Sex and Alzheimer's: Love Stories, Sad Stories, and Lots of Questions

Last updated: September 22, 2009
With Love...
Image by suchitra prints(Away for a few days) used under the creative commons attribution license.

Sexual urges don't stop just because Alzheimer's or another dementing illness invades the brain. Sometimes this is a blessing; some long-married couples say that the mind and body long remember the behaviors of sexual intimacy, even when short-term memory is on the fritz, which helps reinforce their closeness despite the disease-related adversity. Sometimes, on the other hand, sexuality coupled with dementia can cause big problems.

Few of us care to think about our parents having sex at any age or in any circumstances. But when the circumstances include dementia, certain issues might sidle up to a caregiver anyway. Reading this terrific legal overview in the Washington Post about an Alzheimer's rape case is a great reminder to family caregivers that sex is a fact of life (sometimes a thorny fact of life) all through life.

What are the most common minefields?

  • A consenting couple, in which one party has Alzheimer's, but both enjoy the sexual relationship.

Potential minefields: Symptoms can ebb and flow, meaning a partner who seems like "her old self" one night might have a hard time with reading nonverbal body language and respond appropriately the next. As the ongoing demands of the disease take their toll on intimacy generally, a caregiver may feel more frustrated, less close, to the spouse, even when the sexual relationship persists.

Worth mentioning again: This is not universally true for all couples. But what is true is that the "balance of power" within the relationship is shifting in one direction, and the caregiver is more aware of these changes than the person with dementia, as time goes on.

Consensual sex between partners who live in assisted living situations is a hot button issue in long-term care. Whether one or both parties have dementia, who is to say when sexual activity should cease? Sexual communication is important to a relationship and worth respecting. And yet semi-communal living situations can afford little privacy, or make (often young) staffers who are mentally unprepared for this reality feel awkward.

  • The person with Alzheimer's wants sex; the spousal caregiver, not so much.

Potential minefields: Changes brought by the disease as the person becomes more child-like and dependent can curb the spousal caregiver's desire. He or she may feel guilty about this reality. At the same time, disinhibition is a common side effect of Alzheimer's; the person may make aggressive sexual advances or strip as a function of the disease, rather than desire. It can be hard for a stressed caregiver to know the difference.

  • The spousal caregiver wants sex; the person with Alzheimer's is past the point of consent (or isn't the object of desire).

Potential minefields: When within the bounds of marriage can intercourse be called rape? The definitions can get murky.

In the case of the spouse who no longer seeks the sexual companionship of his or her partner with dementia, weighing one's moral and practical appetite for an affair can become an issue. Given that people can live for a dozen years or more with advanced dementia, satisfying sexual needs can become a real issue for spousal caregivers.

  • The person with Alzheimer's wants sex (or seems to) with oh, anybody.

Potential minefields: Sexual desire is a biological urge, but a hallmark symptom of dementia is a lack of judgment. So the person risks acting on perfectly natural urges -- though in ways that may or may not be appropriate. Or the person may embark on a sexual affair that, because of the disease's other effects, is otherwise an imbalanced one; for example, the father who wants to wed the nurse he becomes attracted to (who may be in love with him "“ or his money; how's a family to be sure?).

Disinhibition ties in, too; others may perceive disrobing or making sexual comments as advances whether they are or not. [Hired or family caregivers around this hypersexual behavior can be very uncomfortable] (

  • A non-spousal caregiver or other person takes advantage of the person with Alzheimer's. (Or is it consensual?)

This is the crux of the fascinating case in the Washington Post feature. Sexual abuse is unconscionable, as in headline-making cases of nursing home workers accused of fondling or having intercourse with residents with such late-stage disease that it can't possibly be consensual. But what's rape in cases where the person can't exactly remember what happened and may or may not have been in agreement at the moment? What constitutes "taking advantage" of someone who's basically mentally impaired? Are the definitions different morally, ethically, and legally?

They're all tough questions nobody likes to think about. Spousal caregivers encounter them first, but so might any of us. They're potentially strange bedfellows, sex and Alzheimer's. Are you ready?

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12 Comments So Far. Add Your Wisdom.

Anonymous said 9 days ago

To: Bob care a lot I'm in the same boat as you are. I still crave intimacy even after prostate surgery but my wife of 49 years with early Alzheimer's disease has no libido or desire for sex or any form of affection not even close contact. Always says I'm a sex maniac and claims I always have been. We're just 2 people living in the same house together, friendly but not lovers anymore.

