Dementia and sexual relationships
A sexual relationship can be an important part of a person’s wellbeing and a person with dementia has the same needs as anyone else. It’s important to understand that dementia brings about changes in the brain which lead to changes in feelings and behaviour, including changes to intimate relationships.
Having a dementia does not mean the end of a healthy sex life. Following a diagnosis of dementia, sexual relationships will continue as before for many couples.
However, as the dementia progresses, the person can appear cold and detached or they may no longer recognise their partner and reject them. Sometimes they might forget they’ve had sex and become overly demanding.
Dementia, the brain and sexuality
Having a dementia can affect how the brain works and sometimes people with dementia will behave in a way that’s out of character or socially inappropriate.
Dementia can affect a person’s ability to inhibit their thoughts and behaviour.
This can lead to them:
- saying or doing things in public that they would previously have kept private
- exhibiting more or less interest, or even no interest at all, in sex
- having more or less ability to perform sexually
- appearing less sensitive to others and perhaps being aggressive
- using sexualised language that others have never heard them use or that seems out of character
- making unwanted sexual advances towards others or mistaking them for their current or previous partner
- misinterpreting the intentions of those supporting them with personal care tasks, such as washing and dressing
Some partners and families can adapt to these changes, but others will find it difficult and upsetting. They might experience feelings of loss, anger, embarrassment, anxiety, fear or frustration.
It’s important to know that if someone with dementia is unable to communicate their feelings verbally, their behaviour, however inappropriate, may be a form of expression.
Responding to inappropriate behaviour
Sometimes understanding the changes in behaviour can help us accept and adjust to them.
A person with dementia can have difficulty expressing their needs and feelings and their behaviour can be a sign these needs aren’t being met.
If someone with dementia is behaving in a sexually inappropriate way, consider whether they:
- might have an infection
- could be in pain
- are too hot or cold
- are feeling uncomfortable
- have enough privacy
- feel lonely
- are feeling bored
Responses to inappropriate sexualised behaviour can include:
- trying to sensitively distract the person or encouraging them to go somewhere private
- using humour respectfully and appropriately to diffuse the situation
- if the person is not your partner, telling them that you’re married or in a relationship
- trying to steer the conversation to something else, such as a story they like telling
- gently reminding the person who you are if they have mistaken you for someone else
- if the behaviour continues, firmly but politely telling them you feel uncomfortable and walking away or asking for help
Helping someone meet their needs in an appropriate way
A person with dementia can feel lonely and afraid. They often need help to make sense of the world around them. Offering them help and support can help reduce the risk of inappropriate behaviour.
Things that might help include:
- encouraging friends and family to spend time with the person in activities that are suitable for their abilities and interests
- give the person appropriate physical contact when interacting with them – you might hold their hand, hug them or sit close to them
- give them something comforting to hold – this might be a blanket or soft toy
- a hand massage can be soothing and reassuring
People with dementia who live in care homes may continue to have sexual relationships. This might be with their partner or they might form new sexual relationships with other residents.
This can be difficult for a family to accept, especially if the relationship is not with the person’s recognised partner. In these circumstances, the home manager must make sure families are fully involved in discussions about how to deal with the situation.
If you have a relative with dementia living in a care home and you’re worried about any of this, speak to the manager.
All care homes should have a policy on sexual relationships which should:
- safeguard the rights of all residents
- ensures privacy for all residents
- promotes and protects the emotional wellbeing of residents and their families
The manager and all staff at the home should be aware of the policy. They should be trained to respond appropriately to issues around relationships, sexuality and sexual health.
Consent, capacity and protection
Simply having a diagnosis of dementia doesn’t mean that someone lacks mental capacity to give consent. Capacity is always specific to a particular decision at a particular time.
Partners should learn to recognise what the person with a dementia might be trying to communicate in relation to their consent to intimacy. This can include non-verbal messages.
Sometimes the person with dementia might find it difficult to understand the needs of their partner and to understand that their partner doesn’t consent to sex.
It is important that their partner responds in a way that’s clear, but sensitive so the person doesn’t feel rejected or unloved. Think about other ways to show affection, such as holding hands or hugging.
Anyone starting a new relationship, or people in a long-term relationship who haven’t done so, should talk about safe sex. You can speak to your GP in confidence if you have any worries.
Where to find help and support
You can find more information and support services from the following organisations, see also ‘more useful links section’:
The Public Health Agency has also produced a range of information to help support people with a dementia, their families and friends.
This information includes the following publications:
- Ten common signs of dementia
- Early stages of dementia
- Communicating effectively with a person living with dementia
- Are you worried about dementia?
Dementia apps library
The ‘Apps4Dementia’ library is a digital service which groups together safe, trusted apps to provide information and guidance on the condition.
There a number of apps that offer support, self-care of symptoms and enable users to carry on with their day-to-day activities for as long as possible.