Firstly and most importantly, people have sex, its fine, there is little enquiry that is done with the sex lives of other people, so it shouldn’t be different for people with dementia.

The issue is consent, do they consent to have sex with this person?  Do they consent to this particular act of sex with this person?

We all have preferences around sex, how often, what happens and where, as well as with whom. It is not for the carers to choose how a person with dementia has sex, they can have it however they want it, as long as they and the person or people that they are having sex with consents.  Dementia does not mean that their sex life ends!

The test for capacity to consent to generally quite low, do they understand the nature of the act, does the other person consent and do they understand the risks, which are STDs and for some there is a risk of pregnancy, but that might not be a risk for older people.

There is also an issue with long standing couples who may have been married for many decades and have a pattern for their sex life that was started long before they lost capacity or one of them lost capacity and as long as the person with dementia remains happy to continue, then the test for capacity for sex in these circumstances is very low, it is basically around whether they resist or object.

For their family and carers, often the most challenging part is accepting that they do have sex.  Children usually don’t want to think about the sex lives of their parents and it may well remain none of their business if their parents are continuing to have the sex that they have always enjoyed.

People can be creative about the kind of sex that they like, it might be “vanilla” or it might be much more imaginative, whichever they choose, is fine, it is their choice.  Their body, their sex life, their pleasure, their choice.

People have sex, that’s normal.  People with dementia are people and they might be having sex and that’s normal.  Consent may be an issue that needs some enquiry, but if that is not an issue, then I hope that those lovely people with dementia are having brilliant sex!