Chapter 1: Introduction
Nurse's Role in Sexuality and Reproductive Health\n\n## Introduction to Nursing Perspective\n* Importance: Sexuality is an integral part of human experience throughout life, including older adulthood. Nurses must approach this topic professionally, without personal bias, acknowledging that older adults are sexual beings.\n* NCLEX Relevance: Components of sexuality are included in the NCLEX test plan under 'Health Promotion and Wellness'.\n* Curriculum Context: This class provides foundational knowledge on sexuality in older adults, complementing more in-depth coverage in Fundamentals and other courses.\n* Exam Focus: The slides with highlighted titles indicate content most important for the exam. Students should focus on these highlighted areas and related readings.\n\n## Effects of Aging on the Female Reproductive System (Chapter 20)\n* Hormonal Changes: Typically occur in late 40s and 50s, leading to menopause.\n* Vulva: Atrophy of the vulva, flattening of the labia, loss of subcutaneous fat and hair.\n* Vagina: Common for older women to experience vaginal dryness, increasing risk of injury and infection. The need for additional lubrication is often present.\n* Internal Organ Atrophy: Cervix, uterus, fallopian tubes, and ovaries may experience atrophy, meaning a decrease in muscle mass, cell number, or cell size.\n* Breasts: Sagging and less firm, possible nipple retraction. Firm linear strands may develop due to fibrosis and calcification.\n* Cultural Perception: Negative societal depictions of female aging can lead to negative self-concept among older women. It is a myth that sexuality ends with menopause.\n\n## Effects of Aging on the Male Reproductive System\n* Cultural Perception: Society generally views male aging more kindly than female aging.\n* Sperm: Reduction in sperm count, less live sperm in ejaculatory fluid.\n* Tissue Changes: Muscle tissue replaced with connective tissue. Seminiferous tubal changes include increased fibrosis and epithelium thinning.\n* Testes: Atrophy and reduced testicular mass.\n* Testosterone: Levels remain similar or decrease only slightly (andropause) – not as drastic as female hormonal changes.\n* Erection: More time required to achieve an erection.\n* Prostate Gland: Enlargement is common and often benign, but there is an increased risk for malignancy as it grows.\n\n## Health Promotion and Screenings\n* Female Health Promotion: Breast self-examination (BSE) remains crucial for early detection of lumps. Pap smears are no longer required after age 65 if a woman has had at least three normal Pap tests. Even for younger women without issues, Pap smear frequency is often spaced out.\n* Male Health Promotion: Testicular self-examination. Regular prostate exams (e.g., every 6 months) are necessary to check for tumor formation, which involves palpation.\n* Nurse's Role: Nurses are responsible for teaching self-examination techniques and educating patients on screening guidelines.\n\n## Nursing Assessment and Communication\n* Assessment Guide: Refer to page 302 for an assessment guide outlining changes to consider during patient interviews.\n* Sensitive Topics: While open-ended questions are generally preferred, direct, specific, closed-ended questions are acceptable for sensitive topics like sexuality to gather immediate 'yes/no' answers. Nurses must then investigate further if a concerning answer is identified.\n\n## Dyspareunia (Painful Intercourse)\n* Definition: Painful intercourse, very common in older adult women due to hormonal changes.\n* Incidence: More frequent in nulliparous women (women who have not had children); the exact pathophysiology is not fully understood.\n* Contributing Factors: Gynecologic problems like vulvitis and vaginitis.\n* Intervention: Requires a thorough gynecologic exam to determine the cause.\n* Nursing Goal: Help the individual achieve a satisfactory sexual life aligned with their choices.\n\n## Sexuality Myths vs. Reality (Chapter 31)\n* Myths Busted: \n * Older adults cannot engage in sexual intercourse: False. Many wish to and do, though choice not to should be respected.\n * Nothing can be done about body changes interfering with sexual activity: False. Sexual therapists and various interventions can help.\n * Sex causes heart attacks: False. While heart attacks can occur during sexual activity, it is not common and media portrayal is exaggerated.\n * Sex isn't important to older adults: False.\n * Older adults do not need to worry about sexually transmitted infections (STIs): False.\n* Realities: \n * 67\% of older adults aged 60 to 80 are interested in sex.\n * 40\% of older adults are sexually active.