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Luke’s Journal July 2026  |  Vol.31  No.2  |  Sexuality

Our culture typically presents older people who desire to be sexually active as at best deviant and typically dirty.¹ This article considers sexuality amid ageing and dementia from a Christian perspective for medical professionals in four sections: theology, dementia, challenges, and practice.

A Cameo

Let’s start with a hypothetical:

Sam’s dental practice is in a country town; therefore, he sees a diversity of patients. Mary always smells of berries as she loves baking sponge cakes and has been Sam’s patient for twenty years. Despite a forty-year age difference and attending different churches their relationship is built not simply as clinician/patient but through community engagement and particularly interdenominational events and activities. Mary is a much loved and respected member of the church and broader community, whose love of baking sponge cakes is only superseded by her love of Jesus. 

One of the first signs of Mary’s cognitive decline was that the cream on the sponge cake she always brought to her annual dental check-up was off. A second sign was that her hygiene had declined, which was striking as she had always been passionate about her appearance.

Clinically, Sam’s greatest challenge went from encouraging Mary not to enjoy too much sponge cake, to encouraging Mary to prioritise oral care at home and to book more frequent visits to the clinic. When the dental assistants started complaining about her body odour, Sam responded by taking over the basic cleaning. Mary’s dental health improved, though Sam suspected being given the attention was of more value than the ‘clinical’ work.

Being genitally groped while giving Mary her normal clean was distressing on multiple levels, not least of which was trying not to hurt her as Sam tried to extract himself from her grip.

This cameo highlights it is not simply health professionals providing showering and continence care who face challenges of a sexual nature. Throughout this article, underline will refer to Sam and Mary as a case study.

Theology – Biblical Sexuality

Sam’s experience, and that of many medical professionals, highlights the need for a brief refresher on Biblical sexuality.¹

God created humans as sexual beings and marriage as the only context for sex.²

Not only did God invent sex, but He did so pre-Fall. Thus, while sexuality has been broken by the Fall, e.g. rape, incest and paedophilia, sex started as a good part of creation. God’s statement, “It was good,” includes sex and sexual activity (Genesis 1).³

Not only did God create sex and describe it as ‘good’, but He also instructed humans to have sex – to “Be fruitful and multiply” (Genesis 1). This is arguably the one commandment which has been practised almost universally!

One of the reasons scholars believe Paul was a widower was that, as a good Pharisee, part of keeping the law was to marry and produce offspring. One of the rabbis of the time went so far as to specify how often a couple should have vaginal intercourse, depending on the husband’s employment.⁴

God created humans as sexual beings and marriage as the only context for sex.²

Not only did God invent sex, but He did so pre-Fall. Thus, while sexuality has been broken by the Fall, e.g. rape, incest and paedophilia, sex started as a good part of creation. God’s statement, “It was good,” includes sex and sexual activity (Genesis 1).³

Not only did God create sex and describe it as ‘good’, but He also instructed humans to have sex – to “Be fruitful and multiply” (Genesis 1). This is arguably the one commandment which has been practised almost universally! One of the reasons scholars believe Paul was a widower was that, as a good Pharisee, part of keeping the law was to marry and produce offspring. One of the rabbis of the time went so far as to specify how often a couple should have vaginal intercourse, depending on the husband’s employment.⁴

While sexuality and reproduction are biologically and biblically linked, Scripture presents sexuality as important for more than reproduction. For example, Song of Solomon is erotic but includes no mention of reproduction.

Genesis 2 also makes it clear that holy sexuality is designed for a man and wife within marriage. This was very counter cultural compared to ancient near-Eastern and human history across the globe where sex outside of marriage (at least for men) and polygamy were quite common. The Old Testament records numerous accounts of God’s people having multiple wives, concubines and extra-marital relationships (e.g. Genesis 19; Genesis 38, 1 Kings 11 & Joshua 2). None of these polygamous or other relationships are presented as healthy. It is also important to note that Genesis 2 says, “A man shall leave his parents,” not, “A child shall leave his parents.” Therefore, marriage and sexuality are designed for adults.

Scripture brutally presents how sinful sexuality became post-Fall, in terms of evil sexuality, [e.g. Genesis 19 (Sodom), Judges 21 (rape and abduction) & 2 Samuel 13 (incest)], and also sexual dysfunction:

• in Ecclesiastes 12, “The grasshopper drags itself along,” relates to sexual dysfunction in later life⁵;
• the fact that David did not have sex with Abishag, a beautiful young woman who was given to him to ‘warm’ his feet strongly suggests he was impotent, particularly as David’s strong libido was a feature of the rest of his life (2 Samuel 11-12).

