Nursing Care of the Postmenopausal Woman, 3rd Edition
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Table 1-4. Other Sexual History Questions ● Are you currently in a sexual relationship? ● If yes, are you currently having sex with a man, a woman, or both? ● How long have you been with your current sex partner? ● Are you in a committed, mutually monogamous relationship? If not, do you use condoms? Do you practice safe sex? ● Have you ever had a sexually transmitted infection? ● What was it? Were you treated? Have you had any problems with it since? ● Do you have concerns about your sex life? ● Do you have a loss of interest in sexual activities, such as libido, desire? ● Do you have a loss of arousal (tingling in the genitals or breasts; vaginal moisture)? ● Do you have a loss of response, such as a weak or absent orgasm? ● Do you have any pain with intercourse, such as with vaginal penetration? If yes, how long ago did the pain start? ● Please describe the pain. Do you have pain with penetration, or pain inside? Do you feel dry?
Note : Adapted from North American Menopause Society. (2019). Sexual function. In Menopause practice: A clinician’s guide (6th ed.) .
The PLISSIT model is one method nurses can use to determine sexual func- tion, quality of life, and sexual distress (Kingsberg et al., 2019). PLISSIT stands for Permission, Limited Information, Spe- cific Suggestions, and Intensive Therapy. Permission involves getting permission from the patient to create a safe space to initiate a sexual discussion. Once the pa- tient identifies a concern, the nurse can provide limited (targeted) information to educate the woman on the normal meno- pausal changes that lead to this condi- tion, as well as signs and symptoms. This is followed by specific suggestions to ad - dress the concern, with reassurance that there are other treatments available to try if the first suggestions are not successful. In needed, a referral can be made for in- tensive therapy with a specialist, such as a pelvic floor therapist, sex therapist, or sex educator who may provide more compre- hensive guidance and support (Kingsberg et al., 2019).
The sexual history should be initiated with simple, nonthreatening questions. The nurse can then progress to more sen- sitive inquiries. Open questions should be used to encourage the woman to provide more than one-word answers. The nurse can explain to the woman the importance of the questions being asked. The nurse should use correct, but not incomprehen- sibly technical, terminology. A brief sexual history can be included within the full health history. A brief histo- ry can include just two questions: (1) Are you currently in a sexual relationship? and (2) Are you having any sexual difficulties or problems at this time? If the woman answers that she has problems, a more detailed sexual history should be taken by the healthcare provider. If the woman has one of the aforementioned concerns, notify the healthcare provider. Frequent- ly, the woman may feel more comfortable talking with the nurse about these ques- tions than with the provider.
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