The rights and pleasures of sex in later life – a tale of two books

Both books, published at a similar time, discuss the topic of sex and intimacy which for everyone may not be an easy read, despite it being a natural activity, upon which humankind depends, that can be pleasurable and add value to relationships. This is not an automatic given, however, especially when society has strong views on whom, and how, one should relate to one another sexually. Views may become further polarised when they concern people deemed to be ‘old’, unwell and/or in the care of others. Mutually the books address many facets in a brave ‘no holds barred’ manner, without over-sensationalising the matter. The books combined discuss the stigma that is associated with sexuality in later life and/or when someone is affected by dementia. Each book has a separate approach and is aimed at slightly different audiences.

Some of their difference in contents is reflected in their titles, the framework they base their book on and their usage of referencing. For instance, Barrett and Hinchliff (editors) use the principles of the World Association for Sexual Health (WAS) and have entitled their book Addressing the Sexual Rights of Older People: Theory, Policy and Practice, and focus on ‘addressing the sexual rights of older people … evidence-based and applicable to professional practice’. While Lipinska's Dementia, Sex and Wellbeing: A Person-centred Guide for People with Dementia, Their Partners, Caregivers and Professionals takes a more personal approach as ‘The book is written primarily for professionals, lovers and families’ (p. 20) and uses Professor Tom Kitwood's (Reference Kitwood1997) flower of psychological needs of the person living with dementia as a framework. Both books are an excellent resource for further information as they refer to various research papers and internet webpages, and signpost to other organisations. Barrett and Hinchliff reference throughout the text in a traditional academic style, ending each chapter with a reference section, whereas Lipinska uses fewer references and has summarised those in the bibliography and further resources section at the end of the book. This is in line with the different audiences both books aim for as undoubtedly ‘lovers and families’ may find academic references throughout the text harder to read. Another subtle difference is that Barrett and Hinchliff mainly focus on older people but also comment on people with dementia, as opposed to Lipinska whose book is focused on people with dementia, yet her considerations can also be applied to (older) people in general.

The books also differ with their objectives and themes. Barrett and Hinchliff set out their objective as shifting how the sexuality of older people is viewed and approached in a global perspective and aim to address the sexual rights of older people. Various authors critique the different research papers and make recommendations for actions on how to overcome the issues. It is commendable how varied the chosen topics are. For example, not only do they include the challenges that the LGBTQ+ community specifically face, but they also involve intersex ageing (p. 84), sexual assault of older women (p. 97), internet dating (p. 139) and the challenges in reducing sexually transmitted infections (STIs) while fulfilling and enhancing the sexual rights of older people (p. 111). The latter is very current as various sources and research indicate that STIs in older age are on the rise. So much so, that the charity Age UK launched a social media campaign to raise awareness in October 2019. Challenging the ‘viagrization’ of heterosexuality and ageing (p. 125, Barrett, Wentzell and Ferrero Camoletto) is another progressive theme. Just when perhaps the general public is beginning to shrug off their shyness in asking for Viagra over the counter to prolong sexual activity which otherwise might have been hindered by reduced physical performance, the book challenges the notion that: ‘sexual rights in older age are synonymous with the right to access medical intervention to continue youthful and normative forms of sexuality’ (p. 126). Though not challenging this concept in a similar manner, Lipinska recognises too that ‘sensuality and intimacy, non-sexual touch, holding and cuddling’ (p. 99) is equally valid.

The objective of Lipinska's book is to ‘create an overview and an introduction’ on ‘human relationships and sexual selves’ (p. 15). She further sets out the hope of finding ‘new and positive ways to address sexuality within the context of living well with dementia and to normalise those conversations’ (p. 20). Lipinska rightfully recognises the conundrum that ‘Adult children find it especially challenging and emotionally complex to think about their parent or relative as a sexual being with rights and needs as well as care needs’ (p. 20).

Lipinska includes many anecdotes about conversations about sexuality in her practice as a counsellor and makes suggestions on how these could be used as a training tool. This set-up makes the book easily accessible, even for adult children, who may be struggling internally with this topic. Each chapter ends with ‘points for reflection’, which encourages the reader to examine their own thoughts and feelings. Lipinska hopes that these reflections will promote discussion between the person with dementia, relatives, colleagues and other professionals involved.

Lipinska discusses an interesting point, which is often easily overlooked, about how changes in sexual behaviour before a diagnosis of dementia as well as how different types of dementia may bring out different sexual behaviours (p. 83). This is important to highlight as dementia can develop earlier in life or may not display typical symptoms and therefore may not be recognised by the general public. Families who are affected by this may especially find comfort in and benefit from the book.

A short book review does not fully justify the wealth of information both books offer on the topic. Though both books are different, together they complement each other and give a comprehensive overview of sexuality in older age and dementia care. It therefore makes them ‘a must read’ for anyone who is affected by dementia, whether personally or professionally, and who would like to be better informed without prejudice.