Dementia, sexuality and intimacy

Jan 14, 2019

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Dementia, sexuality and intimacy

Dementia, sexuality and intimacy

Posted in : All, Living with dementia on by : Giulia Melchiorre

It can be difficult to talk about topics that are as personal and sensitive as someone’s sexual and intimate behaviour. In our society we do not like to openly discuss sexual acts, even less so when a close relative is affected. However, this can be an important topic to consider when it comes to dementia because of the impact it can have on everyone involved. It is estimated that between 7% and 25% of people with dementia exhibit inappropriate sexual behaviour, and this is more common in men than in women.

What is inappropriate sexual behaviour?

What do we mean when we talk about inappropriate sexual behaviour or sexual disinhibition? This can include being rude, saying things that are not appropriate (sometimes to strangers), undressing in public, as well as inappropriate sexual acts of touching, exposing, grabbing or masturbating. The most common inappropriate behaviour is sex talk or use of foul language that is not normal for the individual.

It is important to distinguish between two types of inappropriate sexual behaviours:

  1. Normal sexual behaviour in a misplaced social context, inappropriate location or time, i.e. the person with dementia is expressing their normal sexual desires but in socially inappropriate environments due to confusion, disorientation or misinterpretation
  2. Sexually disinhibited behaviours, i.e. the person with dementia is showing behaviours which are part of the general behavioural disinhibition in dementia

The two key questions that come to mind are: Why do these changes happen? And what can be done?

The need for normal sexual expression

We often think that as people get older they no longer engage in sexual behaviours. However, research has shown that 50% to 80% of people older than 60 are still sexually active at least once a month. Regular sexual activity continues through the 80s and 90s. Therefore, a person with dementia that behaves sexually inappropriately may simply be expressing an unmet need. People with dementia maintain their need for physical contact, which in addition to sex may include gentle stroking and touching, regular kissing or cuddling. They may be searching for physical closeness, and it is key to communicate with the person with dementia to understand their needs. At the same time, restrictive attitudes and a lack of privacy can make it difficult for the affected person to fulfil their sexual needs. It is important to ensure that the person with dementia has space for normal sexual expression, like for example being able to masturbate in private, while preventing inappropriate sexual behaviours.

Communicating unmet needs

Non-sexual unmet needs can also underlie inappropriate sexual behaviours. For example, a person with dementia may be undressing at inappropriate times because they are needing the toilet or because they are too hot or cold. Urinary tract infections and itching can lead to handling the genital area. Alternatively, they may be bored, and taking part in regular activities can provide the needed stimulation. Some medications cause side effects that can alter sexual behaviour. For example, psychotropic drugs such as levodopa, benzodiazepines and alcohol have all been linked to increased agitation and sexual disinhibition. Other underlying conditions that have been linked to inappropriate sexual behaviours include delirium, psychotic and mood disorders, strokes, tumors, surgeries, and brain trauma. Therefore, it is important to check with your doctor if the person with dementia is taking any medication or suffers from another underlying medical condition that could affect their behaviour. These can be treated and the behavioural issues may resolve as a result.

Changes to the brain

Dementia changes the brain, and some of the brain systems that can be affected by dementia play a key role in sexual behaviours. If dementia causes damage to these, this can affect how the person behaves:

  1. The frontal system: damage to this area is associated with disinhibition
  2. The temporo-limbic system: damage to this area is associated with hypersexuality and autoerotic behaviours
  3. The striatum: damage to this area is associated with obsessive compulsive sexual behaviours
  4. Hypothalamus: lesions to this area are associated with increased sexual behaviours

Dementia not only damages areas of the brain directly related to sexuality, but also causes other symptoms, such as confusion, disorientation and memory problems. This affects a person’s understanding of social situations, which can lead to behaviour that may be considered inappropriate. This highlights that such inappropriate behaviours are due to the disease causing changes to the brain, rather than the individual themselves.

In next week’s blog, I will share advice on how we can address inappropriate sexual behaviours.

 

This article is based on research publications and information from well-known organisations in the dementia space. Sources include:

 

 

 

 

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