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Dementia and Sexual Expression

Do you remember watching your parents kiss or be frisky with each other and thinking - "Gross." Or did you have more of a romantic perspective, but instead of thinking gross, you hoped to find someone to share that kind of love with someday? Sexual expression is a fundamental part of human nature. Yet many people assume it is no longer enjoyable as adults age into their third act of life. This sentiment is not entirely valid. Others believe that those living with Dementia are incapable of desire and sexual expression completely. Also not true.

As you reflect on who your loved one was before their mental health degraded or how they used to connect with others, ask yourself why they would stop wanting to feel loved. Why would they stop wanting to be hugged? Caressed or still waiting for a moment to be intimate with their spouse? Or even have a moment by themselves to release sexual tension.

The harsh reality with Dementia is that because it is a degenerative process, our loved ones are losing far more than cognitive functions, memory, and control of their behaviors. One significant impact often overlooked with a Dementia diagnosis is the ability to resume sexual expression, which overlooks a fundamental part of human nature. The symptoms related to many forms of Dementia, including Alzheimer's, may make it difficult for your loved one to initiate or participate in sexual activities, but that does not mean the desire or fire inside has been distinguished. It does mean that more consideration and patience may need to be applied.

Another side to this degenerative process I experienced was when, as my mother told me, "even though there are ashes in the furnace, the embers are still burning." Statements like that were the lighter side of when she began to have inappropriate sexual conversations. Mom's comments were initially funny and timely, while she still attempted to be socially engaging.

Over the next couple of years, the timing seemed off, yet we eventually decided she loved the shock factor from her comments or jokes. The lack of reasoning and judgment was not as noticeable when her words began to go down that uncomfortable path. Her social filter was gone.

Mom's comments gradually included out-of-character behavior like flirting with doctors, touching her body as if she "was just telling a joke" in front of the family, or describing sexual fantasies with preferred partners. And yes, partners, as in she wanted more than one 25-year-old at a time. Eventually, her comments left her audience shocked and uncomfortable, so they visited less.

Our problem during those years was not knowing what hypersexuality is, so we could not recognize her comments and behavior as symptoms of early-onset of Dementia. HYPERSEXUALITY, also known as compulsive sexual behavior, is an excessive preoccupation with sexual fantasies or urges that can cause distress and negatively affect someone's health, job, or relationships. Hypersexuality or inappropriate sexual behavior (ISB) is often the first symptom of early onset Frontotemporal Dementia (FTD).

More specifically, hypersexual behavior is typical for those with the behavioral variant Frontotemporal Dementia (bvFTD). The ventromedial frontal and adjacent anterior temporal regions specialize in interpersonal behavior. I understand now that those areas of her brain were affected by the mini-strokes she experienced decades before witnessing these behaviors.

The embarrassment I felt in reaction to Mom's comments or behaviors, especially in public, the less I was able to recognize what underlying need truly was. It is important to recognize that people with Dementia have the same rights as anyone else to express themselves sexually, as long as it is consensual and does not harm themselves or others. Caregivers and family members can support them by providing a safe and comfortable environment for sexual expression, offering appropriate privacy, and respecting their choices.

Even if our reaction on the inside might be like our younger selves thinking "gross," we must not visibly show this in response as disgust. When you can keep in mind that your loved one is still human, you can respond in a more considerate way. Showing them contempt with your facial expressions or hurtful words can lead to feelings of isolation, frustration, and even depression for people living with Dementia. Those feelings eventually lead to more aggressive behaviors when they do not feel validated.

Most healthcare professionals can provide guidance on how to handle sexual behavior changes, and support groups can provide a safe space for people with Dementia and their caregivers to discuss their experiences and concerns.

People living with Dementia have the right to express themselves sexually, and caregivers and family members can play a vital role in supporting them to do so. By recognizing and addressing the sexual needs and desires of people with Dementia, we can help them maintain their dignity, autonomy, and quality of life.

While sexual expression can be challenging for people living with Dementia, it also offers a range of health benefits that can improve their overall well-being. Here are some of the health benefits of sexual expression for people with Dementia:

  1. Improved mood: Sexual expression can release endorphins, which are natural chemicals that can improve mood and reduce feelings of depression and anxiety.

  2. Enhanced physical intimacy: Sexual expression can promote physical closeness and intimacy, which can help people with Dementia feel more connected to their partners and reduce feelings of loneliness.

  3. Reduced stress: Sexual expression can reduce stress levels by promoting relaxation and releasing tension.

  4. Improved sleep: Sexual expression can enhance the quality of sleep by promoting relaxation and reducing feelings of anxiety without medication.

  5. Increased physical activity: Sexual expression can be a form of physical activity that can improve cardiovascular health, strengthen muscles, and promote overall well-being.

  6. Reduced pain: Sexual expression can release endorphins, which can act as natural painkillers and reduce feelings of discomfort or pain.

  7. Enhanced cognitive function: Sexual expression can promote cognitive function by stimulating the brain and promoting mental stimulation.

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