Sexuality - Interest

1. Most studies of middle-aged and older women demonstrate that interest in sexual intimacy continues into advanced old age. Prevalence varies by area, country and population surveyed. From 30% of community dwelling US women older than age 65 to 95% of community dwelling Danish women the same age have stated that they have regular intercourse. According to a length study conducted by the Consumers’ Union, most women over age 65 engaged in sexual activity at least once a week.15 Older women report less sexual activity than men the same age, correlating with...

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Aging Midlife

1. Women in midlife, age 40 to 65, can use guidance regarding the impact of chronic illness, hormonal changes, and medications on sexual functioning. Women at this age may be experiencing changes in family structure and the psychosocial adjustments these demand. The variety of needs is amazing. Midlife women may be trying to become pregnant, be menopausal, be widowed, or caring for young children or grandchildren. 2. Women may express fears about the effect of time and hormones on their self-image and desirability. Information about physiological...

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Facilitation

Facilitation 1. Physicians can best assist their patient to maintain healthy sexual functioning by taking a sexual history and exploring a patient’s sexual concerns, fears, and expectations. 2. Physicians may suggest positional changes, environmental changes (placement of pillows, use of hot tubs or waterbeds) and alternative activities to penetrational intercourse such as hugging, caressing, cuddling, and mutual masturbation. 3. Both the patient and her partner must be willing to consider suggestions regarding alternative positions and practices. 4....

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Chronic illness

Many individuals begin to experience the onset of chronic illnesses during the fifth and sixth decades of life. Diseases such as cardiac and circulatory problems, diabetes, arthritis, osteoporosis, chronic obstructive pulmonary disease, hypertension, neurological disorders, and depression, among others, have a profound impact on sexual functioning (Table 6.1). 1. Heart disease The effects of cardiac illness on men have been well researched. Few studies have addressed the specific issues of women following a cardiac event and their unique counseling...

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Disability

1. Studies have addressed the sexual needs of spinal-cord injuries, little research has assessed the sexual health needs of persons born with physical and intellectual disabilities. Societal attitudes toward sexual expression among people with intellectual disabilities have not been favorable. Families, fearing exploitation and abuse, may shield their impaired children from obtaining any sexual knowledge or keep them from participating in appropriate sex education programs. 2. Clearly, an assessment of the intellectual capabilities of the individual...

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Breast cancer

1. A diagnosis of breast cancer brings numerous psychological, emotional, relational, and sexual ramifications for the woman, her partner and her family. Cultural and personal views of the breast as a symbol of femininity and attractiveness and conversely as a source of life and nutrition, play a role in how the woman and her partner respond to the diagnosis. 2. Assessing the woman’s self concept, her body image, expectations of fertility, and her sense of femininity when discussing treatment options are important. Women also fear the response...

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Gynecological cancers

1. While the sexual consequences of gynecological cancers vary according to the treatment needed, dyspareunia is more common among women who have radiation than surgical interventions.6 2. Vaginal dilators may be used for women experiencing dyspareunia following radiation treatment or surgical interventions. Use of the dilator two or three times a week may reduce anxiety about pain and enable the woman to resume sexual activity more comfortably and experience penetration without pain.7 3. Different positions may be used so that the couple can find...

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Medical problems and sexuality Cancer

1. The diagnosis of cancer has a profound effect upon the woman, her partner and her family. Loss, fear, anxiety, anger, and depression are common responses to the diagnosis. Loss may be related to expectations of fertility, of experiences as becoming less whole, less feminine, and more vulnerable to the exigencies of life. Fears associated with the treatment, pain, loss of control, change in perceived desirability, and death are frequent responses. Those cancers that affect sexual organs are traumatic for the patient and her partner. Since cancer...

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Postpartum

1. Following delivery, women gradually return to former levels of sexual desire and interest, although physiological factors such as vaginal bleeding or dyspareunia may contribute to decreased sexual interest during the postpartum period. 2. Fatigue, lack of sleep, psychological concerns, role overloads, and stress may also have a negative impact upon the resumption of sexual activity in the new mother. 3. The husband’s fear of injuring his partner may impact the couple’s resumption of sexual activity. The family physician can offer guidance as...

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Pregnancy

1. Pregnancy creates many physical and psychological changes in the woman’s and couple’s relationship. The woman may have body image changes, physical discomfort, and fears for the safety of the pregnancy. 2. Sexual desire decreases during the first trimester, increases during the second trimester, and decreases again in the final trimester. Some studies have linked advanced pregnancy to decreased sexual desire and satisfaction. 3. For couples who want to continue sexual intimacy throughout pregnancy, the physician may recommend positional changes...

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Sexuality and adolescence Initiation of sexual intimacy

1. Adolescence is a time of great physiological, emotional and psychological change. It is a time of exploration, emancipation, and a search for self-identity. Sexual intimacy is one aspect of accomplishing this transition. 2. Many women, especially teenagers, define themselves by their relationships to others. Having sexual relations may cement these relationships. 3. In the USA, more than three-quarters of boys and two-thirds of girls have had sexual intercourse by their senior year of high school. Nearly half of all 15–19 year olds have had...

