Complete_Week6_Post Menopausal and Sexuality Issues in the Maturing and Older Adult Discussion

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Students will not receive credit for any discussions posted after Sunday 11:59pm MT. Ageism and gender bias can affect who and how we ask about sexual health, sexual activity, and concerning symptoms... . Depending on your own level of comfort and cultural norms this can be a tough conversation for some providers. But this is an important topic and as our videos discussed, women are wanting us to ask about sexual concerns. This week we also reviewed sexually transmitted diseases and the effects of ageism on time to diagnosis so it is necessary to ask these questions and provide good education for all patients. You will not know any needs unless you ask. Discussion Questions: Review the required NAMS videos. What was the most surprising thing you learned about in the videos? Explain why it was surprising. What is GSM? What body systems are involved? How does this affect a woman's quality of life? What treatment does Dr Shapiro recommend? Review one aspect of treatment that Dr Shapiro recommends and include an EBP journal article or guideline recommendation in addition to referencing the video in your response. Sexuality and the older adult What is your level of comfort in taking a complete sexual history? Is this comfort level different for male or female patients? If so, why? How will this information impact the way you will interact with your mature and elderly clients?  4/29/2019 Topic: Week 6: Post Menopausal and Sexuality Issues in the Maturing and Older Adult Discussion https://chamberlain.instructure.com/courses/40085/discussion_topics/1033976?module_item_id=4867001 2/45 Search entries or author Unread    Subscribed (https:// Wanda Galvan Rivera (hps://chamberlain.instructure.com/courses/40085/users/22704) Apr 8, 2019  Hi Dr. Mompoint and Class, The most surprising thing I learned is that many older adults do not use protection during sex because they no longer have the risk of getting pregnant. I also found it shocking that older adults do not get asked about sexual health during office visits with providers because do not view sexual dysfunction as a real issue. As adults age, we as society expect them to have less sex or none at all, which is not the case. Patients are more satisfied when sexual health is discussed and addressed during health visits. GSM stands for genitourinary syndrome of menopause. It involves the whole system with symptoms of the vagina, the urinary tract and sexual symptoms related to decreased estrogen (Kim et al, 2015). Approximately 90% of postmenopausal women have clinical symptoms of GSM (Santoro & Lin, 2018). It affects the quality of sex life of a women after menopause causing decrease in self-esteem and intimacy with their partners (Kim et al, 2015). Signs and symptoms include vaginal dryness, burning sensation, irritation of genital area, decreased vaginal lubrication, pain or discomfort with intercourse, impaired sexual function, painful urination, and recurrent urinary tract infections (Kim et al., 2015). GSM does not get better with time. It is a chronic and progressive condition that can be managed with symptom treatment (Kim et al., 2015). Dr. Shapiro recommends over the counter lubricants, moisturizers, pelvic floor physical therapy, and low dose vaginal estrogens if other therapies are not effective. One recommended treatment by Dr. Shapiro is low dose vaginal estrogens which is the most effective treatment if nonpharmacological treatment fails. Local vaginal estrogen targets GSM symptoms and has minimal effect on estrogen levels in the body (Santoro & Lin, 2018). Vaginal estrogen comes in many forms such as creams, tablets and rings that are placed in the vaginal cavity for absorption. This correlates with the information Dr. Shapiro provided in the video stating that vaginal estrogen  4/29/2019 Topic: Week 6: Post Menopausal and Sexuality Issues in the Maturing and Older Adult Discussion https://chamberlain.instructure.com/courses/40085/discussion_topics/1033976?module_item_id=4867001 3/45  is safe to use and has minimal effect on estrogen levels in the body (MenopauseSociety, 2016). The black box warning of vaginal estrogen includes risk of endometrial cancer, cardiovascular disorders, breast cancer and probable dementia (Santoro & Lin, 2018). The vaginal estrogens are in very low doses and the black box warning pertains to higher doses (Santoro & Lin, 2018). The newest alternative to vaginal estrogen treatment is (DHEA) vaginal dehydroepiandrosterone. It works by converting androstenedione and testosterone into estradiol and estrone which help with symptoms of dyspareunia (Santoro & Lin, 2018). The DHEA treatment are found to be safe in patient with history of cancers, however, studies on breast cancer have not been conducted (Santoro, & Lin, 2018). When I first started doing my clinical rotation, I was a little uncomfortable asking older adults if they were sexually active. However, as I have asked several patients about their sexual activity, I was thanked by a few for asking which has made me more comfortable with asking. Their sexual health is important to them and I want to be able to address any concerns they have. The information learned from this lesson makes we want to address the sexual health of older adults. Just because patients are older does not mean they are not having sex or that they don’t want to. I plan to make sexual health apart of the annual health maintenance exam. Wanda Kim, H. K., Kang, S. Y., Chung, Y. J., Kim, J. H., & Kim, M. R. (2015). The Recent Review of the Genitourinary Syndrome of Menopause. Journal of menopausal medicine, 21(2), 65–71. doi:10.6118/jmm.2015.21.2.65 Santoro, N., & Lin, I. (2018). Genitourinary syndrome of menopause: Underdiagnosed and undertreated. Contemporary OB/GYN, 63(7), 10–23. Retrieved from https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx? direct=true&db=ccm&AN=130763242&site=eds-live&scope=site (https://search-ebscohostcom.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=130763242&site=eds-live&scope=site) MenopauseSociety. (2016, June 22). Dr. Shifren discusses GSM. Retrieved fromhttps://www.youtube.com (https://www.youtube.com/) /watch?time_continue=356&v=hrzTdhO4pso (http Marie Mompoint (Instructor)   4/29/2019 Topic: Week 6: Post Menopausal and Sexuality Issues in the Maturing and Older Adult Discussion https://chamberlain.instructure.com/courses/40085/discussion_topics/1033976?module_item_id=4867001 4/45 Apr 10, 2019  Hi Wanda, Thanks for a great discussion. Many practitioners are just not comfortable with the conversation. As you discussed, becoming comfortable with having this discussion can be beneficial to your patient overall sexual health . Yes, older people are having sex!...more and more nowadays and it is usually unprotected. Great job Dr. Mompoint [Show More]

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