Tips for managing inappropriate sexual behaviour in people with dementia

A recent CMAJ article focuses on the management of inappropriate sexual behaviour in people with dementia. This condition can occur in up to 25% of people with dementia, with about 85% of reported cases occurring in males and 15% in females.1 Inappropriate sexual behaviour can involve a range of sexual expressions, including inappropriate sexual comments, self-exposure, public masturbation and unwanted sexual touching. These behaviours can occur in patients with any dementia subtype and can cause substantial distress for patients, families and staff. Stigma and uncertainty about management can result in under-reporting.1 Not all sexual expression in people with dementia is inappropriate. Appropriateness of sexual behaviours is often specific to the setting. Clinicians should consider cultural and relational context, as what is appropriate in one setting may be inappropriate in another.1 New-onset inappropriate sexual behaviour requires a structured assessment, including a medication review. Medical triggers (e.g., delirium) and comorbid behavioural and psychological symptoms of dementia should be assessed. Medications should be reviewed and potential triggers (e.g., dopamine agonists) deprescribed. The patient’s unmet needs for intimacy, social connection, environmental stimulation and personal care should be explored.1Behavioural and environmental interventions are first-line treatments for inappropriate sexual behaviours. Behavioural strategies may include caregiver education and gentle redirection. Environmental modification may involve giving the patient some private space, a caregiver change or distracting activities. These measures often reduce inappropriate sexual behaviours and are usually preferred and well tolerated by patients.1When pharmacotherapy is needed, selective serotonin reuptake inhibitors (SSRIs) and hormonal agents have the best evidence, although evidence for use of medications is limited. SSRIs for male or female patients, and hormonal agents (e.g., finasteride) for male patients, are the best tolerated options. They are also the medications most frequently associated with symptom improvement in case studies.1 A table summarizing off-label pharmacotherapy options for management of inappropriate sexual behaviour in people with dementia is provided as an appendix to the CMAJ article, based on evidence from 152 cases.2 The table includes suggested starting doses and maximum doses, tolerability, side effects and other considerations/warnings for SSRIs (citalopram, escitalopram), finasteride, cyproterone acetate, atypical antipsychotics (quetiapine, risperidone), intramuscular medroxyprogesterone acetate, anticonvulsants (gabapentin) and GnRH agonists (e.g., intramuscular leuprolide). Choosing pharmacotherapy that may be beneficial for comorbid symptoms (e.g., SSRIs in patients with comorbid agitation) will minimize polypharmacy.1 Referral to a psychiatrist or geriatric specialist should be considered if behaviours are refractory to initial behavioural and pharmacologic interventions.1ReferencesLane NE, Seitz D, Watt JA, Managing inappropriate sexual behaviour in people with dementia. CMAJ 2026;198(36):E1407 (accessed October 20, 2026) Lane NE, Seitz D, Watt JA. Managing inappropriate sexual behaviour in people with dementia. Appendix. CMAJ 2026;198 (accessed October 20, 2026)

Tips for managing inappropriate sexual behaviour in people with dementia

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