Intimacy when your partner has cognitive decline | members only

Here’s a problem no one wants to have: how to handle sex and intimacy when your partner is cognitively impaired. It’s a heartbreaker — and a question In the Mood has received from multiple

readers. Our experts offer their best advice. WHEN YOU HAVE A PARTNER — IN THIS CASE, MY WIFE — WITH COGNITIVE DECLINE, HOW DO YOU KNOW WHEN IT’S STILL OK TO HAVE SEX WITH THEM? Not

surprisingly, every expert I interviewed started with consent.  “Consent is the same — no matter if you’re 20 or 50, if you have cognitive decline or don’t. If you cannot affirm that you

have gotten proper consent, that’s where you back off,” says Padma Kandadai, a urogynecologist with Boston Medical Center. But as I got into the weeds with my reporting, I learned that there

is little that’s black-and-white about how a cognitively impaired person conveys consent — and a whole lot of gray. Here’s what you need to know. COGNITIVE IMPAIRMENT IS NOT

ONE-SIZE-FITS-ALL. Depending on the individual and the cause, the progression of the decline could last years, says neuropsychologist Hayley Kristinsson, a health sciences clinical

professor at the University of California, Irvine. And it’s usually not a toggle switch — you aren't on one day and off the next. According to Kristinsson, cognitive decline often

starts with occasional forgetting: which words to use, or details of recent events. At its most severe, she says, you have minimal awareness of your surroundings, and you no longer recognize

familiar people. To more fully understand what your wife is experiencing now and what to expect, certified sexuality educator Jane Fleishman suggests that the two of you consult a

neurologist about her current stage of cognitive decline if you haven’t done so already. DISCUSS CONSENT EARLY ON. If you know your partner’s cognition is beginning to fail, certified sex

therapist Chris Fariello suggests having a conversation about intimacy and asking her permission to make decisions about sexual engagement when she can no longer verbalize what she wants.

“Some people may lose the ability to be verbal, but they may still want to be sexual,” says Fariello, founder of the Philadelphia Institute for Individual, Relational & Sex Therapy, a

therapy practice specializing in sexual health. “Any conversations about the future, including what sex looks like, are important conversations to have.” A sex therapist can help navigate

that discussion, he adds. Right now, Fleishman says, there’s no assessment tool to determine whether someone with cognitive impairment is able to give consent, which makes that conversation

so critical. “The more you can face reality early on, the better off you’ll be,” she notes.