Introduction

Although old age is still desexualised in many ways, there have increasingly been signs of more positive attitudes to sexuality in later life over the last two decades. Sexuality is increasingly positioned as significant to overall positive and healthy ageing (Gott, 2005; Sandberg, 2015). However, older people with illnesses and disabilities are still positioned as asexual, as pointed out in several other chapters of this volume. This is particularly true of the large group of older people living with dementia. Fifty million people worldwide are currently living with dementia, and this number is estimated to triple by 2050 (WHO, 2019).

Discourses on the sexuality of people with dementia are highly contradictory. On the one hand, pervasive discourses of dementia as a ‘loss of self ‘ also degender and desexualise people with dementia (Sandberg, 2018). Also, the degendering and desexualisation of people with dementia contributes further to the erosion of subjectivity in older people with dementia. On the other hand, there are discourses of sexuality and dementia as excessive, problematic and undesirable. These discourses are commonly reflected in the medical scientific literature, where sexuality among people with dementia is almost exclusively discussed in pathologising terms such as ‘hypersexuality’ or ‘inappropriate sexual behaviours’ (Sandberg et al, 2020). But the tendency to deem sexuality among people with dementia problematic is also reflected in the literature on nursing, which suggests that care staff tend to experience discomfort with, and try to suppress or redirect, sexual expressions among residents with dementia (Villar et al, 2015; Dupuis et al, 2012). Interestingly, intimacies such as kissing, sexual language and touching are sometimes considered challenging behaviour (Villar et al, 2019).

As Foucault (1990 [1976]) argues, sexuality is assumed to be at the core what it means to be a subject in western culture. Still, while sexuality is understood as desirable in normative subjects, it is, as suggested by Shildrick (2009, p 117), ‘viewed as deviant, degraded or simply not acknowledged in the non-normative subject’. Both desexualisation and the construction of sexuality in dementia as problematic and excessive thus positions people with dementia as ‘Other’, outside the realms of ideal modernist subjectivity.