Caregiver guide
Intimacy, sexuality and dementia: a guide for partners and caregivers
Dementia often changes intimacy and sexuality for both partners. Interest in sex may fade, grow or show up in ways that surprise you. These changes come from the disease, not from a lack of love, and there are kind ways to stay close.
How does dementia affect intimacy and sexuality?
Dementia changes the parts of the brain that handle memory, feelings and judgment. That can change how your person shows love and how they respond to touch.
Some people lose interest in sex. Some become more clingy and need you close all the time. A few become very interested in sex or act in ways that would have embarrassed them before.
If you're a spouse or partner, you may feel lonely, confused or guilty for having needs of your own. If you're an adult child, you may be facing behavior you never expected to handle. Both are common, and both are hard to talk about. This guide is a place to start.
Why intimacy changes for both of you
For the person living with dementia. Memory loss can be frightening. Your person may feel worried, low or angry, and lose confidence. They may forget shared history, forget how to be intimate, or forget that you are their partner.
Other things can lower interest in sex too, such as depression, other health problems and the side effects of some medicines. If you notice a change, mention it to the doctor. See our guide to managing medicines for questions to ask.
For you, the caregiver. It's hard to feel romantic toward someone you also bathe, feed and remind. Many partners pull back without meaning to. You may feel it's no longer right to have sex with your person, or that they seem like a stranger. Those feelings are normal.
Over time, many couples find a new kind of closeness. It may look different, but it can still be meaningful.
How to stay close when sex is no longer part of the relationship
Everyone needs to feel loved and safe. Small, regular moments of affection often matter more than words.
Say it often
Tell your person you love them, that they are safe and that other people care about them too.
Use gentle touch
Hold hands, hug, sit close, brush their hair or give a hand or shoulder massage.
Share familiar pleasures
Listen to your wedding song, dance in the kitchen, look at old photos or take a slow walk together.
Plan time together
Set aside time that isn't about care tasks: coffee on the porch, a drive, a favorite show.
Keep other people in their life
Visits from friends and family help your person feel valued and give you a little breathing room.
Focus on what's still there
Notice the smile, the laugh or the hand that still reaches for yours. Hold on to the good parts of your relationship.
What is hypersexuality in dementia?
Hypersexuality means a person shows much more interest in sex than before. They may make sexual comments, touch themselves or others, undress in public or try to seduce someone who isn't their partner.
This behavior is a symptom of the disease. Dementia can damage the part of the brain that stops us from acting on every urge. It often doesn't mean the person truly wants sex. They may be seeking comfort, attention or touch, or they may be uncomfortable, bored, too warm or needing the bathroom.
What type of dementia causes hypersexuality?
It can happen with any type of dementia, including Alzheimer's and Lewy body dementia. It is more often linked with frontotemporal dementia, which affects the front of the brain where judgment and self-control live. Ask your person's doctor what is likely in their situation.
What to do about sexually inappropriate behavior in dementia
Stay calm. Your reaction sets the tone. These steps help many families. If the behavior puts anyone at risk, call the doctor right away.
Don't scold or shame
Your person may not understand what they did wrong. Speak quietly and kindly.
Look for the need behind it
Check for discomfort, a full bladder, tight or itchy clothes, being too hot, boredom or loneliness.
Redirect gently
Offer something to hold, a snack, music or a walk. Lead them somewhere private if they're undressing.
Give more affection, not less
Extra hugs, hand-holding and reassurance can meet the need for closeness in a safe way.
Adjust clothing
Clothes that open in the back or have no zipper in front can make undressing in public less likely.
Keep a simple log
Note when it happens, where and with whom. Patterns help the doctor find causes.
Talk to the doctor
Rule out medicine side effects, infection or pain. Some people need medicine to manage these behaviors, and only the doctor can decide that.
Warn others kindly
Let visitors, home aides or grandchildren's parents know what to expect so no one is caught off guard.
When your person falls for someone else
Sometimes a person living with dementia forms a romantic attachment to someone new, often another resident or a regular helper. They may not remember their spouse at all.