While David’s not having intercourse with Abishag appears to be linked to his ageing, Scripture nowhere presents holy sexuality as only for young adults, e.g. Abraham and Moses remarried late in life (Genesis 25 & Numbers 12). Paul instructs younger widows to remarry and does not prohibit older widows from remarriage (1 Timothy 5). The academic literature also highlights that while sexual activity tends to decline with age,⁶ there is ‘no known age limit for sexual activity’.⁷

Paul’s teaching on marriage brings up the topic of celibacy. Paul clearly taught the importance of sex within marriage and advocates for the advantages of being single and celibate (1 Corinthians 7). Jesus’ decision to not marry was incredibly counter- cultural, given the commandment to ‘be fruitful and multiply’ (Genesis 1). Hebrews’ description of Jesus resisting all forms of temptation logically includes resisting sexual temptation (Hebrews 4).

Finally, it is important to note that, biblically, holy physical touch, intimacy and sensuality can happen outside of matrimony (e.g. Luke 7). Therefore, activities such as hand holding, cuddling and kissing are permissible, with the caveat they are ‘risky’ in terms of leading to sexual activity outside of marriage.

Overall, biblically, sex is a good, though damaged, God-given gift, designed for within the marriage relationship.  Celibate singleness is also Biblical. The only group of people who Scripture does not teach should have the option of marriage and sex is children.

Theologically, therefore, Mary’s desire for sexuality is not evil or aberrant, even if her actions were wrong.

Dementia

Dementia is not mentioned in Scripture, as Alzheimer’s was only described in 1906.⁸ Medically, dementia is a group of over 200 different diseases of the brain, of which Alzheimer’s is the most common. Dementia is degenerative, terminal and currently largely untreatable. While a person can experience dementia in childhood, the biggest risk factor for dementia is being older.⁹ Regarding sexuality, while dementia can cause challenges in terms of intimacy and sexual function,¹⁰ people living with dementia ‘are more likely to be sexually active than not’,¹¹ and hypersexuality also occurs.¹²

Kinghorn proposes an alternative definition of dementia – where the primary issue is not cognition but rather relationship. That is, dementia is not primarily a disease of the brain but rather a disease of relational abandonment.¹³ This definition is critical to a theology of sex and dementia, since a major issue for many older people is loneliness, and the literature is clear that social connection is critical for better quality of life later.¹⁴ As sex and marriage are innately relational, older people are at high risk of loneliness, and people living with dementia are acutely at risk of social isolation.¹⁵ The importance of sex, intimacy and marriage in the midst of dementia is hard to overstate,¹⁶ as a person who feels starved of relationship and/or is struggling with their libido is vulnerable to making poor decisions.

As a dentist who embraces wholistic health, Sam may need to consider how he can refer to other professionals and community members to see that Mary is socially supported. 

Challenges – Sex, Ageing and dementia

Having highlighted the importance of sexuality for many adults from a biological and biblical perspective and that ‘sexy seniors’ are healthy, not aberrant, it is important to examine the four key challenges older people and people living with dementia face regarding sex: stigma; partner; health and consent.

STIGMA

As previously mentioned, stigma is a significant issue for many people living with dementia with reference to sex.¹⁷ Not only does our culture treat sexual desire, desirability and sexual activity as confined to younger people, but historically, sexual desire has primarily been seen as a male characteristic.¹⁸

Modern research has demonstrated that libido amongst humans is quite variable between individuals, across time and by gender.¹⁹ This aligns with the Scriptural teaching of the diversity within humanity; e.g. Ecclesiastes 2:8 speaks of the delight of sex, while Ecclesiastes 12:5 relates to sexual dysfunction in later life.²⁰

While Christian literature, such as ‘Every Young Man’s Battle’²¹, highlights that lust is typically a major challenge for younger men, the inference that lust is not an issue for older men and women is dangerous. For example, while ‘Mills and Boon’ have historically been a key part of women’s lustful literature, there is increasing research showing that women,²² including Christian women, are accessing pornography.²³

Compounding this issue, Christians have been reticent to even talk about sex.²⁴ As Scripture clearly teaches, sex is a good, God-given gift (e.g. Genesis 1 & Song of Solomon) and highlights how sex was broken by the Fall (Genesis 3).  That Christians are hesitant to discuss sex as a good (though broken) God-given gift is incongruous and unhelpful.

