What can I do about my husband's inappropriate sexual behaviour?

'My husband, who has dementia, is making inappropriate sexual comments to care home staff, and I'm worried it may get worse. How do I balance his needs with other people's?'

The diseases that cause dementia can damage parts of the brain that usually stop us behaving in inappropriate ways. Remarks or actions of a sexual nature can cause problems, particularly if directed at a friend or family member. However, it is important to realise that they are usually a symptom of the person’s dementia. Care home staff should know this and be trained in how to respond.

If someone with dementia is behaving in this way, they may not recognise the person or might mistake them for someone else. They may not be able to recall what people should or shouldn’t do or say in various contexts – for example, not to make sexually explicit remarks to a relative stranger.

Communication and understanding

Understanding that someone’s inappropriate sexual behaviour is probably caused by damage to their brain may help to make it easier to deal with. However, some friends or relatives may still find the behaviour difficult to deal with despite knowing this, and this could limit how they spend time with them.

Sometimes what we think of as sexual behaviour could actually be a person’s way of expressing discomfort, anxiety or distress. For example, they may take off their clothes in public simply because they are too hot, and so addressing the root cause should help.

If the person’s behaviour is intended to be sexual in nature, then you might be able to find a sensitive way to explain to them – calmly and without judgement – why it is inappropriate. This could take several attempts, and is likely to be less effective as the condition progresses.

Environment and behaviour

Our emotional need for physical intimacy doesn’t disappear just because we develop dementia. In some cases, it might be helpful for the person with dementia to express their sexuality by having some time alone with their partner, when they can both enjoy the comfort, pleasure and reassurance that this brings.

Inappropriate behaviour can also be a result of under-stimulation and boredom, so it might help to fill the day with engaging social activities – exercise, eating and drinking, doing housework, arts and crafts, or simply talking with other people.

Lastly, although drugs have been used to address sexually inappropriate behaviour, there isn’t good evidence that they work. Taking more medications increases the risk of side effects, and some drugs could make it harder for a person to communicate discomfort or distress. Drugs should only ever be considered if the behaviour is very serious, and only as a last resort once all other options have been tried.

Next steps

• Inappropriate sexual behaviour is often associated with frontotemporal dementia.

• Read more articles from Dementia together magazine..