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Sex in Nursing Homes Sex in Nursing Homes | Pelvic Floor Dysfunction | Living Alone


Sex in Nursing Homes | Pelvic Floor Dysfunction | Living Alone


Whether the world wants to believe it or not, a lot of seniors are still having sex. Yet, many nursing homes are not addressing the topic. Dr. Cheryl Phillips, a specialist in geriatric medicine, discusses the controversial matter of sex in nursing homes. Henry Rayhons shares the heartbreaking story of his arrest for the sexual assault of his own wife, who suffered from Alzheimer’s.

Talking about senior citizens having sex is almost taboo, but the fact of the matter is that being sexual is a part of being human. Dr. Phillips explains that sexual needs and desires do not disappear as a person ages, even if they suffer from memory loss. Additionally, advances in medicine and wellness have helped baby boomers stay sexually active longer than generations prior.

Many nursing home patients still desire to be sexually active, and the world of elder care is facing numerous challenges handling the matter. Memory problems and dementia are common among seniors, and evaluating a patient’s ability to consent to sexual activity can be difficult. A patient with cognitive issues, like Alzheimer’s, may no longer be able to make legal decisions, but they can still make decisions based on their basic wants and needs. An Alzheimer’s patient being visited by their significant other may still desire to express their sexuality. Although the ability to consent becomes muddled here, a patient that is willingly participating in sexual activity with their longtime partner is consenting. Many nursing homes do not have policies regarding sex, and it’s difficult for staff to understand what the normative action is when they encounter sex in the nursing home.

Henry Rayhons was arrested in 2014 for sexually assaulting his wife who suffered from Alzheimer’s. A roommate in the nursing home reported sexual activity between Rayhons and his wife. Rayhons was charged with sexual assault because his wife may have been unfit to consent. In 2015, Rayhons was acquitted of all charges of sexual abuse, but he remains devastated. Dr. Phillips says that his case was a “perfect storm” involving children from a prior marriage, uncomfortable nursing home staff and a couple that wanted to maintain their intimacy. Rayhons’ case made national headlines and sparked an ongoing and important conversation in the medical field. 

So, how do we avoid problems involving consent and sex in nursing homes? Dr. Phillips encourages families to start by having conversations about sexuality prior to entering a nursing home. It’s also important that senior care focuses on each individual person’s wants and needs. Although there remains a long way to go, many nursing homes are looking closely at their policies regarding sex. Dr. Phillips believes there will be positive changes for nursing homes in the near future.


A person suffering from lower back pain, incontinence or pelvic pain may find that the culprit is Pelvic Floor Dysfunction. Pelvic Floor Dysfunction, or “PFD,” refers to weakened or damaged muscles, ligaments or nerves in the abdomen. Fortunately, patients with PFD can find help, and Dr. Kristene E. Whitmore teaches us how. 

Dr. Whitmore, Chair of Urology and Pelvic Medicine at Drexel University, explains that PFD is the malfunctioning of the bladder, bowel or genital muscles. There are two types of PFD: “High Tone” PFD and “Low Tone” PFD. 

“High Tone” PFD is an inflammatory disorder that makes the pelvic region’s muscles too tight. These patients may suffer from the following symptoms:

  • Inflamed bladder
  • Inflamed vulva
  • Difficulty urinating
  • Pain during intercourse
  • Difficulty passing bowel movements

“Low Tone” PFD is when a patient is unable to contract the muscles in the pelvic region properly. These patients may suffer from the following symptoms:

  • Stress incontinence
  • Fecal incontinence
  • Pelvic Organ Prolapse (Bladder/Uterus/Bowel/Colon drops into the vagina, and the muscles are too weak to pull the organs back up)

PFD can be caused by vaginal childbirth, obesity, chronic cough, menopause or smoking cigarettes. There are many approaches to treating PFD that are effective and FDA approved. “High Tone” PFD is typically treated with physical therapy. When treating PFD, the physical therapist should be certified in pelvic floor physical therapy and be familiar with “internal massaging” to relax the patient’s trigger points. If physical therapy is not successful on its own, a doctor may prescribe certain medications for “High Tone” PFD. “Low Tone” PFD patient may opt to have a surgical sling or “mesh” implanted. Certain types of sling or mesh surgeries, like the urethral sling and abdominal mesh, can be beneficial and are approved by the FDA. On the other hand, vaginal mesh surgery (using a bladder, uterus or colon sling) is no longer approved by the FDA. There have been instances of vaginal mesh eroding into the vagina and organs, or contracting and causing extreme pain. Contrary to older beliefs, men are also susceptible to PFD and should seek treatment if they suffer from symptoms of PFD.

Preventing PFD is possible by taking the following precautions:


  • Learning how to do pelvic floor exercises
  • Taking care of yourself during pregnancy
  • Keeping your body mass index under 30
  • Quitting smoking
  • Treating reflux or GERD disease



Whether by choice or by circumstance, more than 11 million Americans live alone. The independence can be empowering, but it’s important to stay safe and socially involved. Suzanne meets with three women who offer their insight on how to make the most of this potentially exciting new chapter of life. Suzanne first speaks with University of Pennsylvania’s Professor of Gerontological Nursing, Dr. Sarah H. Kagan, about the prospect of living alone. While it can be frightening, Dr. Kagan says living alone has many advantages. It’s a great opportunity to make connections, plan your life and develop a newfound sense of independence.

Suzanne also meets with to two senior women, Phyllis and Elayne who have been living alone since their husbands passed. Phyllis is a widow who sold her house of 37 years to move to the city. She has enjoyed the excitement and activity of the urban lifestyle and describes her transition as a wonderful reawakening. Elayne is also a widow who joined an organization called “The Transition Network” which helps a lot of older women move into the city and find new connections. She also stays active teaching elementary school students how to knit.

Dr. Kagan does believe that there may be a time when living alone can be too much. She explains that if you are becoming less comfortable, are spending too much time alone or if people close to you are concerned about your living situation, then it might be time to make a move. 

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