There is growing evidence for the need to recognize persons with dementia as sexual beings who wish to continue expressing their sexuality, including within their couple relationship. The aim of this literature review was to investigate empirical qualitative studies that examined sexuality and sexual intimacy in the couple relationship when one spouse has dementia. A systematic literature review was performed in January 2021, five data bases were searched: Pubmed, MedLine, Lilacs, Scopus, and SciELO. The references of articles included in the review were screened together with the references of other relevant reviews. Nine studies were identified that investigated sexuality and sexual intimacy from the perspective of the couple living with dementia or from the perspective of the spouse. The analysis identified four key themes: addressing dementia and sexuality; challenges to maintaining sexuality within the couple relationship; forms of sexual expression; and the desire to be seen as a sexual being. Despite evidence of the importance of sexuality in later life and the positive effects it has on the quality of the couple relationship, research has identified the difficulty of destigmatizing sexuality and older persons, particularly when considering couples affected by dementia. Further research is required to better understand how living with the illness impacts sexual expression and the intimacy of the couple relationship.