Well, brace yourself, Effie, I'm going to go there today! Having the sex talk with Mom may not have been as funny as the line delivered on Mrs. Doubtfire by Robin Williams, but it certainly brought about another reality check. Even though Mom is now living in stage six of the seven stages of Dementia, we still had to have - "the talk." Dementia may cause the loss of many cognitive functions, but the natural human response to sexuality and intimacy remains.
I experience the moment I never expected. Because I know to read between the lines, I had to sit down with Mom to figure out what she really wanted, aside from the shock factor. Moments of aggression with more sex talk are increasing. This topic is often overlooked because it is frankly uncomfortable or embarrassing to others. A spouse longing for connection may welcome the change, but an adult child or memory care staff may be offended by the sex talk.
During stage 5 of Dementia, I spent days pleading with Mom not to talk about sex in a manner that seemed so vulgar or gross. Then it was somewhat funny, and she liked the shock factor followed by our laughter. Mom reminded me often, "There might be ashes in the furnace, but it's still burning." She is still a woman with needs, basically, and I can't argue with her. I also could not provide her with, um, tools or opportunities to resolve sexual frustration. Redirecting conversations became an art to avoid the sexual sass talk. These behaviors add challenges to caring for our loved ones, so we must be prepared for when the topic arises.
When Caregivers are not trained in topics like sexual expression in the elderly, they are left to reactions based on their comfort level. A difference of opinion may create the viewpoint that their behavior is wrong, unnecessary, or embarrassing. This difference may create more frustrations for you or cause a respite caregiver to leave. I know dealing with an erection might be way more difficult to respond to than words of sexual expression. It's a part of human nature that cannot be avoided, unfortunately.
What caregivers need to understand about this kind of behavior is that it is a new form of communication, not necessarily a need for alarm. Sexual expression can provide stress reduction to alleviate loneliness or provide a tension release without having sex. Just as we used to try to fit in during adolescent school years with this kind of talk, a senior reverting to an earlier mental age is also looking for a sense of belonging.
As the talk persists, your loved one may be hoping for a positive relationship or trying to enhance their self-esteem. The obvious choice is a better quality of life through this form of connection, and possibly even some exercise would be nice. Since Mom refused social engagements, my only logical response for Mom was to provide her with a 'Buddy for me time.' The problem is figuring out who would be responsible for the maintenance and sanitation of Buddy. Uncomfortable topic indeed, which is why it is avoided and our loved one's aggressive behavior gets worse.
To avoid my inquiry of this topic, Mom would say, "No, I want the real thing!" Then I would encourage better hygiene and social outings. Mom's response inevitably was, "Nope. I don't need it that bad." We would get stuck in this loop over and over on shower days, especially. Until recently, the sex talk has returned with descriptive words and aggressive responses when asked to stop. Even though this is all normal for someone living with Dementia, it does not make it easier to witness.
If caregivers do not have positive attitudes towards sexuality and self-expression, it becomes more difficult to assist our loved ones. So I decided to sit down to talk about what Mom wanted yet again. When Mom says, "I'm so horny it hurts," this is communication that might indicate more than a sexual desire. Requesting an order to have Mom tested for another UTI was processed before asking what could satisfy her craving this time.
Part of Mom's response to the sex talk was similar to her aggression response - she is bored. And yet, when presented with opportunities to engage, she is quick to complain and withdraw. Where aggression becomes a defensive mechanism, sex talk becomes a cry for connection. We all walk a fine line between connections because we want to encourage positive behavior over negative. Sexual expression is not negative, but it creates delicate boundaries to respect.
If you find yourself needing to have "the talk" with your loved one, then consider the following to research further before you approach them:
1. Are they taking any new medications that might have sexual side effects, or is it time to adjust current medications?
2. Could your loved one be experiencing a UTI yet unable to express it?
3. Has your loved one recently experienced a stroke, diabetes, arthritis, or other illness? Their need to feel normal and reconnected may be presented through sexual expression.
4. Is it possible your loved one experienced sexual abuse as a child? When our loved ones go back in time mentally, they may be re-experiencing a time when their body was used inappropriately. Their memory may be fading, but the body still has muscle memory.
5. Are you in a later marriage, perhaps? Your loved one might feel the need or pressure to perform as much as they may need the connection. Have you turned away from your loved ones because of their illness?
6. Has your loved one had removal of prostate/testes or uterus/ovaries? Amputation of a limb or breast(s)? Have they undergone a colostomy or ileostomy procedure? The body heals differently for those not living with Dementia but still may cause a reaction with a need for sexual intimacy as part of the healing process.
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I hope this gave you more food for thought. Until next time, BE PROACTIVE. Take care everybody.
Intro: Vacation Time by Khris Paradise
Outro: Misty by Khris Paradise