Practically, this hesitancy has left a vacuum in terms of sex education and research, which has then been filled primarily by people who are not in relationship with Jesus. There are many Christian resources on sexuality but limited Christian material on sexuality and ageing; even less on sexuality and dementia. By contrast, the Australian federal government’s ‘Sexualities and Dementia’ report focuses on the challenges of people who identify as LGBTIQ+ and is negative towards spirituality.²⁵

PARTNERS

Which brings us to the second challenge regarding older people and sex – that of a partner. A key weakness of ‘Sexualities and Dementia’ is its focus on the sexual challenges for people who are not heteronormative.²⁶ This neglects the academic research, which shows the primary challenge for most older people who want to be sexually active is the lack of an available partner.²⁷ This may be due to the death or ‘disability’ of their lifelong partner, challenges in making friends in later life, and (for women) the higher male mortality rate.

HEALTH

Perhaps the most obvious challenge for older people is physical sexual health and dysfunction, as popularised by Viagra. Ageing bodies can experience sexual challenges, e.g. thin vaginal mucus membrane, low lubrication and erectile dysfunction.²⁸ However, general health issues can also significantly impact older people’s sex lives. Arthritis can make sex painful, incontinence can make sex embarrassing, and lack of privacy, particularly in an aged care facility, can risk making sex public.²⁹ Finally, cardiac and pulmonary dysfunction can adversely impact sex.

CONSENT

While health, partner and stigma are challenges for all older people regarding sex, dementia makes consent particularly challenging,³⁰ raising the question of who should give consent,³¹ the record of consent and the confidentiality of any documentation.

Australian law emphasises the critical importance of consent, and that only adults can give consent – hence the provision of the charge of statutory rape. The challenge is that dementia can diminish an adult’s ability to make decisions, hence the importance of enduring power of attorney and enduring guardianship. Please note ‘diminish’ as most people living with dementia, including those with advanced dementia, are highly capable of some level of consent. Like other adults, this ability is somewhat variable over time.³²

Australian law generally assumes a conscious adult has the right to consent to, or decline, sexual activity, even if their cognition is impaired by drugs or alcohol. Thus, while adults are expected to limit the opportunities for sexual activity of minors, limiting the sexual activity of another adult is seen as controlling and abusive.

The challenge comes when the adult is living with impaired capacity, and particularly when the person who has power of attorney or enduring guardianship has conflicting motivations. For example, should an adult child of a person living with dementia be informed that the person has developed a relationship which may be romantic, intimate or sexual? Such a relationship could negatively impact the ‘child’s’ inheritance, and the emotional response to mum or dad being interested in a new partner is often traumatic.

Assuming the person living with dementia has the right as an adult to consent to sexual activity, what happens if their short-term memory is compromised? For example, a person with dementia could consent to sex, fall asleep in their partner’s arms and wake up with no recollection of the consent. Memory loss also means a person is vulnerable to abuse. Notably, being in a long-term, or even marital, relationship does not mean a person consents to sex.

As part of his ongoing professional development Sam purchased and read “The Best Sex for Life” by Patricia Weerakoon. This helped him think about sexuality generally, and the chapter titled, “Grow old with me: sex and the 60+” helped inform his care of Mary and other older clients.

Practicalities – Sex and Dementia for Christian medical professionals

Sex amid dementia can clearly be significant and complicated for a range of cultural, emotional and spiritual reasons. To suggest Christian health professionals can resolve these would be foolish. Similarly, the position that Christian health professionals are ‘impotent’ in helping in this context is untrue, particularly with reference to the four key challenges identified in the previous section.

Here are some practical ways that Christian medical professionals can address each of those challenges:

STIGMA

Training, continual learning and clinical experience mean medical professionals are uniquely placed to understand sex and have a role in educating their patients.³³ Some initial resources around sex and dementia can be found here.³⁴ The challenge is not information but comfort – raising issues, asking questions, listening and discussing sex, particularly with older patients.³⁵ Yet, medical professionals are skilled in discussing topics which may be taboo in other contexts, e.g. mental health, and continence challenges.

As with any topic, the conversation may feel uncomfortable, and the patient may not be keen to have the conversation, but raising the topic allows the patient to make the decision to engage. For many older people, it may be a rare or unique opportunity to discuss a key part of their health. This is particularly true of older women, as historically the stigma around female sexuality has been profound.

Conversations, and particularly challenging conversations, are hard for medical personnel given they take time which is always in short supply. Practically, booking a morning, longer appointment and making sexual health part of an annual review may be helpful.

There is also a significant need for Christian sexologists, in both practice and research. If you are passionate about Jesus, and considering further study please consider sexology.

PARTNER

As noted above, lack of potential partners is a significant challenge facing many older people in terms of intimacy, and sexuality. Many people living with dementia are particularly vulnerable to elder abuse.³⁶ While the most common forms of elder abuse are financial and emotional, sexual abuse does occur.³⁷ Moreover, the desire for intimacy can leave people vulnerable to financial abuse via romance scams. Health professionals have an opportunity to detect, prevent and report elder abuse.

