Ch 16 - Sexuality and Intimacy

increase

A study showed that estrogen may help protect young women's hearts, reduce the risk of hip fracture, diabetes, and colon cancer. But, it also revealed that the hormones can (increase, decrease) the risk of other problems, such as blood clots and stroke

estradiol

Before menopause, what is the main source of estrogen?

Testosterone

Besides estrogen and progesterone, what is another hormone that some menopausal women have a decrease in that affects their libido and sexual pleasure?

7

By the age of 65, there are __ men to every 10 women

5

By the age of 85, there is 1 man for every __ women

40

By what age do most women start having irregular periods?

lowest, shortest

Currently, it is recommended that if estrogen is used to treat menopausal symptoms, it is prescribed at the ____________ effective dose for the ___________ period of time

a physical examination

Due to the range and complexity of conditions and causeswhich can cause erectile dysfunction, what is essential to do when erectile dysfunction is reported?

3-5

EPT should be limited to _-_ years of use after women go through menopause to minimize the symptoms

chronic

ET is not recommended to treat/prevent ___________ conditions in post-menopausal women or post-menopausal women who had a hysterectomy

7

ET should be limited to about _ years after women go through menopause

moderate to severe

Estrogen therapy should only be prescribed for someone with __________ to ____________ symptoms

security, comfort, emotional well-being

Feeling important and wanted by another person promotes what in people of all ages?

later, this is due to them ignoring symptom and attributing it to normal aging

HIV is usually diagnosed at a(n) (earlier, later) stage in older persons

- educate a,, ages on the realities and importance of sexual function in later life - ensure nursing care does not enforce negative attitudes about sex

How can nurses advocate for older adults on the topics of sex and intimacy?

- give them the realistic expectation that occasional impotence is not unusual or an indication that one is too old for sex

How do you ensure that older persons have realistic expectations about their sexual abilities as they age?

address the topic in a matter-of-fact way

How should a nurse approach asking an elderly person about discussing their sex life/sex life issues?

younger

Men have a tendency to marry women (younger, older) than them

married, widowed

Most older men are (married, widowed) and most older women are (married, widowed)

male

Most older men with HIV contracted it through sex with a (male, female)

male

Most older women with HIV contracted it through sex with a (male, female)

- ACE inhibitors - alcohol - alpha adrenergic blockers - antianxieties/benzodiazepines - anticholinergics - antidepressants - antihistamines - antihypertensives - antiparkinsonian agents - dietetics - dopamine agonists - MAOIs - nicotine - nonsteroidal anti-inflammatories - sedatives/hypnotics - recreational drugs

Name a few of the different types of medications that can affect potency, libido, orgasm, and ejaculation:

increases

The likelihood of developing andropause (decreases, increases) with age

fifth

The older population accounts for one _______ of the human immunodeficiency virus (HIV)/AIDS cases in the US

false, a decrease in the frequency of sexual activity in older persons is not necessarily

True or false: A decrease in the frequency of sexual activity in older persons is usually accompanied by a reduction in sexual interest or ability as well

true

True or false: Androgen therapy is an option for men going through andropause

false, not all men get it

True or false: Andropause is normal in aging men

partially true, estrogen therapy helps to prevent osteoporosis but only for as long as someone is on it. As soon as they stop the medication, the prevention effect is gone

True or false: Estrogen therapy helps prevent osteoporosis

false, interest in sex stays pretty consistent with age

True or false: Interest in sex decreases with age

false, it is normal for older men to sometimes have issues achieving an erection

True or false: It is a sign of another underleading issue if an older man has the occasional issue achieving an erection

false, many older women gain a new interest in sex. Thought to be from no longer having a chance of pregnancy, or due to increased time and privacy

True or false: Many older women lose interest in sex after menopause

false, older men are slower to erection, mount and ejaculate

True or false: Older men are slower to erection and mount, but are quicker at ejaculation

false, sexual pleasure and intimacy have positive effects on the health and should be encouraged

True or false: Older people who are institutionalized should not participate in sexual activity by themselves or with others to prevent injuries

false, premature ejaculation is not an age-related change. In fact, older men take longer to get off compared to younger men

True or false: Premature ejaculation is an age related change

true

True or false: The incidence of acquired immunodeficiency syndrome (AIDS) has increased more than twice as quickly in people 50+ than in younger adults

false, the testes usually do not lose their ability to produce testosterone

True or false: The testes usually lose their ability to make testosterone

false, starting hormone therapy 10+ years after menopause significantly increases your risk of heart problems

True or false: The time between when menopause and hormone therapy happen has no consequence on the symptoms

true

True or false: With age, there is a decrease in sexual responsiveness

false, there is a decrease in the frequency of orgasm with age

True or false: With age, there is no change in the frequency of orgasm,

false, there is no scientific evidence that would cause someone to reccomend herbal, natural, or custom-compounded hormones to help with menopause

True or false: bioidentical, custom-compounded hormones, herbal supplements, and other natural products are usually recommended prior to ET or EPT

true

True or false: sexual dysfunction can have a psychological cause

false, do not assume anything

True or false: you do not have to ask married people about their sex lives and should assume because they're married that its monogamous and healthy

Kinsley, Masters & Johnson

Until the work of ___________ and __________&____________, there had been minimal exploration into the realities of sex in old age.

- medications - penile prostheses - lubricants - surgery - sex counseling

What are some interventions for sexual activity issues?

- breast enlargement - osteopenia - osteoporosis - shrinkage of the testes - reduced libido - reduced sexual function - erectile dysfunction

What are some medical conditions which can occur due to lowered testosterone?