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Sexuality through the life-cycle

Introduction 1. Sexuality is a significant aspect of all individuals’ lives. Physicians and health care professionals who provide continuing care to individuals and families have an opportunity and responsibility to provide appropriate counseling, anticipatory guidance and education. Many women consider their physicians as experts in the area of human sexuality. 2. Sexual issues are frequently ignored in practice. Sexuality provides individuals a way to express their feelings, demonstrate caring and communicate and develop intimacy with another person....

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Conclusions

Providing excellent psychosocial care to women throughout the life-cycle is one of the most complex and rewarding tasks a primary provider will undertake. The attention, time, and focus by the provider to the broad spectrum of emotional, developmental, economic, cultural, and social issues that will impact one’s health will be time well spent. Women, by virtue of their unique caretaking, childrearing, and employment responsibilities, have special concerns that require care and attention. Respect and appreciation for the value of psychosocial care...

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Older women

Although poverty is an enormous issue in the psychosocial life of any woman, this issue becomes more important in elderly women. Women older than the age 65 constitute the fastest growing segment of the population and comprise the significant majority of that total population. By the year 2012, people age 65 and older will comprise 14% of the total population, twice the number in 1956.20 Moreover, women comprise an even higher percentage of the elderly poor (72%), and twice as many African-American women live in poverty as Caucasian. Elderly women...

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Adult women

As women emerge from adolescence into adulthood, issues of relationship persist, but the complexities of attaining a livelihood, sustaining oneself, and possible partnering come more directly to the fore. Many young adult women will be continuing to traverse tasks of adolescence, while many others will have long since been pushed prematurely into assuming sets of responsibilities normally thought of as adult. The developmental tasks faced in adulthood are numerous (Table 5.4). These broadly apply to most women in a western culture but will be affected powerfully...

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Psychosocial health through the life-cycle – adolescents

Providing humane, thoughtful psychosocial care to young women during the period of enormous transition and growth that marks adolescence is exciting and often very challenging for the provider. The stakes may be high and there is significant content in screening, assessment, and risk factor identification that need to be covered. Often adolescents do not really want to talk, and there are medical aspects of a visit with which to contend. The 1990s brought an explosion of work, both scholarly and popular, about the risks and transitions for adolescent...

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Principles of psychosocial care for women

The busy provider, hustling through a day packed with sick patients and interspersed with physicals on well children and adults, has her doubts about all this. For many, taking care of ill people and performing well care with the requisite attention to preventive counseling and screening, and doing this well, is more than a day’s work. Nonetheless, it is also true that when practitioners enter the exam room and ask “how are you?” they begin the process of providing good psychosocial care. The principles of good psychosocial care are both simple...

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Women’s psychological development

Relational theory sees women in a context broader than that assigned by their reproductive abilities or gender driven caretaking roles. If development is understood as unfolding from infancy onward via one’s affiliations, there will be a much broader context from within which to understand women as they are self defined rather than as role or gender defined. Being “self defined” means recognizing that women are both self defined and in relationship to others, whatever the context of that “other” might be. Relational theory, therefore, would suggest...

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Theories of early psychological development

1. Theoretical constructs of psychological development have been rooted for much of the twentieth century in theories based on observations and studies of men. Theories designed to describe normal psychological development of men, thus, resulted in description of women’s development as aberrant or arrested.1 Theories designed to describe normal psychological development of men, thus, resulted in description of women’s development as aberrant or arrested. 2. While extensively debated over the decades, the works of Freud and Erickson remain, to this...

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Definitions and background

1. “Psychosocial” refers generally to the psychological status of an individual within the context of their social environment. 2. “Well woman” refers both to the absence of disease and the experience of health. This implies a broad definition of health to include cognitive, emotional, physical, psychological, spiritual, and environmental factors. 3. Assessment of and screening for psychosocial health is deeply connected to the quality of the provider–patient relationship. The life and clinical experience of the provider has a profound impact on...

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Psychosocial health of well women through the life-cycle

Primary care providers are uniquely positioned to assess the psychosocial health of women. While most individuals who seek care are “patients,” – those who require or request care for specific problems – women are frequently seen when they are well. Whether for Pap smears, prenatal care, or general physical exams, primary practitioners will more likely encounter healthy women throughout their lives. Psychosocial health is the substrate from which a woman adapts to the complex world that comprises her life. As such, whether seen in illness or in...

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Disease considerations

The most common causes of morbidity and mortality in the United States are associated with modifiable risk factors, such as obesity, sedentary lifestyle, smoking, and poor diet (www.cdc.gov). Exercise is important as a preventative measure as well as a treatment option for certain diseases, combined with a healthy balanced diet, relaxation practice, and continued supervision/treatment from a physician. Exercise prescriptions can be modified for those persons who have a diagnosed disease. Exercise guidelines are given in Table 4.4 for select diseases. In...

