the person appearing cold and detached, forgetting they have just had sex, failing to recognize their partner, or mistaking their partner for someone else – or the other way around. The key is not to take it personally and react in a way that helps preserve the person’s dignity.  

 

Adapting and Coping

Caregivers’ feelings toward sex and their partners can also change. Some will be happy that they can still have sex with their spouses; others will be put off by the fact that sex is the only thing left that they have in common, thus depriving it of any emotional meaning. Some may be wary – or thrilled, you never know – of being intimate with someone who is for all intents and purposes a stranger. Admittedly, that does not make for great emotional connection, though it has the potential of providing for some quite interesting role playing. Some couples may continue to sleep in the same bed, while others may end up in different rooms – in the latter case, it would be a good idea to discuss the move with healthcare provider, since this separation, albeit temporary, can confuse the person with dementia.

Both caregiver and the person with dementia can resort to alternatives to let off some sexual steam, such as exercise, masturbation, massage, or reflexology. It may be too that sexual need is actually a need for contact, closeness, a feeling of belonging, acceptance, and other needs that range from physical to metaphysical. When these are met, it may turn out that the sexual need is no longer so urgent.

Be safe

Having sex with a person with dementia is not the same as having crazy sex. You shouldn’t have to worry about the person being clumsy or inconsiderate, or kinky, or being suddenly into bondage, golden showers, or brown parties. On the other hand, people of all ages and mental states who are sexually active are susceptible to STIs. Prophylactics and contraceptives are widely available in case they are needed.

Related Read:

Alzheimer’s, Sexuality, and Intimacy: 13 resources for family and professional caregivers