- vacuum pumps - penile implants

What are some non-medication ways to treat erectile dysfunction?

- sildenafil citrate (viagra) - tadalafil (cialis) - vardenafil (Levitra) - alprostadil

What are some of the drugs used to treat erectile dysfunction?

- moodiness - depression - memory problems - fuzzy thinking - lack of concentration - lower tolerance for annoyance - quick to anger - greater impatience - anxiety, restlessness, new onset of panic disorders - paranoia, psychotic symptoms

What are some of the emotional/cognitive symptoms of menopause

- hot flashes - fatigue - new onset of migraines - symptoms of arthritis, fibromyalgia -heart palpitations, atypical angina - restless leg syndrome - vaginal dryness and itchiness - loss of subcutaneous fat in the labia - insomnia - decreased BMR - weight gain - increased fat on the stomach and hips - lower urinary tract symptoms - bladder and vaginal infections - increased risk of osteoporosis, heart disease, colon cancer

What are some of the physical symptoms of menopause?

- less lubrication - decreased distensibility - thinning of the vaginal walls

What are some reasons older women may experience dyspareunia?

- women with breast cancer - history of breast cancer - suspected or known estrogen-sensative cancer - Coronary artery disease - untreated hypertension - active liver disease - pulmonary embolism - undiagnosed vaginal bleeding - high sensitivity to hormone therapy

What are some reasons that someone might not be advised to take estrogen therapy?

- reduced muscle mass - reduced energy - reduced strength - reduced stamina

What are some results due to lowered testosterone?

- higher chance of type II diabetes - increased risk of cardiovascular disease

What are some risks connected to low testosterone levels?

- fluid retention - sleep disorders - breast enlargement/tenderness - prostate growth

What are some side effects and risks associated with androgen replacement therapy?

Alzheimer's disease

What can HIV-related dementia often be misdiagnosed as?

Estrogen levels fall and the reduced number of ovarian follicles lose their ability to response to gonadotropic hormone stimulation

What causes menopause to occur?

1/3

What fraction of men over the age of 65 have wives younger than 65?

estrogen-progesterone therapy

What is EPT?

estrogen therapy

What is ET?

andropause

What is a decline in testosterone levels due to aging called?

they attribute it to a normal aging process and do not seek medical attention because of it

What is a risk with STDs/STIs in older persons that often lead to them going untreated?

erectile dysfunction

What is commonly referred to as impotence and is a condition in which a man is unable to attain and maintain an erection sufficient enough to engage in sexual intercourse?

- promoting sexual capacity - maintaining sexual function

What is regular sexual expression important for in both sexes as they age?

- andropause is a slower process - andropause does not occur in all men - andropause can begin earlier in life than menopause

What is the difference between menopause and andropause, besides the hormones it effect?

Alprostadil

What is the drug which is an injection into the penis to increase blood flow?

erectile dysfunction

What is the inability to attain and maintain an erection of the penis sufficient to engage in sexual intercourse called?

Rhapontic rhubarb

What is the one herbal supplement that, in studies, has been shown to significantly reduce hot flashes and other symptoms of menopause?

perimenopause

What is the period of time several years prior to the onset of menopause called?

menopause

What is the permanent cessation of menses for at least one year called?

hormone replacement therapy (HRT)

What is the replacement of estrogen and/or progestin hormone(s)that is/are no longer being made by the body called?

dyspareunia

What is the term for painful intercourse

postmenopause

What is the time beginning 12 months after the last menstral cycle called?

ovaries

What organ produces estradiol?

sexual history

What part of a comprehensive assessment helps with revealing barriers to sexual active?

35%, with increased prevalence with age

What percentage of men ages 40 to 70 years old are affected by erectile dysfunction?

44%

What percentage of new HIV infections from persons 55+ are gay or bisexual men?

medication review

What should be reviewed when a new sexual dysfunction occurs?

it is a normal feature of the illness

What should family members and caregivers be told about inappropriate sexual acts done by a patient with dementia

do a comprehensive physical examination

What should you do if the reason for sexual dysfunction is not readily available through a history?

the work of masters & johnson

What study provided the first major insight into the sexual responses of older persons?

hormone therapy

What therapy has been known to help reduce symptoms of menopause?

- history of prostate cancer - history of breast cancer

What two risk factors would cause a doctor to not reccommend androgen replacement therapy?

- woman's individual health profile - potential risks - age of starting

What two things should guide HRT use?

30s

When does andropause begin in men?

around the 5th decade of life

When does menopause typically occur in most women?

the conversion of androstenedione to estrone in the skin and adipose tissue

When ovarian function declines, most estrogen is then obtained through what?

nondrug

When possible, (drug, nondrug) modalities should be used to manage health issues first

FSH (follicle stimulating hormone) and LH (luteinizing hormone)

When testosterone falls too low levels, what two hormones does the body increase the production of in an effort to increase testosterone?

ET

Which one carries lower risk: EPT or ET?

using them over the number of years recommended has been shown to increase one's risk of breast cancer and breast cancer mortality

Why do EPT and ET have recommended years of use?

- they do not understand context - inappropriate behavior such as masturbating in public - accuse care-er of sexual advances - touching and statements can be taken as invitations to advance sexually

Why do people with dementia commonly prove to be difficult to those caring for them due to their sexual needs?

- pregnancy is no longer a risk - belief that STDs only affect younger persons

Why might older persons not consider using a condom anymore?

higher

Women who start hormone therapy 10+ years after menopause have a significantly (lower, higher) risk of heart problems

lower

Women who start hormone therapy within 10 years of menopause appear to have a (lower, higher) risk of heart arrack and breast cancer