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Adolescents

With an alarming increase in the incidence of obesity, diabetes, and the metabolic syndrome among adolescents in America, the need for regular physical activity and exercise is overwhelming.49 Diet and exercise can reduce variables of the metabolic syndrome in youth to a level that “declassifies” them as having the metabolic syndrome, meanwhile improving lipid profiles, insulin sensitivity, and reducing blood pressure and body weight.50,51 Awareness that low body satisfaction in adolescents is associated with healthcompromising behaviors (i.e....

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Older women

With an increase in age there are certain physiological changes occurring that impact the ability of an older adult to complete daily tasks. Thus, exercise prescriptions for older adults aim to improve physical function by impacting the most influential variables, such as muscle strength, muscle power, and aerobic capacity. Various exercise programs for older adults have demonstrated efficacy to improve muscle strength, bone mineral density, aerobic capacity, and physical function, and to reduce falls. Recent research has questioned whether power...

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Middle ages

During a woman’s middle-aged years, many physiological changes occur, some of which are modifiable. Regular physical activity can reduce the risk of premature death from coronary artery disease, colon cancer, hypertension, and diabetes mellitus.3 However, more than 60% of adult Americans are not regularly physically active, 50% of adolescents aged 12–21 years do not participate in vigorous activities, 25% of adult Americans are not active at all, and women continue to be less active than men, regardless of age.3 The World Health Organization states...

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The career woman

Women with busy daily schedules can still find time to exercise and take care of their health by manipulating their daily routine. The American College of Sports Medicine has recently stated that 30 minutes of continuous exercise is not necessary to elicit health benefits, rather 30 minutes of total accumulated time is required (a minimum of 10-minute bouts).44 The time commitment is less restrictive, which allows a woman to plan exercise sessions around her work and family schedule. For example, a 10-minute walk in the morning before work, 10-minute...

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Exercise prescription for special populations The athletic woman

Exercise prescriptions for a female athlete are specific to the demands of her sport. Differences in energy system requirements dictate the intensity and design of the program. Training of an anaerobic athlete (sprinter, swimmer, etc.) requires high intensity, short duration activities, whereas an aerobic athlete (runner, triathlete, road cyclist, etc.) requires low to moderate intensity for longer durations. Periodized endurance- and strength-training programs alter the training variables (speed, intensity, volume, etc.) to maximize performance....

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Endurance training

The cardiovascular system is most effectively improved by endurance training. Endurance training involves rhythmic movements of large muscle groups. For example, running/walking, bicycling, swimming, and dancing are effective and common modes of endurance exercise. However, a combination of modalities within an exercise session might provide extra motivation and reduce boredom. The exercise prescription for endurance training offers variety, similar to resistance training. The American College of Sports Medicine recommends 20 to 60 minutes a day,...

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Resistance training

Resistance training is the mode of exercise performed to stimulate the neuromuscular system. Variations of the number of sets, repetitions, rest period, and weight lifted determines the outcome of the training program. Programs designed to increase strength are typically performed at a high intensity (80% of the one-repetition maximum, 1RM) with long rest periods (2 to 3 minutes) and low to moderate volume (2 to 3 sets of 8 to 10 repetitions), whereas programs designed to promote muscle hypertrophy are performed at a moderate to high intensity...

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Exercise prescription for healthy populations

The type of exercise performed depends on the desired goal. If a woman wants to build muscular strength, then resistance training is appropriate. Endurance training (walking, running, cycling, swimming) is required if a woman wants to improve her cardiovascular health and endurance. Yoga and Tai Chi are therapeutic alternatives to the rigors of strength and endurance training that can reduce stress, increase strength and flexibility, and improve cardiovascular parameters. A certified yoga or Tai Chi instructor should be consulted for more information on...

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Non-traditional exercise

Non-traditional styles of exercise, such as Yoga and Tai Chi, have also demonstrated positive improvements in health.32 Yoga involves various standing, seated, and supine postures and breathing and relaxation techniques designed to enhance functioning of the various physiological systems by supporting a natural posture. Tai Chi incorporates slow body movements (forms) that concentrate on balance and body weight transfers. Young and old men and women have performed yoga and Tai Chi for centuries in Eastern countries. Both have been purported to...

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Endurance training

Sarah is a 42-year-old bank teller with no known cardiac risk factors who was found to have a fasting total cholesterol level of 299 mg/dL with an LDL of 179 mg/dl at a recent screening. After 3 months of vigorous change of diet to a low-fat diet, she returns for a fasting lipid profile. Total cholesterol has only decreased to 245 mg/dL with an LDL of 145. She asks what else she can do without starting on pharmacotherapy. You suggest walking three times a week for 30 minutes each day as a form of exercise. She agrees; six months later, she has...

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