sexuality
Edited by: Ayelet Saar - Occupational Therapist. (The article was published in Bulletin No. 18 of the Alzheimer's Israel Association)
Humans, by nature, feel a need for touch, caress, and warmth. For an Alzheimer's patient, this need even increases over time. The disease affects each patient differently. For one, interest in sex will increase, while for another, interest will be lost completely. These changes often lead to relationship problems, sadness, pain, disappointment, shame, or anger.
Physiological and mental factors for changes in sexual behavior:
Depression – may reduce interest in sex, both in the patient and their partner.
Physical illness – may cause the patient to lose interest in sexual intercourse, or to experience pain or even difficulty in having it. Sometimes, reactions to certain medications can cause a decrease in the desire to have sex.
Paranoia – may cause the patient to become suspicious and jealous for no apparent reason, and in an exaggerated manner. (For example, the patient may suspect that his wife is cheating on him and is going to visit her “lover,” just because she wanted to go out on her usual morning errands.)
Changes in the brain – which cause loss of control over behavior.
Examples of inappropriate sexual behaviors:
Blunt behavior – the patient may forget his status as a married person and flirt, sometimes in a manner that does not fit social conventions, with members of the opposite sex. Exposure – the patient may forget how to perform activities such as dressing/undressing, and sometimes perform these tasks at the wrong time and place.
Self-indulgence – The patient is able to forget social rules, and may touch intimate parts of his body (including masturbation) without understanding the prohibition of this act. Although the act may appear to be provocative or a desire to embarrass others, it must be remembered that the patient does not necessarily understand his actions and act accordingly.
Misjudgment – The patient may flirt and even show affection for strangers who look similar to their spouse, lover, or other person from their past. In addition, the patient may forget the fact that they are married and show affection for others, even when their spouse is nearby.
Problems arising from the need to have sex (in the patient and his/her partner):
The patient may feel an increased need for sexual intercourse, sometimes even at strange times, in unacceptable places and with exhausting frequency. Often, the partner will feel like an object. Once the patient has reached his satisfaction, he may completely forget what happened. Sometimes, the patient may become aggressive if his demands are not met. In such a case, it is advisable to stay away from contact until the anger passes.
Problems resulting from decreased sexual drive (in the patient and their partner):
Many Alzheimer's patients lose interest in physical contact. They may become withdrawn and, although they will accept physical contact from others, will not initiate it themselves.
Sometimes, even though the patient is willing to continue sexual intercourse, the partner may experience feelings of guilt because they feel that the patient is unable to function or respond as before.
The partner may not understand and feel hurt by the patient's lack of interest.
Partners may feel that they cannot think about having sex with the patient, since they are treating him as if he were a child (bathing, eating, using diapers, etc.).
Couples may feel so engrossed in the grueling physical therapy that they are unable to even think about it.
Many couples claim that they feel like they are living with someone "other," since so many aspects of the relationship with the patient have changed due to the illness (such as feelings that the patient is clumsy, awkward, does not maintain personal hygiene, etc.).
Many couples feel guilty about their feelings and reactions and feel the need to talk to someone about these issues . This is an important and necessary need that should not be suppressed!
Ways to deal with the problem:
Look for the reason for a particular behavior – remember that the reason for touching intimate parts in public may be a way of expressing the patient's need to go to the bathroom, and removing clothes may express fatigue and a desire to go to sleep.
Respond patiently and gently – If the patient engages in unwanted sexual activity, gently remind them that this behavior is inappropriate. They can be escorted to another corner/room in their environment, and distracted with another activity. Avoid getting angry, laughing, or dismissing the behavior inappropriately. In many cases, anger or laughter can provoke a negative reaction from the patient. Also, it is not always necessary to stop sexual activity (such as masturbation) – but only direct the patient to do it in an isolated corner, thereby preserving their privacy and dignity.
Accusations and threats – If the patient makes accusations or becomes suspicious, it is better, rather than getting drawn into an argument, to distract him/her through another activity, or by providing reinforcement, such as a handshake or hug. It is important to remember that strange or atypical behavior on the part of the patient is part of the illness and is not directed personally at the partner.
Clothing and dressing changes – Consider dressing the patient in pants with a back zipper or use a tracksuit with no zipper at all, to make it difficult to remove clothing unnecessarily.
Using the right physical touch – It is important to provide the patient with physical contact expressed through caressing, hugging, etc. In many cases, a person with anxiety needs the security of touch and loving connection.
Adapting to changes in sexual desire – as the disease progresses, the partner may prefer to sleep separately from the patient – especially when the latter becomes more jealous, demanding, or unreasonable.
Sexual satisfaction of the partner – Many partners do not like to talk about the subject and feel embarrassed and guilty, but they can also find refuge in masturbation. Some partners find comfort in the arms of others and this helps them cope with everyday life, while others say they cannot do this as long as the patient is at home – or even have difficulty doing so when he is hospitalized in an appropriate ward. Some eliminate all thought of the subject. Each partner must find the solution that suits him/her.
Use of medication – Partners who feel that the patient's sexual needs are no longer controllable may seek medication to reduce sexual drive. This is recommended only as a last resort.
Getting support from an outside source – It is possible and desirable to deal with personal problems through sources outside the family (such as counselors or psychologists). It is important to make sure that this source is knowledgeable about the disease and its effects and can deal with the issues raised in an open and appropriate manner.
Many people, including professionals, believe that when people reach retirement age they no longer feel the need to have sex . This is not true ! Sexuality is not necessarily a problem. There are couples who still enjoy healthy and enjoyable sexual relationships for a long time.