Sexuality Flashcards
Older adults, LGBTQ, Sexaully Transmitted Diseases
True Or False:
Older adults still engage in sex.
True: Those who continue to engage in sex have greater enjoyment in life, greater cardiovascular health, greater self-esteem, and a greater sense of comfort and security.
A helpful starting point in a busy primary care practice to facilitate sexual and gender identity disclosure is intake paperwork that ask questions such as:
asking patients their preferred pronouns (e.g., if they refer to themselves as “he/him/him,” “she/her/hers,” “they/their/theirs,” or other pronouns in their social history). Other important social history questions to explore include if persons are having sex with men, women, or both, and then asking if they identify as gay, lesbian, or bisexual. Both with gender and sexual identity, it is important to ask for this information and to not make assumptions.
Gender dysphoria:
Distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth. This distress may also be from the associated gender role or attributed sex characteristics.
Gender identity:
A person’s intrinsic sense of being male, female, or an alternative gender.
Sex:
Sex is assigned at birth as male or female, usually based on the appearance of the external genitalia. Natal gender.
Gender expression:
The way an individual socially expresses gender, such as style of clothing, speech, and mannerisms. Gender identity and gender expression may differ. There may also be people who do not present in the binary or masculine or feminine roles, presenting as an alternate gender, such as genderqueer.
MSM Screening
HPV, HIV, Anal Cancers
An 86-year-old female comes to your office for a wellness visit. Her blood pressure is 125/70mmHg, pulse 69 beats per min, and respiratory rate 18 breaths per min. She is well appearing and reports she is up to date on her routine vaccinations. She introduces her partner of 35 years whom she would like to make medical decisions for her in case she becomes unable to make decisions for herself. She reports that she and her partner are not married. She asks if she needs any further documentation to ensure her goals of care are followed.
Which one of the following would be the most appropriate recommendation for this patient and her partner?
a.Advise them to complete a POLST.
b.Advise them that they have adequate documentation to be recognized legally.
c.Advise them to file an advanced directive.
d.Respond that although they lack documentation, her partner will be recognized de facto.
c.Advise them to file an advanced directive.
An 81-year-old transgender female with history of depression and hyperlipidemia presents to your clinic for routine care. She endorses a history of smoking, currently smoking 1 pack per day, and occasionally drinks a glass of wine, although she denies illicit drug use. She reports she takes atorvastatin 20mg and subcutaneous estrogen therapy.
Which of the following is the most important next step in this patient’s primary care?
a.Counseling on starting aspirin
b.Counseling on alcohol cessation
c.Counseling on smoking cessation
d.Counseling on mammogram
c.Counseling on smoking cessation
3.An 84-year-old male with history of stroke without residual deficit, systolic heart failure, and type 2 diabetes presents to clinic for follow-up. He is independently living in a retirement community and still works part time on a golf course. He currently takes aspirin 81mg, metoprolol tartrate 25mg BID (twice a day), furosemide 20mg BID, and lisinopril 10mg daily. He reports his last colonoscopy was 8 years ago, with no abnormality. He reports he is sexually active with men and women, engaging in receptive oral, receptive anal, and penetrative sex. He states he has had over three sexual partners in the last year with intermittent condom use.
What sexually transmitted infection testing should be offered?
a.Urine testing
b.Urine testing, blood testing
c.Urine testing, blood testing, anal swab
d.Urine testing, blood testing, anal swab, and oropharyngeal swab
d.Urine testing, blood testing, anal swab, and oropharyngeal swab
A 72-year-old woman reports vaginal dryness that interferes with coitus. Her medical history includes type 2 diabetes, hypertension, and osteoarthritis. Medications are
glyburide, chlorthalidone, and acetaminophen. What would be your first step in therapy?
a. Stop glyburide
b. Stop chlorthalidone
c. Stop acetaminophen
d. Start topical vaginal lubricant
b. Stop chlorthalidone
A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely cause of her problem?
a. Vaginal atrophy
b. Provoked vulvar vestibulodynia
c. High-tone pelvic floor dysfunction
d. Endometriosis
c. High-tone pelvic floor dysfunction
