Behavior Changes with Dementia: Sexually Inappropriate Behavior

Oct 25, 2019 | Living with Dementia

This article is part of a 3-part series on the behavior changes that come with dementia. You can find the rest of the series below.

Behavior Changes with Dementia: Aggression
Behavior Changes with Dementia: Hallucinations

Handling Sexually Inappropriate Behavior

Inappropriate sexual behavior is disturbing, but it may feel like a much greater challenge when your loved one or the one you care for with dementia acts in ways that are new or different for them.

Sexual Desire in People with Dementia

Consensual sexual activity may decrease in elderly people and those with dementia, but this does not mean they lose interest in sex altogether. As dementia progresses, cognitive deterioration, poor judgment, and personality changes may contribute to deviations in sexual attitude as well as inappropriate sexual behavior.

A man or woman who appeared to have no interest in sex or those that were sexually inactive prior to dementia may suddenly begin showing sexual interest towards someone other than their spouse, professional caregivers, or strangers. This is not always inappropriate, as consensual sexual behavior can be considered normal and healthy as long as the participants have the cognitive ability to consent.

Defining Inappropriate Sexual Behavior

While a healthy interest in sex is normal, it is an entirely new ballgame when inappropriate sexual behavior occurs. Before we talk about how to cope, let’s be concise with what inappropriate sexual behavior looks like (but not limited to):

Masturbating or fondling genitals or breasts in public
Making sexual advances or touching others in unwanted ways
Sexual language including explicit sexual comments and describing sexual acts
Removal of clothing outside of the bedroom or bathroom
Exposing genitals or breasts in public

Take Immediate and Calm Action

When working with a person with dementia, especially when it involves corrections, your method should always include a calm demeanor as well as firmness.

People living with dementia typically understand, notice, and react to body language much better than they do verbal commands.

When inappropriate behavior occurs, make comments such as, “No, that is not right!” or, “No, that is not acceptable!” but also include body language such as a frown on your face, or shaking your head to gain attention.

Be consistent. Confusion may develop if you ignore inappropriate sexual behavior but later attempt to correct it.

Avoiding Inappropriate Sexual Contact

Hugging: It may feel unnatural to avoid hugging someone you deeply care about, but people with dementia may become confused and mistake your display of affection as sexual in nature and then you might experience wandering hands. How do you correct this? Put space between you and the other person through this method:

Instead of hugging, stop when you are within arm’s reach of the person and raise your hands as if you are gesturing “stop.” Make eye contact and smile. Remember, body language is key to communicating with a person with dementia.
Encourage the person with dementia to raise their hands and make contact with yours, palm to palm. Your goal is to interlace fingers.
Once you have control through the holding of their hands, lean in to touch cheek to cheek, or through a kiss on the cheek. Kissing mouth to mouth may encourage sexual advances.
Do not linger once the embrace is finished. Step away and release the hands.

This allows the person with dementia to touch you, the person that they care about, without touching you where they shouldn’t.

Distract Attention: To avoid inappropriate touching from a person with dementia, try to distract their attention. Start with these steps:

Ask a question.
Turn on the television.
Offer a snack.
Turn on the music that they like.
Offer to go for a walk.
Ask if they want to engage in their favorite hobby.
Guide the person to another area.

As a last resort, you may need to firmly tell them “Stop” or “No!” Remember, body language speaks to a person with dementia more effectively than verbal language, so you may also need to remove their hands and place them in their lap or shake your head as you let them know that their behavior will not be tolerated.

Never physically fight the person with dementia. If you feel you are at risk of physical harm, you may need to call in assistance.

If none of these steps work, consider leaving enough space between you and them so they cannot reach out and touch you.

Treatment of Inappropriate Sexual Behavior

Specific medical treatments for inappropriate sexual behavior in people that have dementia have not been developed.

There can be medical reasons, other than dementia, that magnify the behavior, but keep in mind there may be practical ways to help prevent the behavior without resorting to medication, such as:

To prevent a person from disrobing in public, you may need to dress them in clothing that is difficult for them to remove. But, before you do so, remember that they may be taking their clothes off because they are uncomfortable. Discomfort may be caused by the clothing itself, by excess warmth in the environment, and may also demeanor by a hidden medical reason.
A person who masturbated at home prior to their diagnosis of dementia may have lost the ability to differentiate between public or private space, yet they may still feel pleasure from masturbation. Consistent guidance to masturbate only in private living areas may do the trick, but you, the caregiver, may also need to tote something with you when in public areas to quickly cover exposed genitalia up.

Medical Exam: Pharmaceuticals that affect hormone levels, or those that reduce depression or anxiety, may help to diminish inappropriate sexual behavior in general. But, the first step must always be a medical exam. Discomfort of any type, such as warmth, pain, or itchiness, may lead a person to grab or fondle their genitals or breasts, which has nothing to do with sexual behavior.