\n * Soaring STI Rates: A study from 2010-2019 on the 55+ population showed significant increases: \n * Chlamydia rates up 204.5\%\n * Gonorrhea rates up 88.8\%\n * HIV rates up 142\%\n * Reason for STI Increase: The current generation of older adults (Baby Boomers) is more sexually active than previous generations and may engage in sexual activity with multiple partners, often without the awareness of STI risks due to the absence of pregnancy risk.\n\n## Benefits of Sexual Expression (Exam Focus)\n* Increased happiness, energy, and relaxation.\n* Improved cardiovascular health.\n* Increased self-esteem.\n* Improved satisfaction with relationships.\n* Decreased pain and depressive symptoms.\n* Note: While sex can address certain issues in relationships, it's important to consider if it masks underlying problems that need deeper attention.\n\n## Generational History and Sexuality\n* 1960s Sexual Revolution: A period of rebellion against conservative norms, parental authority, and the Vietnam War, leading to significant shifts in sexual discourse and education in the US.\n* Past Education: Baby Boomers and many Gen X parents often did not discuss sex with their children.\n* Modern Shift: Starting around the early 2000s, there was a greater emphasis on sex education in schools and organizations, recognizing that parents might not provide it.\n* Current Context: Marketing often sexualizes products, leading to ubiquitous sexual content. Movements like Title IX and Me Too have further reshaped discussions around women's sexual expression and autonomy.\n\n## Menopause: Beyond a Disorder\n* Symptoms: Involves significant physical, emotional, and cognitive changes due to hormonal shifts (
Chapter 20
List changes to the male and female reproductive systems that occur with age.
Female Reproductive System Changes
Hormonal Changes: Typically occur in late 40s and 50s, leading to menopause.
Vulva: Atrophy of the vulva, flattening of the labia, loss of subcutaneous fat and hair.
Vagina: Common for older women to experience vaginal dryness, increasing risk of injury and infection. The need for additional lubrication is often present.
Internal Organ Atrophy: Cervix, uterus, fallopian tubes, and ovaries may experience atrophy, meaning a decrease in muscle mass, cell number, or cell size.
Breasts: Sagging and less firm, possible nipple retraction. Firm linear strands may develop due to fibrosis and calcification.
Male Reproductive System Changes
Sperm: Reduction in sperm count, less live sperm in ejaculatory fluid.
Tissue Changes: Muscle tissue replaced with connective tissue. Seminiferous tubal changes include increased fibrosis and epithelium thinning.
Testes: Atrophy and reduced testicular mass.
Testosterone: Levels remain similar or decrease only slightly (andropause) – not as drastic as female hormonal changes.
Erection: More time required to achieve an erection.
Prostate Gland: Enlargement is common and often benign, but there is an increased risk for malignancy as it grows.
Describe measures to promote reproductive system health in older adults.
Female Health Promotion
Breast self-examination (BSE) remains crucial for early detection of lumps.
Pap smears are no longer required after age 65 if a woman has had at least three normal Pap tests. Even for younger women without issues, Pap smear frequency is often spaced out.
Male Health Promotion
Testicular self-examination.
Regular prostate exams (e.g., every 6 months) are necessary to check for tumor formation, which involves palpation.
Nurse's Role
Nurses are responsible for teaching self-examination techniques and educating patients on screening guidelines.
Outline factors to consider in assessing reproductive system health in older adults.
Assessment Guide: Refer to page 302 for an assessment guide outlining changes to consider during patient interviews.
Sensitive Topics: While open-ended questions are generally preferred, direct, specific, closed-ended questions are acceptable for sensitive topics like sexuality to gather immediate 'yes/no' answers. Nurses must then investigate further if a concerning answer is identified.
Describe the symptoms and management of dyspareunia.
Definition: Painful intercourse, very common in older adult women due to hormonal changes.
Incidence: More frequent in nulliparous women (women who have not had children); the exact pathophysiology is not fully understood.
Contributing Factors: Gynecologic problems like vulvitis and vaginitis.
Intervention: Requires a thorough gynecologic exam to determine the cause.
Nursing Goal: Help the individual achieve a satisfactory sexual life aligned with their choices.
Chapter 31
Discuss the effects of societal attitudes toward sex and older adults.
