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Post menopausal, sexuality issues, and urologic concerns in the maturing and older adult

Post menopausal, sexuality issues, and urologic concerns in the maturing and older adultPost menopausal, sexuality issues, and urologic concerns in the maturing and older adultAgeism and gender bias can affect who and how we ask about sexual health, sexual activity, and concerning symptoms. Depending on your own level of comfort and cultural norms this can be a tough conversation for some providers. But this is an important topic and as our videos discussed, women are wanting us to ask about sexual concerns. This week we also reviewed sexually transmitted diseases and the effects of ageism on time to diagnosis so it is necessary to ask these questions and provide good education for all patients. You will not know any needs unless you ask.Discussion Questions:What is GSM? What body systems are involved? How does this affect a woman’s quality of life?What treatment does Dr Shapiro recommend?Review one aspect of treatment tat Dr. Shapiro recommends and include an EBP journal article or guidelines recommendationORDER A PLAGIARISM-FREE PAPER HERESexuality and the older adultWhat is your level of comfort in taking a complete sexual history? Is this comfort level different for male or female patients? If so, Why?How will this information impact the way you will interact with your mature and elderly clients?Post menopausal, sexuality issues, and urologic concerns in the maturing and older adultMen and women both can experience urologic concerns with aging. This week’s presentations and readings covered urologic concerns and common problems.Utilize the national guidelines and scholarly references to develop your responses.Urinary IncontinenceMen and women can both get UTIs. What factors contribute to the development of a UTI in men versus women? Include risk factors. In which sex is a UIT more concerning and why?BPHAs a provider it is essential for you to know to interpret DRE findings and what your next step should be. The American Urology Association has specific recommendations based on age. Be sure you know these because the guidelines will guide your patient counseling and treatment plan.What does AUA state about drawing PSA levels?If you decide to draw a level what specific counseling should you include in your education today?Urinary tract infectionsIt is important to know when to treat a UTI and when not to treat. Is there a particular situation where you would not treat a UTI?  Post-Menopausal, Sexuality Issues, and Urologic Concerns in the Maturing and Older AdultNameInstitution  Post-Menopausal, Sexuality Issues, and Urologic Concerns in the Maturing and Older AdultGSMGenito-urinary syndrome of menopause, famously known as GSM, forms one of the novel terms that describe the multifarious menopausal signs and symptoms. According to Hyung-Kung et al. (2015), thesesymptoms encompass, among others, general symptoms (irritation, burning, dryness), sexual symptoms (impaired function, pain or discomfort, and absence of lubrication) and urinary symptoms (recurrent UTIs, dysuria, urgency). The condition is principally related to the decline of estrogen levels in post-menopausal women and the quality of life of these women has been substantially negatively impacted as a consequence.Further, the progression of genito-urinary syndrome for menopause affects certain body systems such as the lower urinary tract, and the vulvovaginal system, and the endocrine system.The low level of estrogen that accompanies the condition leads to varied health problems. The resultant symptoms from the GSM are chronic, less likely to be resolved spontaneously, and they progress if left unattended. Although the above symptoms do not threaten the life of postmenopausal women, they progressively advance and profoundly impact their lives. One of the manners in which the impact on the quality of life occurs is via affecting intimacy with their sexual partners and their self-esteem. A study that was recently published revealed that GSM’s vaginal discomfort affected the intimacy of 58% of women as well as 78% of men (Hyung-Kung et al.,2015). A further study known asRealWomen’s VIews of Treatment Options for Menopausal Vaginal ChangEs (REVIVE) reported that women posited that the vaginal symptoms caused by GSM impacted their sleep (24%), enjoyment of sex (59%) and enjoyment of life (23%)(Kingsberg et al., 2013).Post menopausal, sexuality issues, and urologic concerns in the maturing and older adultDr. Shapiro, in her analysis of the condition, recommends an individualized intervention for GSM. According to her, non-hormone treatments involving a healthy diet need to be undertaken as the first line of treatment in menopausal women. In other words, Dr. Shapiro recommends for a proactive approach to the management of the condition, with diet and exercise forming the basis of her approach. This approach, particularly the one on nonhormonal treatment plans, is