As a person’s dementia progresses, they may display changes in sexual behaviour. Our specialist dementia nurses share advice to help you understand and manage these changes.
There are three main categories of change in sexual behaviour that may occur in someone with dementia:
- sex talk, eg using crude language; saying inappropriate things to family, friends or members of the public
- sexual acts, eg touching or grabbing themselves or other people; exposing themselves; masturbating in front of others
- implied sexual acts, eg an obsession with pornographic material; requesting unnecessary genital care
Some forms of dementia can cause a loss of inhibitions, especially frontotemporal dementia. This may lead to sexually inappropriate behaviour.
The person may not understand that their behaviour has changed, and that other people find it inappropriate.
Sometimes disinhibited behaviour results from the person misinterpreting other people’s actions – for example, if a carer is performing personal care, they may interpret it as sexual contact.
Changes in sexual behaviour may be an expression of the person’s need for closeness and affection that they are struggling to communicate.
Dementia may also cause the person to mistake other people’s identities and behave in a sexually inappropriate manner. They may believe that another person is their partner, or forget that they have a partner and initiate intimate contact with someone else.
Sometimes, the person’s behaviour may be misinterpreted by others – for example, trying to undress or touching their genitals could indicate needing the toilet, feeling too hot or cold or being in discomfort, rather than a sexual act.
Problems may also arise because of:
- other people’s prejudices about dementia
- misunderstandings, eg the person not understanding that their partner is not consenting to sex
- ageism – the belief that older people are not interested in sex
- judgements about the person’s sexual preferences and gender identity, for example if they identify as LGBT+ and show attraction to people of the same sex
- lack of privacy, for example in a care home
If a person with dementia is showing changes in sexual behaviour, family and friends may find it difficult to tell anyone what is happening.
Their partner or other family members or friends may feel at risk, for example if there is sexual force or violence.
If the person is liable to displaying uninhibited sexual behaviour or using inappropriate language in public, other people may avoid going out with them, leading to social isolation.
If the person does display sexually inappropriate behaviour in public there is a risk of the police being called. This could lead to them being detained in custody or under the Mental Health Act (sectioned).
There may also be breakdowns in care arrangements – for example if the person behaves in a sexual manner towards their carers, they may feel unable to continue to support them.
Changes in sexual behaviour are the result of the person’s dementia and are rarely intentional, so it is important to try to stay calm and understand what is happening from their perspective.
The following tips may be helpful:
- Try to establish a reason for the behaviour, such as a desire for affection or needing the toilet. This can then be addressed – for example by offering a cuddle or taking them to the bathroom
- Avoid places that may exacerbate the changes in sexual behaviour, eg crowded and over-stimulating environments
- Try to distract the person: suggest a cup of tea or a walk to a quieter, less stimulating place
- Limit alcohol intake as this may further reduce inhibitions
- Carry a ‘help card’ that explains that the person has dementia and how it may affect their behaviour. This can be discreetly shown in difficult situations
- Quietly explain to others why the person is behaving in this way
- If the person is masturbating publicly, quietly guide them to their room or another private area
- In cases of mistaken identity, attempt to reorientate the person by reminding them who the other person is and gently steering them away
- Do not avoid going out or seeing other people for fear of the person doing something embarrassing: social contact is important for you and them
- In a personal care situation, you or the carer should calmly explain to the person what is happening to avoid misunderstanding – eg “I am going to help you take your clothes off and have a wash”
- If the person is heterosexual and showing problematic sexualised behaviour during personal care, it may help to have a same-sex carer. If they are attracted to people of the same sex, you may wish to consider a carer of the opposite sex
- Ask the person’s health and social care workers for advice – professionals are used to dealing with these issues
On rare occasions, a person with dementia may become sexually aggressive or abusive. If this happens, remove yourself from the situation until they are calmer. In an emergency, phone 999 for the police.
If you have been injured, make an urgent appointment with your GP, call 111 for advice, or go to A&E, depending on the severity of your injuries.
The health professional can also record what has happened and advise you on what to do next. This may depend on whether the person with dementia is deemed to have had ‘mental capacity’ when they carried out the act, and what action you would like to take. For instance, you may not wish to inform the police, but a Mental Health Act assessment may be appropriate.
Emotional support is also very important, whether that is from a family member, friend and/or professional. Many charities provide support around domestic and sexual violence for both men and women. You could also ask your GP about what support is available.
To speak to a dementia specialist Admiral Nurse about a stay in hospital or any other aspect of dementia, please call our free Dementia Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday and Sunday 9am-5pm, every day except 25th December), email email@example.com or you can pre-book a phone or video call with an Admiral Nurse.
Dementia UK resources
- Changing roles and relationships
- Sex, intimacy and dementia
- Coping with distress
- Dealing with restlessness
- When someone stops recognising you