Anonymous said about 1 year ago

Recently started dating a woman and to find out she has the onset of dementia. I am concerned and fearful of the meaning od this,we've been sexual and now I have to pull back and ......Damn it

over 1 year ago

I just am no longer sexually attracted to my husband since I have become his caregiver/mom and less of a wife. He wants sex but I can no longer imagine having sex with him as there is no attraction for him as a lover. For me the intelligence of a man is important in order for the attraction to exist. I hate what the disease has done to us and don't understand people who can see it as a positive thing which it certainly isn't. So far he hasn't accused me of having other men in my life which I don't.

over 2 years ago

Hello. i am a male caregiver for my wife who has had Alzheimers for 6 years; she is 65 and i am 60. My sex drive is still healthy and my wife has 0 interest in not only sex, but affection also. i am frustrated and have considered having a relationship even for sex only on the outside but have not done that yet. Down the road I can see myself doing that. All opinions are welcome. Bob

over 3 years ago

Hi anonymous, Thanks for your comment. I'm sorry to hear you've been having difficulty with your husband lately, that must be tough for you. If you are interested, you may find some useful information in our "Sex and Relationships" section, here: ( ). You can also post a question in our Ask & Answer section, located here: ( ). I hope that helps. Take care -- Emily | Community Manager

Anonymous said over 3 years ago

I have lost all desire for sex in the last year. Caregiving is so stressfull and draining somedays and my husband's approach is so differrent than it was before the disease. I feel guilty at times for not feeling the same desire that he apparently does. If I don't respond to him he accuses me of seeing someone else and saving it all for the other man and not loving him. That is so untrue. He was my first love/lover I can't even imagine being with anyone else. Do I just need to give myself to him and not think of myself?

almost 4 years ago

It is very helpful to know that my feelings are shared by others. Sometimes the situation can be a bit overwelming, but I always manage to bounce back. Piled onto the situation with my husband's Alzheimer's are other family issues - oldest son (USAF) is in Afghanistan, third son involved in motorcycle accident, and youngest granddaughter (2 1/2) is battling leukemia. You know how that goes. Some weeks are better than others. I've learned that many times when I get overwelmed at not being able to help others more, I just have to give it up to God and remind myself that I'm not really in charge. I'm so glad I stumbled onto this website last week. How nice to have a life line!..........Gillian

about 5 years ago

WellSpouse thanks for adding your perspective -- coincidentally I just mentioned your organization in a newer post about why spousal caregivers often miss out on resources for help.

about 5 years ago

A very perceptive entry. I am the President of the Well Spouse Association,, a non-profit group offering peer support to husbands, wives or partners of persons with chronic illness and/or disability. We have members whose spouses have Alzheimer's or other illnesses involving dementia. That apart, very often in the case of any chronic illness/disability, intimacy gets disrupted, due to fatigue and other symptoms that make it less interesting or possible for the ill spouse, and less appealing or attractive for the well spouse. The situation described by pollytnjc certainly can occur. Usually it's the family who takes exception to the "abuse" of a new spouse/caregiver. The WSA concentrates on helping the well spouse regain balance in his/her life in order to help them look after their ill spouse. This principle applies no matter what the situation. So in the case of dementia and Alzheimer's, I would say we would encourage the well spouse so that the emotional well-being of both partners is paramount.

about 5 years ago

My father's sexual needs grew so much that he wanted sex all the time. My mom as his care giver gave in for a long time but after he proceeded to the next stages and became very aggressive he had to be moved to an Alzheimer's Facility. It was not condusive to sex and privacy so the sexual activity stopped. My father, of course didn't understand so he would become angry and accuse my mother of having a boyfriend. It became very ugly at times. We didn't want to put my mother in danger and we didn't know how to handle the whole situation. What do you do when the Alzheimer's "victim" is so angry and aggressive? Unfortunatly we lost my dad in 2008, but maybe someone else could benefit from some insight.

Anonymous said about 5 years ago

No, but I have seen love affairs start up in assisted living homes between residents married to others, very sexual conversations by a man to visitors and staff alike, and strong sexual approaches to caregivers, causing them to quit. These are probably more prevelant.

about 5 years ago

Further, what about a situation where a person with sexual desires and slight dementia is perceived to have a good deal of money, and a caretaker is able to use sexual favors to gain control of this person's resources? Has anyone had experience within their family situations where a caregiver has abused their position like this? Or similar situation where an elderly person has been manipulated this way?

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