CC March 2016 Sexuality with Aging

echoecho's version from 2016-07-03 16:11


Question Answer
We live in an ______ society where myths and prejudices surround this topic?ageist
The majority of patients, especially what gender often are uncomfortable or embarrassed to bring up the subject?women
Why are physicians uncomfortable?1) because of their own views of sexuality with aging 2) fear of offending older patients
Acceptance of sexual activity among older persons varies with what?1) our diverse cultural beliefs 2) social norms 3) religious norms
What myt do patients and physicians accept?sexual activity slows with aging due to physiological and social changes of older persons
List the physiological changes that occur in the older persons?1) hormonal changes (decreased libido in men and women; dyspareunia in postmenopausal women) 2) general decline of physical health (cardiovascular disease, stroke, DM, arthritis, depression, cognitive impairment) 3) medications (SSRIs, b-blockers) 4) lack of available partner (loss of spouse or decreased social contact after retirement) 5) privacy (living in a nursing facility)
True or false? While real challenges exist for many older patients, the perception of sexual activity as no longer important/desirable among older men and women is incorrect?true
Populations studies in the US and other countries like Australia, Sweden and India) found that a large porition of older men and women view sexual activity as what?important and desirable
The % of interviewees aged 57-64 years; 65-74 years; and 75-85 years who reported being sexually active was what?73%; 53%; 26% respectivelly
Which gender reported less sexual activity and lack of partners more often than the other gender?women
*** True or false? Those in very good or excellent health were twice as likely to be sexually active than those in fair or poor health?true
An Australian study of 3,274 men (75-95 years old; 75.5% married) found that _____ % viewed sexual activity at least somewhat important; ___% had had at least one sexual encounter in the past 12 months and ____% preferred to have more frequent sex?48%; 38%; 43%
What is the summary?while frequency of sexual activity may decline, sexual desire and satisfaction is relevant in the elderly
Family MDs should have what attitude when discussing this topic with the elderly?open-minded and non-judgmental attitude
One should ask _____ before initiating coversation and listen carefully with respect and understanding?permission
Older patients and their significant others often have ____ concerns, especially for those in poor health?safety
What is needed before any medications can be prescribed?a thorough medical, mental, social and sexual hx (including an appropriate physical exam)
What medications should be reviewed?prescribed meds, herbal supplements, OTC meds
What should be addressed as well?1) safe sex practices 2) risks of sexually transmitted infection (STI) 3) advice on hep B vaccination 4) HIV screening
A difficult challenge is determining whether older patients with mild_______ are capable of consenting to sex?dementia
MDs must evaluate each patient individually to protect patients from what?elder sexual abuse
Half of Americans in the 2000-2006 US population based study reported at least ____ sexual problem?one
What sexual problem is the most common male sexual problem?ED
ED prevalence increases with age (___% in 60-69 year age group; ____% of those > 69 years)?22%; 30%
Pts with DM type 2 have a ______ greater risk of ED compared to the general population?3-fold
List the first-line therapy for ED?1) lifestyle modifications (weight loss and exercise) 2) addressing polypharmacy 3) smoking cessation 4) reducing alcohol consumption
In the absence of C.I. (nitrate use), what 4 medications can be prescribed at the lowest dose for older patients?an oral phosphodiesterace-5 inhibitor (1) sildenafil (Viagra), (2) tadalafil (Cialis), (3) vardenafil (Levitra), (4) avanafil (Stendra)
What 2 adverse side effects of oral phosphosdiesterase-5 inhibitors should be discussed with the patient?1) coital angina 2) priapism
What are the CI of oral phosphosdiesterase-5 inhibitors?those who take NTC or isosorbide
What noninvasive and effective second-line option are available for ED?vacuum pump devices
What other invasive options should be avoided because of increased risk of complications?intraurethral / intracavernosal injeciton of alprostadil (Caverject)
*** If patients have had a recent uncomplicated MI, how long after may a patient resume sexual activity and what 2 activities should he be able to do before assuming sexual activity?1) one week 2) perform regular daily chores AND climb 1-2 flights of stairs without symptoms
Are oral phosphosdiesterase-5 inhibitors highly effective and well-tolerated and safe after an MI?yes
Hypogonadism increases with aging. Testosterone levels decline an average of ___ to ___% annually?1; 2
By the age of ____ years, half of men have hypogonadal range testosterone (< 200-300 ng/dL)?80
What is low testosterone associated with?decreased libido
What forms of testosterone are effective replacement therapy?gel, patch, pellet, buccal, injection
Benefits vs risks of testosterone replacement in patients > 65 y.o. are controversial. What should patient receive?counseling regarding potential benefits and risks before taking testosterone replacement therapy
List 3 sexual problems that older women have?1) low sexual desire (43%) 2) vaginal lubrication difficulties (39%) 3) inability to reach organism (34%)
What is the most common reason for older women not to engage in sexual activity, and it has a significant impact on mental and physical health, body image and relationship with their partners?dyspareunia (caused by vaginal dryness and atrophy)
What treatments are available for dyspareunia?1) topical lubricants 2) estrogen cream (more effectively improve vaginal dryness and atrophy)
Compare topical estrogens with ospemifene (Osphena) and oral estrogens?topical estrogens are generally equally effective compared to ospemifene (Osphena) and oral estrogen with fewer adverse effects
What is Ospemifene?1) brand name is Osphena 2) it is a novel SERM (selective estrogen receptor modulator) approved for vulvar and vaginal atrophy and dyspareunia
What are the common side effects of Ospemifene (Osphena)?1) hot flushes 2) vaginal discharge 3) muscle spasms 4) hyperhidrosis
*** If oral estrogen is prescribed, what is the dose that should be given, for how long, and why?1) lowest dose 2) shortest duration 3) reduce risk fo adverse effects like breast cancer and thromboembolism
What medication is routinely given if the patient has an intact uterus, why?1) oral progestin 2) to prevent endometrial hyperplasia
Low libido and sexual arousal problems are common in older women, what medications /supplements are not approved for low libido and sexual arousal problems?1) oral testosterone 2) bupropion (Wellbutrin) 3) oral phosphodiesterase 5-inhibitors 4) herbal supplements
Sexual activity and satisfaction go beyond intercourse, what other activities are equally important and satisfying?handholding, hugging, fondling, kissing
What should physicians confront?myths and personal bias regarding sexuality and aging
What should be offered to older patients who desire to remain sexually active?supportive, appropriate advice
*** SUMMARY = True or false? The perception of sexual activity as no longer important or desirable among older men and women is incorrect?true
*** SUMMARY = What are the sexual problems in older men? in older women?1) ED, hypogonadism 2) low sexual desire, vaginal lubrication difficulties with associated dyspareunia and inability to reach orgasm