supported by evidence-based practice. Gambiacciani et al. (2015) backs the recommendations made by Dr. Shapiro with regards to using nonhormone treatment in the article “Rationale and design for the Vaginal Erbium Laser Academy Study (VELAS): an international multicenter observational study on genitourinary syndrome of menopause and stress urinary incontinence”. According to the researchers, the nonhormone, Vaginal Erbium Laser methodology has proven effective, particularly when utilized with the consent of the patient and in concert with the physician.Post menopausal, sexuality issues, and urologic concerns in the maturing and older adultSexuality and the Older AdultTaking sexual history is becoming a major issue for medical students. According to literature, medical students have naturally reported a high interest in sexual health and as such, it becomes paramount for them to understand how to take a complete health history. However, on a personal scale, the present author’s level of interest in taking such histories is low. Specifically, the religious and cultural barriers between the author and patients make it difficult to freely engage in sexual history-taking. IsHak (2017) opines that whereas some of the patients consider talking about their sexual histories embarrassing, others consider it inappropriate. Consequently, it becomes fundamentally difficult to gauge the reaction of a patient to efforts to discuss sexual histories. To this end, the present author finds it difficult to undertake complete sexual histories irrespective of the qualified and excellent education they have on the same.Post menopausal, sexuality issues, and urologic concerns in the maturing and older adultThe level of interest in taking the complete sexual history from patients also differs markedly based on the gender of a patient. Physicians have severally demonstrated that there is a certain level of uncomfortability when taking the history of the opposite gender. From the author’s experience, the level of interest significantly drops when the patient is a woman. One of the most significant factors in the disinterest when it comes to women is the fear of intrusion. Privacy, as required by the nursing practice, is a key component of medical practice. Thus, the author always feels that they could be asking intrusive questions when engaging members of opposite sex in sexual history taking. In addition, patients also prefer to consult doctors of the same sex when dealing with sexual issues. Also, there is the ‘sexualisation’ of the conversation by the women in some cases. The potential for the female clients to do this by overexposing themselves makes it a difficult subject to broach for the author and as such, his interest reduces significantly when the patient is female. On the other hand, the present author feels more interested when the client is male. This is because male patients are generally more open to such discussions and as such, the barriers to the conversations are negligible.Post menopausal, sexuality issues, and urologic concerns in the maturing and older adultThe above information is particularly important particularly with regards to the author’s future interaction with elderly patients. Normally, addressing the issue of sexuality in this category of patients is always difficult given their advanced age. Physicians fear discussing the issue of sexuality with them for the fear of embarrassing them as well as the technical inability to address some of the issues. However, the above-discussed issues concerning varied gender patients will enable the author to develop strategies that will increase and enhance addressing the matter. The stratagem will eliminate the issues that prevent physicians from fully undertaking the health history of the elderly. By doing this, the author will have the capacity to completely engage them in history-taking endeavors minus feeling guilty or fearing to embarrass them.Post menopausal, sexuality issues, and urologic concerns in the maturing and older adultUrinary Incontinence            Urinary tract infections are caused by bacterial, fungal, and viral infections on various parts of the urinary tract. Amongst the three causative agents, bacteria are the most predominant. Studies stipulate that while both women and men are at risk of acquiring the condition, there are a few differences in the risk factors between the two genders. In men, UTIs are caused by sexually transmitted diseases and prostatitis. The STIs that cause UTIs in men include Chlamydia trachomatis, Ureaplasmaurealyticum, Mycoplasma genitalium, Herpes simplex virus (HSV), Trichomonasvaginalis, anaerobes as well as adenovirus (Young-Suk &Kyu-Sung, 2013). Regarding prostatitis, an enlarged prostrate causes insufficient emptying of urine from the bladder, leading to retention and multiplication of bacteria.In women, the risk factors associated with UTIs is relatively longer. Their short urethra allows E.collito enter and reach the bladder causing cystitis. Further, STDs like