‘Inappropriate’ sexual behaviours in dementia

Abstract

SummaryHuman sexuality is a complex interaction of biological, social and emotional factors. When any or all of these factors are disrupted by a progressive dementia it is unsurprising that sexual ‘problems’ are identified. Most sexual behaviour ‘problems’ relate to expressions of normal sexuality complicated by changes in relationships, care needs and cognitive function, and complex ethical and legal considerations emerge. Rarely, new and severe hypersexual or paraphilic behaviours arise de novo, usually due to damage to certain brain areas, and sometimes due to medication side-effects, psychiatric disorder or delirium. Evidence and approaches to assess and to manage sexual behaviour problems in dementia are discussed.

Donepezil: a case of inappropriate sexual behaviours in dementia

“…Human sexuality is a complex matter of biological, social and emotional interactions. When any or all of these become disrupted, sexual problems may arise . Medications and a number of neurological disorders, including dementia, head trauma, cerebral anoxia, multiple sclerosis, parkinsonian disorders and other brain diseases, are commonly implicated in ISB .…”

“…Two key neurotransmitters promote arousal: acetylcholine in the parasympathetic innervation of the genitalia and nitric oxide acting on the smooth muscle of the genitalia. The proposed mechanism is that the increase in acetylcholine activity can directly stimulate sexual organs, thus causing arousal …”

“…A literature review showed that in addition to dysfunction in several different brain regions, medications can play a role in causing sexual disinhibition. Donepezil is one such agent that has been implicated in causing ISB . Product information reports increased libido (≥1%) as part of the endocrine and metabolic adverse effects of this drug .…”

A case of inappropriate sexual behaviour in mixed dementia

“…It can be postulated that the efficacy of most of these medications is through their effects on the neurotransmitter and hormone systems involved in the sexual response. 7 For example, SSRIs can reduce libido and inhibit orgasm through central and peripheral stimulation of 5-HT 2 receptors and are the most likely psychotropic to cause sexual dysfunction. 8 The adverse effects of SSRIs appear to have been paradoxically beneficial in treating sexual disinhibition in dementia here.…”

Staff responses to residents exposing their genitals in public in long‐term care settings: The gap between common and perceived best practices

“…Inappropriate sexual behaviours in dementia are commonly defined as sexual behaviours which are unsafe or disruptive, impair the care of the resident and cause concern to others ( Wilkins, 2015). Although less frequent than other behavioural or psychological symptoms such as agitation or aggression (Ward & Manchip, 2013), the prevalence of ISBs in people with dementia varies considerably in the literature, ranging from 1.8% (Alagiakrishnan et al, 2005) to 7.8% (de Medeiros et al, 2008), or even 15% (Tsai, Hwang, Yang, Liu, & Lirng, 1999). ISBs are reportedly more prevalent among men than women and among those living in long-term care (LTC) settings than in older people living in the community (Cipriani et al, 2016;Tsatali, Tsolaki, Christodoulou, & Papaliagkas, 2011).…”