Nursing Care of the Postmenopausal Woman, 3rd Edition
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sexual response cycle is not the same in all women, and each woman may report unique emotional and physical sensa- tions. The sensations may be different in each sexual experience, and the woman may not necessarily progress through each phase in sequence to achieve sexual pleasure (Cason, 2022; Masters & John - son, 1966). | NURSING CONSIDERATION It is important for the nurse to recognize that the female sexual response is not compartmentalized; physiological and emotional responses are dynamic and affect one another (Kingsberg & Faubion, 2019). CHANGES IN SEXUAL RESPONSE DURING MENOPAUSE Decreased desire Sexual desire frequently, but not al- ways, wanes as a woman increases in age. Women are more likely than men to ex- perience a loss of desire. Falling estrogen levels during menopause and the associ- ated physical changes of menopause can decrease motivation and desire. Decreas- ing testosterone levels change drive and sensation. Decreased desire is considered a problem when the woman or her part- ner believes that it is a problem (Kings- berg et al., 2020; Kingsberg & Faubion, 2019; Ricoy-Cano et al., 2020). During midlife, sexual feelings can be varied. For some women, sexual activ- ity can be gratifying. For others, sexual activity is less exciting or gratifying. The transition to menopause brings with it physiological changes that can affect all the phases in the sexual cycle. Problems with one’s sex life are common. It is esti- mated that 22% to 43% of women world-
wide have sexual problems during their menopause transition (Cagnacci et al., 2020; Kingsberg & Faubion, 2019). Sex - ual desire can decrease for a while with the changes that occur early in meno- pause, especially vaginal dryness, but most women learn to work around these issues. Some women will use vaginal lu- bricants and vaginal estrogen prepara- tions to help with the vaginal dryness. Sexual dysfunction increases throughout the climacteric, with a peak between age 62 to 65 (Cagnacci et al., 2020). Sleep disturbances caused by the fluctuations in hormones and vasomotor instability can induce fatigue, which can adversely af- fect sexual desire (Cagnacci et al., 2020). Surgical menopause affects hormone and androgen levels and self-image, and it can also interfere with sexuality and de- sire (Cagnacci et al., 2020; Kingsberg & Faubion, 2019; Ricoy-Cano et al., 2020). Women with persistent or recurrent absence of sexual fantasies or desire for sexual activity may be diagnosed with hy- poactive sexual desire disorder ; however, other causes of sexual dysfunction need to be ruled out before they are given the diagnosis. The clinical features must be present for at least six months. Common findings include persistently reduced (or absence of) sexual fantasies, sexual in- terest, responses to partner’s attempts to initiate sexual activity, responses to exter- nal or internal sexual/erotic cues, and sex- ual excitement/pleasure during encoun- ters. Expressed marked personal distress or interpersonal difficulty can result from sexual dysfunction. The risk for hypoac- tive sexual desire disorder is greatest for women who have undergone surgical menopause (Bildircin et al., 2020).
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