trichomoniasis, gonorrhea, chlamydia, and herpes can cause UTIs due to the distance between the vagina and urethra (Lin et al., 2013)Post menopausal, sexuality issues, and urologic concerns in the maturing and older adult. Moreover, a woman’s urinary tract undergoes dilation during pregnancy, allowing the bacteria to easily ascent to the urinary tract system via urethra. The usage of birth control methods such as diaphragms may interfere with the flow of urination, which then permits the growth of bacteria. Lastly, the menopause also causes UTIs due to the menopausal women’s vulnerability to urinary continence. According to studies, the UTIs ar3e more concerning in women because of the likelihood of recurrent infections and heightened risk of giving birth to low weight babies.BPHThe American Urological Association issued novel guidelines regarding the issue of PSA. According to the association, the usage of PSA is supported but only in specified age groups. Further, the routine usage of the PSA testing in healthy men can only occur after a conversation between a physician and a man. In more specific terms, the guideline stipulates that only men within the age bracket of 55-69 years can undergo this screening. According to the AUA, the normal PSA levels should be 4.0 ng/mL of the drawn blood (“American Urological Association”, 2015). The guideline also posits that men of age 40 and below should have a PSA level of 2.5 ng/mL and lower while the elderly have a slightly higher level of the biomarker. So, if one decides to draw a specific level, say >4.0, then the counseling education plan will have to include the effects of life-changes that will occur and how these will be managed by the patient. In specific terms, the testing physician will need to counsel the patient concerning the associated dangers of PSA testing. One of the above dangers includes the possibility of false positive results, which has affected between 100-200 test subjects per 1000 heads (Nordstrom et al., 2016)Post menopausal, sexuality issues, and urologic concerns in the maturing and older adult. In the counseling session, the prospective patient needs to be advised about the resultant anxiety and worry that result from the PSA biopsy. In addition, the counseling plan needs to include the effects of biopsy such as fever, urinary problems, bleeding and infection that a person may undergo during the PSA drawing process (Nordstrom et al., 2016). By counseling a patient regarding the PSA false-positive results and the accompanying effects, they will be better prepared to undergo the test.Urinary Tract InfectionsUrinary tract infections are normally treated by a host of interventions. However, studies have revealed that there could be certain situations wherein one may abandon the treatment of urinary tract infections. According to Matuszkiewicz-Rowinska, Malyszko, and Wieliczko (2015), urinary tract infection in pregnant women with pyelonephritis is difficult to treat, and as such, they may need to be hospitalized and treated intravenously. Therefore, this could be the only time that one does not ‘treat’ the condition.Post menopausal, sexuality issues, and urologic concerns in the maturing and older adult  ReferencesAmerican Urological Association – Early Detection of Prostate Cancer. (2015). Retrieved from, M., Torelli, M. G., Martella, L., Bracco, G. L., Casagrande, A. G., Albertin, E., & … D’Ambrogio, G. (2015). Rationale and design for the Vaginal Erbium Laser Academy Study (VELAS): an international multicenter observational study on genitourinary syndrome of menopause and stress urinary incontinence. Climacteric, 1843-48. doi:10.3109/13697137.2015.1071608Hyun-Kyung, K., So-Yeon, K., Youn-Jee, C., Jang-Heub, K., &Mee-Ran, K. (2015).The Recent Review of the Genitourinary Syndrome of Menopause.Journal Of Korean Society Of Menopause, 21(2), 65-71. doi:10.6118/jmm.2015.21.2.65Post menopausal, sexuality issues, and urologic concerns in the maturing and older adultIsHak, W. W. (2017). The textbook of clinical sexual medicine. Cham, Switzerland : Springer.Kingsberg, S.A., Wysocki, S., Magnus, L., &Krychman, M.L. (2013). Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med,10, 1790–1799.Lin, K.J., Mitchell, A.A., Yau, W.P., Louik, C., & Hernandez-Diaz, S. (2013). Safety of macrolides during pregnancy.Am J ObstetGynecol, 208 (3), 22.e1-8.Matuszkiewicz-Rowinska, J., Malyszko, J., &Wieliczko, M. (2015).Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems. Arch Med Sci 11(1), 67-77.Nordström, T., Bratt, O., Örtegren, J., Aly, M., Adolfsson, J., &Grönberg, H. (2016).A population-based study on the association between educational length, prostate-specific antigen testing and use of prostate biopsies.Scandinavian Journal Of Urology, 50(2), 104-109.Young-Suk L., &Kyu-Sung, L. (2013). Chlamydia and Male Lower Urinary Tract Diseases. Korean J. Urol, 54 (2), 73-77.Post menopausal, sexuality issues, and urologic concerns in the maturing and older adult

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