269 Nursing Care of the Postmenopausal Woman, 3rd Edition
periences are intricately involved in cre- ating and maintaining desire (Kingsberg & Faubion, 2019). Open communication between a woman and her partner about her desire, or lack thereof, will often lead to an improvement in sexual problems. The amount of desire a woman has can vary over her lifetime and can de- crease during the transition to meno- pause (Kingsberg & Faubion, 2019). See Table 1-1 for a range of psychological, sociocultural, interpersonal, and biologi- cal factors that can contribute to sexual disorders in midlife, both positively and negatively. Excitement is the second phase of the classic sexual response. Thought to be the physiological response to desire, excitement leads to sexual arousal. For women, arousal involves vaginal lubrica- tion, lengthening of the vagina, breast tingling and nipple erection, enlargement of the labia, and tightening of the anus. The clitoris also enlarges and becomes extremely excitable and sensitive to touch. Some women experience a rash or flush over the upper body. Systemic phys - iological responses include tachycardia, tachypnea, and increased blood pressure (Cason, 2022; Masters & Johnson, 1966). The height of sexual response is the orgasm, which is generally achieved through clitoral stimulation. Orgasm , the release of sexual tension, is characterized by rhythmic contractions of the vagina and uterus and tightening of the ure- thra and anus. The contractions are the strongest in the muscles that surround the vagina. The woman’s heart rate el- evates, along with her respiration and blood pressure. Hyperventilation is pos- sible. The orgasm can last anywhere from 3 to 60 seconds. Orgasms can occur once or multiple times during the encounter.
Emotional and physiological responses combine to impact orgasm intensity, but reports of intensity of and satisfaction with orgasm vary from woman to woman (Cason, 2022; Masters & Johnson, 1966). Table 1-1. Potential Factors Influencing Women’s Sexual Functioning ● Previous attitudes toward sex. ● Loss of partner. ● Partner’s loss of interest in sex. ● Partner’s renewed interest in sex. ● Age-related changes related to sex drive. ● Communication or lack of it. ● Body image concerns. ● Health concerns resulting from disease or symptoms. ● Psychological problems such as depression or anxiety. ● Weight gain. ● Incontinence. ● Sleep disturbances. ● Significant life stressors. ● Medications that affect sex drive. ● Diminished hormone levels. ● Children moving out of the house. ● Children moving back into the house. ● Parents’ health needs, or parents moving into the house. Note: Adapted from North American Menopause Society. (2022). Other body changes affecting sexuality, sexual side effects of menopause . https://www.menopause. org/for-women/sexual-health-menopause-online/chang- es-at-midlife/other-body-changes-affecting-sexuality Resolution is the final phase of the sex - ual response. The body returns to its nor- mal state. The woman will feel a sense of relaxation and well- being, as well as feel- ings of enhanced intimacy. The resolution in the woman occurs more slowly than in the man, but women do not have the re- fractory period that men experience. The
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