Cultural Perception:
Negative societal depictions of female aging can lead to negative self-concept among older women. It is a myth that sexuality ends with menopause.
Society generally views male aging more kindly than female aging.
Sexuality Myths Busted:
Older adults cannot engage in sexual intercourse: False. Many wish to and do, though choice not to should be respected.
Nothing can be done about body changes interfering with sexual activity: False. Sexual therapists and various interventions can help.
Sex causes heart attacks: False. While heart attacks can occur during sexual activity, it is not common and media portrayal is exaggerated.
Sex isn't important to older adults: False.
Older adults do not need to worry about sexually transmitted infections (STIs): False.
Generational History and Sexuality:
1960s Sexual Revolution: A period of rebellion against conservative norms, parental authority, and the Vietnam War, leading to significant shifts in sexual discourse and education in the US.
Past Education: Baby Boomers and many Gen X parents often did not discuss sex with their children.
Modern Shift: Starting around the early 2000s, greater emphasis on sex education in schools and organizations.
Current Context: Marketing often sexualizes products, leading to ubiquitous sexual content. Movements like Title IX and Me Too have further reshaped discussions around women's sexual expression and autonomy.
Explain the effects of aging on sexuality and sexual function.
Realities of Older Adult Sexuality:
67\% of older adults aged 60 to 80 are interested in sex.
40\% of older adults are sexually active.
Soaring STI Rates:
A study from 2010-2019 on the 55+ population showed significant increases:
Chlamydia rates up 204.5\%
Gonorrhea rates up 88.8\%
HIV rates up 142\%
Reason for STI Increase: The current generation of older adults (Baby Boomers) is more sexually active than previous generations and may engage in sexual activity with multiple partners, often without the awareness of STI risks due to the absence of pregnancy risk.
Identify measures to manage menopausal symptoms.
Menopause: Involves significant physical, emotional, and cognitive changes due to hormonal shifts.
Management: Often involves addressing hormonal changes through hormone therapy, lifestyle adjustments (e.g., diet, exercise), and therapeutic interventions (e.g., relaxation techniques, vaginal moisturizers) tailored to individual symptoms to alleviate hot flashes, vaginal dryness, and mood changes.
Identify measures to manage andropausal symptoms.
Andropause: Characterized by a slight decrease in testosterone levels as men age, not as drastic as female hormonal changes.
Management: Typically involves lifestyle modifications (e.g., healthy diet, regular exercise, stress management) and, in some cases, testosterone replacement therapy, depending on the individual's symptoms and health status, to address issues like fatigue, decreased libido, and mood changes.
Describe factors that can contribute to sexual dysfunction.
Physiological Changes:
Vaginal dryness and atrophy in women.
Increased time required for erection and prostate enlargement in men.
General decline in muscle mass and increase in fibrosis.
Gynecologic Problems: Such as vulvitis and vaginitis, evident in dyspareunia.
Psychological Factors: Negative self-concept due to societal perceptions of aging, depression, anxiety.
Medical Conditions: Cardiovascular disease, diabetes, neurological disorders.
Medications: Certain drugs can affect libido and sexual performance.
Myths and Misconceptions: Beliefs that nothing can be done about body changes interfering with sexual activity can prevent individuals from seeking help.
Describe ways nurses can promote healthy sexual function in older adults.
Education and Counseling:
Teaching self-examination techniques (BSE, TSE) and explaining screening guidelines.
Educating patients on the realities of sexuality in older adults, debunking myths.
Discussing STI risks and prevention methods, especially given rising rates.
Assessment and Communication:
Using an assessment guide to consider changes during patient interviews.
Employing direct, specific questions for sensitive topics like sexuality, followed by further investigation.
Creating a professional and non-judgmental environment.
Intervention and Support:
Addressing specific issues like dyspareunia through thorough gynecologic exams and appropriate interventions.
Helping individuals achieve a satisfactory sexual life aligned with their choices and preferences.
Highlighting the Benefits of Sexual Expression:
Increased happiness, energy, and relaxation.
Improved cardiovascular health.
Increased self-esteem.
Improved satisfaction with relationships.
Decreased pain and depressive symptoms.
Advocacy: Encouraging patients to discuss sexual health concerns with healthcare providers and seeking referrals to sexual therapists or specialists when appropriate.