Sexual Behavior and Alzheimer’s Disease

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Logo for UNC Chapel Hill, Cecil G. Sheps Center

Many times, people with Alzheimer’s still have their sex drive. But changes in their brains can make them act in ways that are new or different for them.

For example, they may show more interest in sex than before. They may touch, hug, or try to kiss others, even strangers. They might touch their private areas, masturbate around others, or try to touch other people’s private areas.

They may use vulgar language or make sexual advances. They may take their clothes off around others or come out naked or in their underwear.

This behavior may surprise you, but remember that it isn’t their fault. It’s caused by the effects of the disease on their brain. It may help you not feel hurt or embarrassed to remind yourself and others of this.

It isn’t usually an emergency. You can often manage it at home.

Causes

These behaviors are usually a sign of a need they can’t tell you about in a way that’s OK. It can be a sign of discomfort, pain, or confusion and not about sex at all. It can also be a sign of loneliness or their need for love, affection, and physical touch.

Certain medications can also boost someone’s sex drive or cause aggressive behavior.

How to Handle Different Situations

If your loved one takes off their clothes, touches themselves, or masturbates in front of others: This may not mean they want sex. It’s often a sign that they’re uncomfortable or need to use the restroom. It could also be that they used to walk around naked or masturbate when they lived alone, and it’s only a problem now that they’re around others more.

Stay calm. If they’ve taken off their clothes, help them put them back on. To distract them, give them something to do with their hands, offer them a snack, or get them involved with an activity they like. If this doesn’t work, take them somewhere private. Ask others around you to excuse their behavior. Don’t fight or hold them back -- this could make them angry and cause them to act out.

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If this happens more than once, try to figure out why. Are they too hot or cold? Do they need to use the bathroom? Do they have skin irritation? Are they uncomfortable in their clothes? Are they in pain? Are they confused about where they are?

You could try to have them wear clothes that don’t have a zipper or that close in the back. It might be helpful to give them private time each day when they can masturbate or go nude. If you notice signs of pain, discomfort, or skin irritation that don’t get better, call your doctor.

If they make sexual advances or touch others in unwanted ways: Gently remind them that this isn’t OK. Be consistent in letting them know that this isn’t acceptable. To distract them, try to give them something to do. Try to make sure their needs for affection and touch are met every day. Hold their hand, give them a back rub, or hug them.

If they make sexual jokes or comments around others: Stay calm and don’t scold them. This can upset them. Gently remind them that this isn’t OK. Try to change the subject, or give them something to do to distract them. Ask others to excuse their behavior. You can also have a premade card ready to give to others to let them know what’s going on. Try to do things in public at non-busy times.

If your partner makes sexual demands: People who have Alzheimer’s disease usually have less sex drive than they did before. But it’s also possible for them to have more. You shouldn’t give in to your partner’s sexual demands if you don’t want to. Turn down any unwanted advances in a firm but respectful way so your partner won’t get upset.

Sometimes it’s best to give them space until the mood has passed. Other times they might need touch and affection. You can hold hands, give them a back rub, and rest together in bed. In some cases, they might mistake these things for a sexual advance, so this may not work well for all couples.

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If they get angry or lash out, back away until they calm down. If their behavior doesn’t get better and makes life hard for you or them, or if you’re scared for your safety or feel physically or verbally abused, call their doctor right away. Have someone else with you when you care for them. Keep dangerous things like guns, knives, glass, and sharp or heavy objects out of the house or locked away.

Don’t hold your loved one back unless you have to. This could hurt you or them, and could make them angrier.

While these behaviors aren’t their fault, you need to feel safe in the home and be assured that your rights aren’t violated. If they lash out, try to stay away from them until they calm down.

You may want to talk with someone you trust. You can also join a support group to express your feelings and get advice from others who deal with the same problem.

If they start a new intimate relationship: Sometimes people with dementia who live in assisted living or a nursing home start new intimate relationships with other residents. This is often hard for their partner or family members. Try to understand that everyone has a need for love and affection. This need often isn’t met in a nursing home.

Of course, the new relationship has to be OK with both people involved -- neither should take advantage of the other. If it is mutual, it's often best to accept the relationship because it can help them satisfy their need for affection and physical touch.

Try not to take it as an insult to your relationship with them. If it makes your loved one happy, try to be happy for them. Don’t think there might have been something you could have done to prevent it. If you have any concerns, talk with the nurses and staff.

If they confuse you for an intimate partner: It’s common for people with dementia to recognize their caregiver as someone else. For example, they may mistake their daughter for their wife. If this happens, try not to act offended or scold them. This can embarrass them. Gently remind them in private who you are.

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What to Watch For

If your loved one doesn’t get what they want or you try to stop their behavior, they may get angry and hit, push, curse, or scream. It’s rare for people with Alzheimer’s disease to abuse those who take care of them. But if they abuse you and you can’t stop them, talk with a doctor or counselor.

People who take their clothes off or rub themselves often can get skin irritation or infections. If your loved one has either of these and it doesn’t get better in a few days with home care, talk with their doctor.

Prevent Problems

You can do some things to try to keep this behavior from happening:

  • Limit the changes in your loved one’s life. These can make them confused and keyed up and lead to new or different sexual behavior.
  • Provide physical touch. Everyone has a need for loving touch and physical contact. Find a way to touch them as part of your everyday routine. Hold their hand or give them a hug or back rub.
  • Spend time with them. Keep them entertained: Look at photo albums, play board games, or go for a walk. These activities can prevent boredom that can lead to sexual behaviors.
  • Avoid things that trigger the behavior. If it happens regularly, pay attention to what happens right before and try to avoid it.
  • Allow certain behaviors in private. Masturbation may be one of the few ways someone with Alzheimer’s disease can feel pleasure or relieve sexual desires. If they do it in private and don’t hurt themselves, it’s often best to ignore it.

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Reviewed by Neil Lava, MD on August 04, 2018

Sources

SOURCES:

Alzheimer’s Society: “Sex and Intimate Relationships.”

Better Health Channel: “Dementia -- Emotional Changes: Sexuality and Intimacy.”

The American Journal of Geriatric Pharmacotherapy: “Inappropriate Sexual Behaviors in Cognitively Impaired Older Individuals.”

Journal of Psychiatric and Mental Health Nursing: “Displays of Inappropriate Sexual Behaviour by Patients with Progressive Cognitive Impairment: The Forgotten Form of Challenging Behaviour?”

Postgraduate Medical Journal: “Sexually Inappropriate Behavior in Demented Elderly People.”

Sexuality and Disability: “Inappropriate Sexual Behavior in Dementia: A Review of the Treatment Literature.”

Mace, N., & Rabins, P. The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss, John’s Hopkins University Press, 1981.

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