Nursing Care of the Postmenopausal Woman, 3rd Edition
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sex or have altered body image because of aging or weight gain that keeps them from desiring sexual activity. Vaginal pH changes from a healthy acidic environment to one that is basic. A pH test of the vaginal sidewall is an ob- jective measurement of GSM. The overall results of these changes are a dry vagi- na, a smaller and thinner-walled vagina, and the potential for dyspareunia, or pain with penetration (Bachman & Pinkerton, 2022). The clitoris becomes smaller and covered by the prepuce. Vascular chang- es can diminish the intensity of muscle contractions during orgasm. A decreased amount of fatty tissue on the labia and mons pubis can cause tenderness during sexual activity, making it easy to damage or abrade these tissues (Alexander et al., 2022; Bachman & Pinkerton, 2022). Urethral tissues surrounding the introitus are also affected by decreased estrogen levels. Urinary symptoms of frequency or pain can also occur and interfere with sexual satisfaction (Bachman & Pinker - ton, 2022). Women with GSM experience pain with intercourse that can lead to decreased interest in sexual intercourse (Bachman & Pinkerton, 2022). Decreased pleasure and response The same changes that can decrease desire and arousal can also decrease pleasure. Discomfort from decreased vaginal lubrication and decreased sensi- tivity of the clitoris can lower a woman’s pleasure and impede her ability to have an orgasm. Orgasms may become less in- tense, take more time to achieve, or not occur at all. If a woman is unable to find pleasure or sexual fulfillment, her desire for sexual intimacy may wane (Goetsch et al., 2022; Kingsberg & Faubion, 2019). One quarter of women, however, have become sexually inactive because all lev-
els of sexual domain and desire, including responsivity, frequency, libido, and pain, worsen with advanced menopause status (Goetsch et al., 2022; Kingsberg & Faubi - on, 2019). Along with physical symptoms, there may be socio-cultural influences, bad relationships, and other psychologi- cal aspects that contribute to decreased desire (Goetsch et al., 2022). Psychological aspects of menopause are also implicated in sexual functioning. Psychological changes related to aging occur at the same time as physiologi- cal menopausal changes. Self-esteem and self-evaluation have an immense ef- fect on women as sexual beings. When a woman has low sexual desire, she may also feel frustrated, concerned, unhappy, disappointed, hopeless, troubled, and/ or ashamed. Other factors remain consis- tent outside of menopause status, such as physical health, availability of a part- ner, stress or mood symptoms, and socio- economic factors (Kingsberg & Faubion, 2019). It is common for women experiencing difficulties with sexual activities to de - velop a sexual dysfunction; however, not all women have sexual problems as they age. Many women find that as their ca - reer and family pressures are reduced and they have more time with their partner, their sexual relationship improves. Even a woman who is no longer able to have a sexual relationship will most likely con- tinue to need closeness and the touch of a loved one (Kingsberg & Faubin, 2019).
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