Additionally, health professionals can prevent the spread and treatment of STIs.³⁸ Older people are particularly at risk, as they have typically received low levels of sexual education, and that education was primarily focused on pregnancy prevention. When starting a new relationship, testing and education on STI prevention may be advisable.

HEALTH

Helping people to enjoy sex as they age can be a critical part of supporting their health and quality of life.³⁹ This might include medications such as Viagra and testosterone, but education is often the best starting point. Education about the normality of sexual challenges that may accompany ageing and dementia⁴⁰ and simple listening can have a profound benefit.⁴¹ If pain is an issue, discussing and potentially prescribing breakthrough pain relief for use before or as part of foreplay is valuable. If the sexual behaviours are problematic, environmental and behaviour interventions are the best initial options.⁴² Finally, health professionals need to be aware that there is a link between sexual dysfunction and some forms of dementia.⁴³

Practical tips

Great medical care relies on a level of intimacy, both verbal e.g. discussing bodily functions, and physical e.g. disrobing and palpation.

Some patients may respond to this with sexual language or behaviour. People living with dementia can mistake compassion and medical care for sexual advances. 

Practical strategies to manage these challenges include:

• Do not assume an older person is asexual, or that an age gap equates to lack of sexual interest.

• Managing privacy and safety for patients and health professionals is critical.

• People can misinterpret platonic intimacy, such as a hug, as a sexual advance. The challenge here is that all people need touch and older people are often only touched by medical professionals.

• Language can easily be misinterpreted. For example, ‘Hop into bed’ or ‘let’s get your clothes off’ could be understood as a sexual invitation, particularly if a person has dementia.

• ‘Harmless’ flirting is, at best, risky! While flirting can help with compliance and feel safe as due to a large age gap, it risks misunderstandings.

CONSENT

While patients’ consent may appear outside the scope of their medical professional, there is some overlap. Firstly, discussing consent with people living with dementia is a powerful educational strategy, particularly since they may have received very limited sex education and the changes in the law and culture regarding active consent may need explanation.

Secondly, clinicians can have a role in assessing legal capacity in a person with dementia. There is always a risk of a person using a power of attorney to abuse, particularly when dementia is part of the equation. This can be a very challenging space to navigate, so care and consideration are critical. 

Conclusion

As Christians, it is critical to align our views and practices with those of Scripture, including Scripture’s teaching regarding sex. As medical professionals, you have an opportunity and an obligation to provide holistic care to your patients, including those who are older and/or living with dementia. As Christian medical professionals, bringing your medical and theological expertise into play will powerfully enhance the care your patients receive.

Public sex – Answers

Some basic questions a GP might ask include:

Does Harry have any sensory loss? (e.g. was he aware he was in a public space?).

Were there any ‘triggers’ that contributed to Harry behaving sexually?

Is Harry’s dementia impacting his sexual expressing more generally?

Care Organisations

The topic of sexuality is particularly challenging for aged care facility providers, trying to balance choice, safety and legislation.

That most care organisations lack of policies and guidelines around sexuality does not help.

Archibald, C. (1998). Sexuality, dementia and residential care: managers report and response. Health & Social Care in the Community, 6(2), 95–101. HYPERLINK “https://doi.org/10.1046/j.1365-2524.1998.00104.x”https://doi.org/10.1046/j.1365-2524.1998.00104.x, p. 96, 99-100.

