Sex and Alzheimer's: The Consent Issue

Q. My wife has Alzheimer’s and we’ve always had a healthy, mutually satisfying sex life. Now, although I would still like to remain intimate, sometimes I can’t tell if she’s interested when I try to initiate sex. Is it wrong if I proceed with sexual intercourse when my wife can’t give her consent?

A. It can be difficult to determine whether some people with Alzheimer’s have no interest in sex or whether they are simply unable to communicate their sexual needs. And it’s a situation that can be fraught with legal ramifications.

Obviously, if sexual intercourse causes emotional or physical distress for your wife, you shouldn’t impose your desires on her. Beyond that, unfortunately, there are no easy or clear-cut answers. But here’s what the Alzheimer’s Association has to say: “If the individual enjoys or initiates intimate behavior and it is mutually satisfying to both parties, sex may be a familiar way of comforting and reassuring the person whose sense of self is eroded by Alzheimer’s disease. The most confused individual with Alzheimer’s is still a sexual being. Attending to those needs is an important part of caring for the person with Alzheimer’s.”

This point of view is not universally accepted. Some believe that it’s always wrong to participate in nonconsensual sex; forbidding it, they say, protects vulnerable people from sexual exploitation and abuse. Others take the position that the main consideration should be given to what the patient would want were she or he able to give consent.

If your wife eventually moves to a long-term care facility, be sure you understand its policy on sexual relationships. If the facility doesn’t have one, ask how this situation is handled.