Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
19 Cards in this Set
- Front
- Back
|
Reproduction System- Sexual Function/Dysfunction in Geriatric Patients by Knepp
|
Reproduction System- Sexual Function/Dysfunction in Geriatric Patients by Knepp
|
|
|
Objectives.
|
-Dramatize the role of sexuality in the life of an older person who is suffering loss of independence.
-Develop an appreciation for the techniques to approach the topic of sex and sexuality in a geriatric patient. -Appreciate the difference between sex and sexuality. -Recognize normal sexual function in the elderly population. -Recognize male and female sexual dysfunction. -Recognize medications that can produce sexual dysfunction. -Construct an effective therapeutic plan when needed to treat elderly sexual dysfunction. |
|
|
Physician Role
|
-Need to dispel popular notions
-Be open to genuine questions and concerns of our patients -Be nonjudgmental in responding to patient concerns and questions -Actively look for symptoms and complaints that may be clues to an underlying patient concern that they are afraid or embarrassed to tell or ask us. -Keep ourselves educated on current evidence on geriatric sexuality -Stay current on the myriad of medication side effects produced by individual meds and aggravated by polypharmacy -Stay current on effective treatment guidelines -Always treat the patient not ourselves! |
|
|
Sex vs sexuality
|
-Sex is the act of physical intimacy, often involving intercourse
-Sexuality refers to the broader topic of physical, social and mental aspects of our self-awareness and attractiveness to others. -Sexuality is dependant on a mature life and ability for self-reflection and may change as we grow older. Brett Farve may still want to play football when he's 75. |
|
|
Elderly Sexual Activity-not a myth!
makes you happy or sad? percentages of it happening... |
-Many maintain sexual activity into 80’s and 90’s
-Bretchnedier, et al found that seniors age 80-102, 87% of men and 68% had intimate contacts and 67% of men and 30% of women had recent intercourse. -Matthias, et al report 30% of all medicare recipents in a large survey had sexual activity in the last month. -Sexual well being correlates high with general happiness. |
|
|
Age does effect sexual function...females...
|
Females
Decreased vaginal Lubrication Delay in arousal Thinning of vaginal mucosa Decreased vaginal length and tone Loss of vulvar tissue Decreased clitoral size Decreased estrogen and testosterone levels |
|
|
Age does effect sexual function...males...
|
Males
Reduced semen volume More penile stimulation needed to achieve and maintain erection Weaker orgasm More rapid penile detumenscence Prolonged refractory period Testosterone declines approx. 1% per year after age 30 |
|
|
Sexual dysfunction-prevalence in males and females.
|
Females:
Lack of interest 33% Inability to orgasm 25% Pain during sex 14% Lubrication difficulty 27% Sex not pleasurable 22% Males: Lack of interest 18% Inability to orgasm 15% Pain during sex 4% Erectile dysfunction 21% Premature ejaculation 27% |
|
|
What social factors contribute to sexual dysfunction?!
|
Tobacco!
Alcohol abuse! Street drugs! ask these questions, no matter the age of the patient. |
|
|
Sexually Transmitted Diseases. Go ahead and name cinco of them.
|
Gonorrhea
HIV Syphilis Gardnerella vaginitis Chlamydia vaginitis |
|
|
Medication Side Effects... CV drugs.
|
Cardiovascular drugs:
Beta blockers Calcium channel blockers Digitalis Clonidine Methyldopa Spironolactone Thiazide Diuretics Alpha adrenergic blockers |
|
|
Medication Side Effects... Psychoactive drugs.
|
Psychoactive drugs:
SSRI antidepressants- 50% can't orgasm when on it. MAO inhibitors Anti-psychotics Tricyclic antidepressants Lithium Benzodiazepines Alcohol Trazadone (Priapism) the nervous pathway, affects synaptic function. |
|
|
Medication Side Effects... hormonal and OTC
|
Hormonal Drugs:
Androgens Progestins Estrogens GnRH analogues (lupron) OTC: affect synaptic activity too. Cimentadine Antihistamines Anticholinergics H2 blockers (OTC for reflux/esophagitis) |
|
|
Medication Side Effects on female/ male sexuality:
|
Possible drug effects on female sexuality:
Increased libido Decreased libido Impaired arousal and orgasm Breast enlargement Galactorrhea Virilization Possible drug effects on male sexuality: Impaired spermatogenesis (reduced fertility) Testicular disorders Penile disorders Gynecomastia Feminization |
|
|
Social, Emotional, and Psychologic Issues
|
-Special Issues in the latter years
-Widow's and widower's syndrome -Family members may not share views about what is appropriate in terms of sexual behavior of the older woman in particular -Health professionals must recognize that often they contribute to the invasion of privacy that deprives older individuals of the sensual and sexual contact they desire |
|
|
Psychological Problems
|
Psychological Problems:
Unrecognized depression Women - fear of rejection or poor self image Retirement Fear of illness or death during intercourse Freedom of fear of pregnancy may enhance sexual activity and satisfaction Fatigue Tension Illness |
|
|
Category A Therapy is what? what does it treat? What can't you use at the same time?
|
Phosphodiesterace type 5 (PDE-5) inhibitors effectively treat ED including that caused by antidepressant therapy.
Cannot be used if taking nitrates in any form! huge side effects. you can go blind. |
|
|
Category B Therapy.. what do these things do?
|
1. Consider adding bupropion SR 150 mg BID for sexual dysfunction associated with antidepressant therapy.
2. Consider adding buspirone (20-60 mg/day) for sexual dysfunction associated with antidepressant therapy. counteract side effects of SSRIs |
|
|
Category C Therapy.. why types of things is this?
|
Simple advise can help lots of couples:
-Mornings are generally best for physical activities -Lubrication, with petroleum jelly, or water- soluble lubricants (which will wash off, and can be heated) helps -There is often need for increased physical stimulation by both partners of each other -Often one partner is much more concerned than the other about changing sexuality -Our human needs for sensual closeness, warmth, a hug, may be somewhat separate from sexual needs; it is wrong for the former needs to suffer from problems of the latter -Elderly women, especially if there are atrophic changes, often benefit from short- term, or sometimes long-term use of estrogens (which may be used vaginal, but the absorption is similar to that given orally) |
