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Nurses can help older women manage changes in their sexual health

Latest research from the nursing and medical journals.

Tremayne P, Norton W (2017) Sexuality and the older woman. British Journal of Nursing. 26, 14, 819-824.

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With increased life expectancy women can expect to live one third of their life post-menopause, when many older women say that sexual activity is still an important part of their relationship.

Reduction in systemic oestrogen can lead to the vagina becoming shorter and drier, with a reduction in vaginal secretions. This may make penetration painful, but can be helped with artificial lubricants.

Lack of oestrogen can also lead to stress incontinence and urinary tract infections, which may be helped by prescribing vaginal oestrogen. Reduced circulating oestrogen can also lead to reduced libido and difficulty achieving orgasm.

Older women are at increased risk of sexually transmitted diseases because dryness in the vagina can lead to micro-abrasions.

They are also at increased risk of some cancers, including breast cancer. Screening continues until the age of 65, but the highest rate of incidence is in women over 85 so it is important that women continue to examine their breasts.

Screening for human immunodeficiency virus should be considered for women with recurrent pneumonia, shingles or tuberculosis.

Many older people would like the opportunity to discuss sexual concerns with nurses, but may be embarrassed to do so. However, the permission, limited information, specific suggestions, and intensive therapy (PLISSIT) model can be helpful.

Nurses using the PLISSIT model can give permission by asking cue questions, such as ‘many women feel that the menopause affects their intimate relationships. Is there anything you would like to ask me about this?’

The second step, limited information, can involve providing leaflets and later checking whether they were helpful. The last two stages of the model require referral to a specialist.

Compiled by Ruth Sander, independent consultant in care of the older person

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