Dementia's toll on sexuality

by Lindsay Novak for Livewell Nebraska:Awhile back, Sandra Day O'Conner disclosed that her husband lived in a long-term care facility due to progressing Alzheimer's.She revealed that she wasn't jealous, but rather pleased, when he fell in love with another woman who also lived in the facility. He was no longer able to remember that he was married or recognize his wife.This is just one example of how dementia can complicate a couple's relationship and intimacy.Dementia is a catch-all phrase for symptoms related to memory or thinking skills. Alzheimer's accounts for more than two-thirds of these cases. Other forms of dementia include the effects of a stroke, Parkinson's, Huntington's, toxic reactions to drug and alcohol and head injury.Relationships struggling with dementia are faced with additional care-taking roles, medication side effects, physical and cognitive changes. Secondary challenges include relationship stress and sexual issues.The care-taking role: Once a person loses the ability of self-care, a dependency grows toward his or her spouse. This changes the entire relationship dynamic to one of parent-child. It's normal to lose sexual desire for somebody who has acquired a dependency on you. To reduce the stress of this role, take inventory on what tasks you can delegate to family, friends and nursing facilities. This can help maintain some sexual and emotional connectedness.Effects of medications: Both temporary and long-term medications can have sexual side effects such as decreased desire, performance issues and even pain with intercourse. Talk openly with your physician about these. In some cases, alternative medications may be possible.Physical impairments: These can obviously create sex and intimacy issues, too, and can range from muscle rigidity and slowed movements to paralysis. If verbal communication is possible, discuss what body areas have sensation as well as which body parts and positions are enjoyable for snuggling and intimacy. Then focus on the positives.Cognitive changes and declines: These can pose issues with the ability to communicate, feel connected or recognize sexual cues and boundaries. In some cases, this can include the inability to consent to sexual behavior, leaving one partner feeling lonely and confused. In this case, it's common to ask: Is a relationship still a relationship if one person can no longer remember it? And how does a person uphold marital vows to someone who no longer recognizes him?The answers aren't definitive. They're personal, based on one's wishes and ability to emotionally and cognitively make a decision - which might not always be possible, depending on the severity of the dementia.And what about the partner with dementia? It's inaccurate to assume that a person with dementia is no longer a sexual being or incapable of feeing sexual desire. If fact, in some cases, dementia causes hypersexual thoughts and behaviors.Regardless of how dementia is causing relationship and intimacy problems, know that you're not alone. Recognize that affection and affirmation are normal, as well as the desire for sex and intimacy with a loving and able partner.