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23. 3 Lies and the Truth about Christian Women and Porn Use | Revive Our Hearts Blog | Revive Our Heartshegospelcoalition.org/article/women-fight-pornography/
24. Why Are Some Christians Afraid to Talk About Sex? — Becoming The One
25. Sexualities and Dementia | Dementia Training Australia (DTA)
26. ^[26]
27. Archibald, C. (1998). Sexuality, dementia and residential care: managers report and response. Health & Social Care in the Community, 6(2), 95–101. https://doi.org/10.1046/j.1365-2524.1998.00104.x, p. 96.
    Freak-Poli R. It’s not age that prevents sexual activity later in life. Australas J Ageing. 2020 Jun;39 Suppl 1(Suppl 1):22-29. doi: 10.1111/ajag.12774. PMID: 32567179; PMCID: PMC7317726. Aging and sexuality
28. Sexuality and Intimacy in Older Adults | National Institute on Aging
29. Higgins, A., Barker, P., & Begley, C. M. (2004). [Rev. of Hypersexuality and dementia: dealing with inappropriate sexual expression]. British Journal of Nursing (Mark Allen Publishing), 13(22), 1330–1334. https://doi.org/10.12968/bjon.2004.13.22.17271, p. 1330.|
    Lipinska, D. (2018) Dementia, Sex and Wellbeing: A person centred guide for people with dementia, their partners, caregivers and professionals, Jessica Kingsley Publishers, London. P. 52-53.
    Wornell, D. (2014). Sexuality and dementia : compassionate and practical strategies for dealing with unexpected or inappropriate behaviors (1st ed.). Demos Health., p. 57-61.
30. D’cruz, M., Andrade, C., & Rao, T. S. S. (2020). The Expression of Intimacy and Sexuality in Persons With Dementia. Journal of Psychosexual Health, 2(3–4), 215–223. https://doi.org/10.1177/2631831820972859, p. 216. P. 54-61.
31. Lipinska, D. (2018) Dementia, Sex and Wellbeing: A person centred guide for people with dementia, their partners, caregivers and professionals, Jessica Kingsley Publishers, London. P. 52-53.
32. A good introduction to this can be found in Chapter 11 ‘Consent and Capasity’ in Hughes, J.C. (2023) Dementia and Ethics Reconsidered, Mc Graw Hill, p. 69-80
    D’cruz, M., Andrade, C., & Rao, T. S. S. (2020). The Expression of Intimacy and Sexuality in Persons With Dementia. Journal of Psychosexual Health, 2(3–4), 215–223. https://doi.org/10.1177/2631831820972859, p. 218.
33. Higgins, A., Barker, P., & Begley, C. M. (2004). [Rev. of Hypersexuality and dementia: dealing with inappropriate sexual expression]. British Journal of Nursing (Mark Allen Publishing), 13(22), 1330–1334. https://doi.org/10.12968/bjon.2004.13.22.17271, p. 1332.
    Lipinska, D. (2018) Dementia, Sex and Wellbeing: A person centred guide for people with dementia, their partners, caregivers and professionals, Jessica Kingsley Publishers, London. P. 143-156.
34. Intimacy and sex | Dementia Australia
    Does dementia impact your libido? | Dementia Australia
    How does dementia affect sex and intimacy? | Alzheimer’s Society
35. D’cruz, M., Andrade, C., & Rao, T. S. S. (2020). The Expression of Intimacy and Sexuality in Persons With Dementia. Journal of Psychosexual Health, 2(3–4), 215–223. https://doi.org/10.1177/2631831820972859, p. 215.
36. Australians urged to be on alert for elder abuse, with concerns more people living with dementia at risk | Dementia Australia
37. Older people – Australian Institute of Health and Welfare
38. Steckenrider, Janie,  Sexual activity of older adults: let’s talk about it, The Lancet Healthy Longevity, Volume 4, Issue 3, e96 – e97
39. Abi Taylor, Margot A. Gosney, Sexuality in older age: essential considerations for healthcare professionals, Age and Ageing, Volume 40, Issue 5, September 2011, Pages 538–543, https://doi.org/10.1093/ageing/afr049
    D’cruz, M., Andrade, C., & Rao, T. S. S. (2020). The Expression of Intimacy and Sexuality in Persons With Dementia. Journal of Psychosexual Health, 2(3–4), 215–223. https://doi.org/10.1177/2631831820972859, p. 215.
    Penhollow TM. Sexuality in Older Adults: Comprehensive Strategies for Clinicians and Patient-Centered Care. Am J Lifestyle Med. 2024 Oct 18:15598276241293100. doi: 10.1177/15598276241293100. Epub ahead of print. PMID: 39540174; PMCID: PMC11556589.
40. I recommend ‘Chapter 9: Growing old with me: sex and the 60+’ in Weerakoon, P. (2014). The best sex for life, growing faith, Sydney.
41. Sharron Hinchliff, Ruth Lewis, Kaye Wellings, Jessica Datta, Kirstin Mitchell, Pathways to help-seeking for sexual difficulties in older adults: qualitative findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), Age and Ageing, Volume 50, Issue 2, March 2021, Pages 546–553, https://doi.org/10.1093/ageing/afaa281
42. D’cruz, M., Andrade, C., & Rao, T. S. S. (2020). The Expression of Intimacy and Sexuality in Persons With Dementia. Journal of Psychosexual Health, 2(3–4), 215–223. https://doi.org/10.1177/2631831820972859, p. 219-20.
43. D’cruz, M., Andrade, C., & Rao, T. S. S. (2020). The Expression of Intimacy and Sexuality in Persons With Dementia. Journal of Psychosexual Health, 2(3–4), 215–223. https://doi.org/10.1177/2631831820972859, p. 218.