Nursing Care of the Postmenopausal Woman, 3rd Edition
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CASE STUDY 1-1
A 51-year-old woman presents for her annual physical examination. She has three children (from three pregnancies), all of whom are grown and out of the house. Her son recently married and moved to another state. The woman tells you that she has been having hot flashes that wake her up several times a night. She relates that she is always so tired that she has no energy left for anything pleasurable. She comes home from work and sits and watches television until it is time for bed. She has no energy left to have sex with her husband. When she does agree to have sexual intercourse with her husband, she gets no enjoyment out of it. She explains that it is uncomfortable to have sex.
Questions: 1. Which types of sexual concerns is this patient describing? 2. What could be causing these concerns? 3. What can the nurse do to help the woman with her concerns?
Commentary : This woman is describing the most common sexual concerns associated with menopause: Decreased desire, decreased pleasure, pain with penetration, and decreased arousal. She is also describing common menopausal symptoms: She is having frequent hot flashes and night sweats. This situation is causing a disruption in her sleep. After a long day at work, she is too tired to have sex. This patient is also concerned about pain and discomfort throughout intercourse. This pain is most likely caused by decreased lubrication and elasticity of the vagina. Her awareness that sex will be uncomfortable lessens desire and destroys any anticipation of pleasure. Although these concerns can easily be the result of menopausal symptoms, the nurse should also question whether the patient might be depressed or whether she has any other health concerns. She is currently experiencing lifestyle changes, which—along with having menopausal symptoms—increase her risk for depression. The woman’s evenings spent sitting in front of the television may in themselves be a sign of depression. Conclusion
References • Alexander, I. M., Konicki, A. J., Boltone, C. A, Mayerson, E., & Witkovic, M. (2022). Menopause. In K. D. Schuiling & F. E. Likis (Eds.), Women’s gynecologic health (4th ed.) . Jones & Bartlett Learning. • Allen, R. H., Cwiak, C. A., & Kaunitz, A. W. (2019). Contraceptives. In Carolyn J. Crandall (Ed.), Menopause practice: A clinician’s guide (6th ed.; pp. 277-284). The North American Menopause Society. • Bachmann, G., & Pinderton, J. V. (2022). Genitourinary syndrome of menopause (vulvovaginal atrophy): Clinical manifestations and diagnosis. Up to date, Topic 5464, Version 30.0. • Bayer Healthcare. (2022). Highlights of prescribing information . https://labeling.bayerhealthcare.com/html/products/pi/Mirena_ PI.pdf • Bildircin, F. D., Özdes, E. K., Karli, P., Özdemir, Z., & Kökçü, A. (2020). Does type of menopause affect the sex lives of women? Medical Science Monitor, 26. E921811. doi: 10.12659/MSM.921811 • Brotto, L. A., & Graham, C. A. (2022). Is Basson’s model of sexual response relevant? Yes, and so are other validated models of sexual response: A commentary on Balon. Sex & Marital Therapy, 48 (1), 13-16. https://doi.org/10.1080/0092623X.2021.1918301 • Cagnacci, A., Venier, M., Xholli, A., Pagliette, C., & Caruso, S. (2020). Female sexuality and vaginal health across the menopausal age. Menopause: The Journal of the North American Menopause Society, 27 (1), 14-19. doi: 10.1097/GME.0000000000001427 • Cason, P. P. (2022). Sexuality and sexual health. In K. D. Schuiling & F. E. Likis (Eds.), Women’s gynecologic health (4th ed.). Jones & Bartlett Learning. • Curtis, K. M., Tepper, N. K., Jatlaoui, T. C., Berry-Bibee, E., Horton, L. G., Zapata, L. B., Whiteman, M. K. (2020). U.S. Medical Eligibility
Sexuality concerns are important con- siderations during the menopause transi- tion. The changes women experience can be confusing, depressing, and misunder- stood. Nurses can alleviate much of the anxiety surrounding sexuality by obtain- ing a thorough sexual history, answering women’s questions in a positive and infor- mative manner, and offering understand- ing and compassion. Sexuality concerns may require a myriad of therapies for sex- ual dysfunction, including medical treat- ment, psychological or sexual counseling, and competent nursing care.
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