Sexually inappropriate behaviour
Changes in behaviour
My father sometimes thinks that I’m my mother and climbs into bed with me. The first time it happened I was very upset. I couldn’t understand it. But I talked it over with the community psychiatric nurse and felt a bit better. Now when he does it I get out of bed and leave the room and then come back in saying, “Hello Dad”, to remind him who I am without embarrassing him. Whilst amongst company, my sister picked up the corner of her skirt and pulled it up over her shoulders. She didn’t seem to be in the slightest bit embarrassed. I was about to say something, when I realised that she looked a bit cold, so I passed her a cardigan. She let go of the skirt and put the cardigan round her shoulders.
People with dementia are not particularly prone to sexually inappropriate behaviour. But if it does happen, you might be scared that it will escalate. This is generally not the case. There may even be a reason for the behaviour which is not actually sexual, e.g. confusion or disorientation. Even behaviour that is sexual could be due to the loss of the person’s inhibitions, the lack of opportunity for sexual expression, mistaking a person for someone else or the need for touch, security and closeness. Nevertheless, you may be embarrassed and find it difficult to deal with. For many people it is a taboo subject. Sexually inappropriate behaviour is often a problem for the carer, whereas the person with dementia is usually unaware that it is inappropriate or unwelcome. For this reason, dealing with it may involve coming to terms with your own feelings and trying to prevent the person from upsetting other people.
How to cope with sexually inappropriate behaviour
Remain calm and don’t show that you are shocked or annoyed
It is important that you try to remain calm when faced with sexually inappropriate behaviour. You may be shocked by the behaviour, but it is important to remember that it is a consequence of the disease and that the person with dementia does not intend to shock anyone. They may be simply unaware that it is not appropriate as they have lost their inhibitions and sense of what is socially acceptable behaviour in public and what is not.
Dealing with masturbation in public
People with dementia who masturbate in public may have lost their inhibitions or simply forgotten the social conventions which dictate that it should be done in private. They are merely doing what feels good. However, to prevent other people from being shocked, you could try to persuade the person with dementia to do something else, distract them or give them something to fiddle with such as a handkerchief. If this does not work, you should try to lead the person away from the public area. Be careful though that they do not interpret this as restraint, as it could lead to an over-reaction .
What to do if the person with dementia makes an inappropriate sexual advance
Try to remain calm and gently inform the person that the advance is not welcome, suggesting that they have perhaps made a mistake. Don’t take the advance personally or feel that you are in some way responsible. It is the result of the disease, not something that you have done. It is possible that the person with dementia has confused you with someone else. For example, a man with dementia might confuse his daughter with his wife, because his daughter looks like his wife did when she was younger and he has a persisting memory of his wife in her youth. If the person with dementia makes an inappropriate advance, it is a good idea to discuss what happened with someone you can trust. Even if you feel that you handled the situation well, you might not realise that it has affected you.
Look for a possible explanation for the behaviour
There is often an innocent explanation for behaviour which seems to be sexually oriented. Sometimes it can be the only way possible to communicate a need or deal with a particular situation. If you can manage not to be distracted or disturbed by the nature of the behaviour, you might be able to understand what the person with dementia needs. For example, fidgeting which seems to be masturbation might be caused by the person trying to loosen clothing to go to the toilet. This might also be a reason for a woman with dementia to lift her skirt and for a man to undo his flies. Taking off articles of clothing might be considered as indecent exposure, when in fact the person is too hot and is trying to cool down. Itching can be due to a urinary tract infection or because a garment is uncomfortable and intimate touching might reflect the need for security, closeness or human contact.
Last Updated: Monday 10 August 2009