This can be deeply painful. It helps to remember that the disease, not a choice, is driving it. Many spouses find that the new friendship brings their person comfort and calm. Others need to step back and protect their own heart. There is no single right response.
If your person lives in a care community, talk with the staff about what's happening and how they handle relationships between residents. If you're also worried about falls, wandering or other risks at home, see our guide to dementia safety at home.
Taking care of your own needs
Your needs for closeness and touch don't go away. It's okay to admit that.
- Talk to someone you trust: a doctor, counselor, faith leader or friend. It may feel awkward, but it helps.
- Join a group of people who understand. ADRC's free caregiver support groups include groups just for men, for Spanish speakers and for adult daughters and granddaughters, in person and online.
- Book a free, one-on-one Care Navigation session. We can help you think through what you're feeling and make a plan.
- Look after your own health. Rest, eat well and see your own doctor.
Hospital stays can also bring out new behaviors. Our guide to a dementia patient in hospital explains why and what to do.
Questions caregivers ask about intimacy, sexuality and dementia
What stage of dementia is hypersexuality?
It can happen at any stage, but it is more common in the middle and later stages, when judgment and self-control change. In frontotemporal dementia, changes in behavior can show up early, sometimes before memory problems. Every person is different, so talk with the doctor about what you're seeing.
Is inappropriate behavior an early sign of dementia?
It can be. New, out-of-character behavior, like rude or sexual comments to strangers, can be an early sign of some types of dementia, especially frontotemporal dementia. It can also have other causes, such as medicine side effects or other health problems. If you notice a sudden change, ask the doctor for a full check-up.
What are some early signs of personality changes in Alzheimer's?
Families often notice their person becoming more anxious, withdrawn, suspicious, irritable or easily upset, especially in new places. Some people lose interest in hobbies or friends. Others become less careful about what they say. Any change like this is worth mentioning to the doctor.
Does dementia cause erectile dysfunction?
Dementia can affect sexual function, and so can other health conditions that are common with age and many medicines. Talk to the doctor before trying any treatment, including products sold online. Some medicines can be risky alongside other prescriptions.
Is it still okay to have sex with my spouse who has dementia?
Many couples stay intimate after a diagnosis. What matters is that your person still understands what is happening and can show, in words or actions, whether they want it. If they seem confused, scared or unwilling, stop. As the disease progresses, this gets harder to judge. It is a sensitive question with legal and ethical sides, and it's okay to raise it with the doctor, a counselor or an elder law attorney.
My spouse doesn't seem to know me anymore. How do I cope?
This is one of the hardest losses in dementia, and you may grieve while your person is still here. Many caregivers say it helps to focus on comfort rather than recognition: your person may still feel safe with you even if they can't name you. Talking with others who've been there can ease the loneliness. Our support groups are free and no reservation is needed for in-person groups.
Can people with dementia have romantic relationships in a care community?
Yes, it happens. Each community has its own policies for keeping residents safe and respecting their dignity. Ask the staff how they handle it and how they'll keep you informed. If you're choosing a community, ADRC's Information & Referral service can help you find options with dementia care.
Who can I talk to about this?
Start with your person's doctor, especially about new behaviors or medicine side effects. For support for you, call ADRC at (407) 436-7750, Monday to Friday, 8:30 AM to 4:30 PM. Our services are free. In an emergency, call 911. For help any time, the Alzheimer's Association 24/7 Helpline is 800-272-3900.
Download the free guide (PDF)
Get the National Institute on Aging tip sheet on changes in intimacy and sexuality to keep or share with family. Find more free guides in our Caregiver Resource Library. Based in part on National Institute on Aging guidance.
Talk with someone who understands
Alzheimer's & Dementia Resource Center (ADRC)
1470 Gene Street, Winter Park, FL 32789
- Monday to Friday: 8:30 AM to 4:30 PM
The Alzheimer's & Dementia Resource Center (ADRC) in Winter Park, Florida, offers free help for caregivers in Orange and Seminole counties; call (407) 436-7750. In an emergency, call 911. The Alzheimer's Association 24/7 Helpline is 800-272-3900.