Lecture 8 Sex, hormones, and happiness Flashcards
Age-related changes affecting sexual wellness
Normal aging does decrease sexual/reproductive efficiency and lengthens sexual response times:
- Degenerative changes in all reproductive organs.
- Diminished levels of sex hormones: Estrogen in women; testosterone in men - but this decline is more variable in men.
- Cessation of menses and loss of reproductive ability in women; older men have variable reproductive ability.
- Altered response to sexual stimulation.
Risk factors that affect sexual function - societal influences
- Myths of aging; attitudes about aging and sexuality.
- Cultural beliefs; Kinsey Reports - public displays of affection, orgasms, etc.
- False perceptions, self-fulfilling prophecy.
- Stigmatization of homosexual individuals.
Risk factors that affect sexual function - individual influences
- Limited opportunities - erectile dysfunction, lack of a partner, social circumstances, lack of privacy, etc.
- Adverse effects of medications, nicotine, and alcohol.
- Functional impairments - arthritis, COPD, incontinence.
- Chronic illnesses - dementia, diabetes, heart disease, depression, BPH, etc.
Medications for erectile dysfunction (ED)
- Sildenafil (Viagra).
2. Tadalafil (Cialis).
Sleep apnea is a risk factor for impaired sexual function because it results in _
Hypertension.
Medications that cause disorders of desire include _
- Psychoactive medications - antipsychotics, benzodiazepines, barbiturates, lithium, and all SSRIs.
- Hormonal agents.
- Cardiovascular medications - beta blockers, calcium channel blockers, thiazide diuretics, hydralazine, etc.
Medications that cause disorders of arousal include _
- Anticholinergics (Levodopa).
- Antihistamines (Benadryl, Claritin).
- Antihypertensives.
- Psychoactive medications - SSRIs, MAOIs (Nardil), benzodiazepines, tricyclic antidepressants.
Medications that cause disorders of orgasm include _
- Amphetamines and related anorexic drugs.
- Antipsychotics.
- Methyldopa.
- Narcotics.
- SSRIs.
- Trazodone.
- Tricyclic antidepressants.
With the exception of _ and _, all antidepressants can cause erectile dysfunction.
- Trazodone.
2. Bupropion (Wellbutrin).
In men, chronic use of alcohol affects production of _ and _ and can cause impotence and reduced libido.
- Testosterone.
2. Gonadotropin.
Regarding sexuality, cigarettes and nicotine are linked with the development of _
Erectile dysfunction.
The chronic condition that can cause retrograde ejaculation is _
Diabetes.
Menopause - biologic changes
- Decline in blood levels of estrogen.
- Vaginal pH becomes more acidic.
- Subcutaneous fat and collagen decrease.
- Production of testosterone - the hormone of desire - declines.
- Changes in the sexual response cycle (neural).
Andropause - biologic changes
- Testosterone production declines 1-2% after age 30, but this is highly variable.
- Seminiferous tubules of testes - narrowed lumen, eventually to the point of obliteration of some tubules; diminished production of viable sperm.
- Seminal vesicles and prostate gland - secretions diminish, firm masses form around prostate urethra.
- Penis - venous and arterial sclerosis and fibroelastosis of corpus spongiosum.
Changes occurring within 1 year of menopause (in the absence of hormone therapy)
- Cervix, uterus, and fallopian tubes atrophy.
- The vaginal wall and mucosa become thinner - increasing the likelihood of UTIs.
- Vagina becomes shorter and narrower.
- Bartholin’s glands atrophy and secrete less fluid - causing the skin to become dry and more prone to injury.
- Less vaginal lubrication during excitement.
- The labia lose fullness and the amount pubic hair diminishes.
Changes occurring within 1-2 years of menopause
- The vulva and external genitalia shrink.
2. Introital stenosis - narrowed opening of the vagina.
Because estrogen is stored in _ tissue, obese women may be less likely to experience atrophy of the vaginal epithelium after menopause.
Adipose.
Estrogen replacement therapy is indicated for _
- Osteoporosis.
- Vasomotor symptoms.
- Genital atrophy.
Androgens, including testosterone, are made by the _ and the _
- Adrenal glands.
- Ovaries.
(So if a woman has an oophorectomy, she will still have testosterone production by the adrenals.)
Functions of testosterone
- Sexual desire.
- Maintenance of muscle mass.
- Maintenance of bone mineral density.
4 phases of the sexual response cycle
- Excitement phase.
- Plateau phase.
- Orgasm.
- Resolution phase.
Sexual response cycle by gender
- Men= 3 minutes from desire to orgasm.
- Women= 12.5 minutes from desire to orgasm.
- Both genders= Plateau phase to orgasm is only 1 minute, therefore foreplay is important to balance out the experience.
Some degree of erectile dysfunction is experienced by _ of men over the age of 70.
70%
PLISSIT model
Tool to assess and develop interventions for *intimacy and sexuality issues*: P = Permission LI = Limited Information SS = Specific Suggestions IT = Intensive Therapies
Erectile dysfunction medications should not be taken with _
Nitrovasodilators (e.g., nitroglycerin, amyl nitrate).
_ is the only FDA-approved medication for increasing sexual stimulation in women.
Flibanserin (Addyi).
Flibanserin (Addyi) contains a black box warning regarding _
A dangerous drop in blood pressure and possible fainting when taken with alcohol or anti-fungal medications.
Older adults are at increased risk for contracting HIV due to _
Vaginal/epithelial changes paired with immune system changes, especially when sex is unprotected.
Diminished _ affects sexual function in older adult women in several ways.
Estrogen production.
