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Talking about Intimacy, Sexuality & Alzheimer’s: Part 2

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In the most recent posting in this series, I examined how intimacy is deconstructed and reshaped within a couple where one spouse has been diagnosed with Alzheimer’s. Sex and intimacy for most couples are intertwined concepts. But as intimacy drifts into unfamiliar territory, like dealing with dementia, many factors act as cumbersome weights on the sexual relationship. Many dementia and sex-related issues are informed by how two people relate to each another as perceptions change. Spouses often have difficulty switching between the roles of sex partner and caregiver. And the person with dementia can become confused about the relationship to their spouse. For example, a woman could think her husband is her father, deem his advances inappropriate and react accordingly.

During the sex act itself, issues such as limited attention span and lack of focus on one’s partner can make the spouse without dementia feel (at the very least) unsatisfied, poorly treated or “used” by their spouse. (Hypersexuality in dementia patients, usually associated with men, is a myth, based mainly on accounts of disinhibition that can result in behaviors such as public undressing; however, erectile dysfunction hovers at about 50% in men with Alzheimer’s.) The idea of being “used” is also fed by common situations such as a person with dementia not recalling their spouse’s name, but continually making sexual advances. Conversely, a spouse may feel that their diagnosed partner cannot give informed consent for the sex act—and as such, questions whether their behavior could be classified as rape. What makes these issues particularly thorny is that many couples view sex as a gateway for two people to celebrate their intimate connection: it is the ultimate physical expression of love. To these couples, it is yet another form of communication that they are robbed of during the course of the disease.

There are no quick fixes for these issues, but keeping the lines of communication open is essential. Everyone’s experience of a disease like Alzheimer’s will be individual—in the same way that no two relationships are alike. The best recourse for couples is to join a support group where you can find others in similar situations. If your spouse has been diagnosed, you need a support network, especially as the person whom you probably were closest to drifts away from you. Sex is an important and non-negotiable need for some people. In a seminar I attended at a recent Alzheimer’s Association conference, the idea was put forth of a person having a new sexual partner once the disease course disallowed a satisfying sexual relationship with a spouse. The elephant in the seminar room was the ensuing guilt that occurs when one ignores the “sickness and in health” portion of one’s marriage vows. Interestingly, the husband in the video we watched (of a couple grappling with his wife’s Alzheimer’s) was a devout Christian; he said in his younger years he never would have understood a man in his situation “having a female friend” once his wife was in a long-term care facility. Although the husband chose not to go this route due to his own religious convictions, his judgment on such relationships was far less harsh; he now found it understandable. One audience member stated that his wife, diagnosed with Alzheimer’s, was afraid of him—and men in general were not welcome in her presence. The same man discussed having a “female friend” with his adult children and was surprised to find that both his son and daughter were open to the idea. In someway, this proves that it is important to keep talking—as you don’t know what people are thinking until they open their mouths.

Keep talking,

Lara Belonogoff

Read Talking about Intimacy, Sexuality & Alzheimer’s: Part 1

Posted in: Alzheimer's & Intimacy, Sex & Alzheimer's, Sexuality & Alzheimer's

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