271 Nursing Care of the Postmenopausal Woman, 3rd Edition
of the aspects of sexual functioning for women who are menopausal, whether naturally or surgically, but currently, the Food and Drug Administration (FDA) has not approved any testosterone prod- uct for the treatment of HSDD/FSAD in menopausal women (Kingsberg et al., 2020; Kingsberg & Faubion, 2019). Pain with penetration Hypoestrogenism, androgen alter- ations, and metabolic considerations all have definite effects on sexuality in menopausal women (Kingsberg & Faub - ion, 2019). Some women report de- creased vaginal lubrication during sexual activities. The International Society for the Study of Women’s Health has recom- mended the term genitourinary syndrome of menopause (GSM) for this decrease of vaginal lubrication. This term may be preferable to calling it vulvovaginal atro- phy (VVA) or atrophic vaginitis because the condition encompasses much more than just the vulva and the vagina (Alex- ander et al., 2022; Bachmann & Pinker - ton, 2022). Hormonal changes can lead to vaginal dryness, genitourinary syndrome of menopause, dyspareunia, vaginal mus- cle spasms, and loss of clitoral sensation (which can decrease the number and in- tensity of orgasms). Introital stenosis or restriction of the opening of the vagina can also accom- pany menopause. Furthermore, there is a decrease in vaginal elasticity, a thinning of the vaginal epithelium, and an overall change in the normal flora of the vagina as estrogen decreases (Alexander et al., 2022; Bachman & Pinderton, 2022; Kings - berg & Faubion, 2019). Women who use topical estrogens to treat their vaginal dry- ness report less pain and increased desire and arousal. Some women report that as they age, they become less interested in
| NURSING CONSIDERATION
It is important for the nurse to recognize the psychological changes that can occur in women during the menopause transition, including depression, anxiety, and self-esteem issues related to changes in a woman’s physical appearance as she ages. Nurses play a vital role in helping women cope with these changes, offering individual assessment, education, and support related to their concerns. Decreased arousal Arousal is the physical readiness to en- gage in sexual activity. Usually, arousal follows desire. As women age, howev- er, desire often begins after the woman experiences the physical responses that characterize arousal (Brotto & Graham, 2022). The changes associated with de- creasing estrogen, such as vaginal atro- phy and dryness, can cause arousal to become more difficult. Additionally, there may be clitoral shrinkage and retraction under the prepuce, making stimulation more difficult. Use of vaginal lubricants such as a water-soluble jelly can assist with arousal (Kingsberg & Faubion, 2019). The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) clas - sifies the decreased arousal that women have during perimenopause and meno- pause in two diagnoses. The first is hypo - active sexual desire disorder (HSDD). The second is female sexual arousal disorder (FSAD). The symptoms of the two disor- ders are so similar that the DSM-5 also includes a single dysfunction, female sex- ual interest/arousal disorder (Kingsberg & Faubion, 2019). Testosterone therapy has been demonstrated to improve some
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