Background: Dementia may result on impairment in intimacy and sexuality of elderly couples. Objectives: Evaluate changes in sexual activity, as well as the factors which cause sexual satisfaction and/or dissatisfaction in couples in which one of the partners has dementia. Method: A search at ISI, PubMed/Medline and SciELO was made for articles about sexuality in dementia, from January 1990 to March 2012, using the keywords: “dementia”, “sexual satisfaction”, “intimacy” and “sexuality”. Results: Twelve articles were selected. The burden of care and the change of roles in couples’ relationship were the main reasons for decrease of sexual activity. Erectile dysfunction in patients and spouses, the decision-making capacity for sexual relationship from the patient who has dementia and the problems related to age and health (physical and emotional) of spouses and/or patients were considered as reasons associated with sexual dissatisfaction. Discussion: When one partner has dementia, the couples’ intimacy and sexual activity are negatively influenced by the relationship of care related to the disease and by the spouse’s burden. On the other hand, sexual activity may be positively replaced by displays of affection and empathy between the couple.