Sexual health assessment across the lifespan

Sexual Health Assessment Across the Lifespan

CONFRONTING ISSUES IN EVERY STAGE

Various studies show that the majority of women in their entire lifespan continue to be sexually active despite problems and other barriers in each life stage. The lack of monitoring data on these problems and resources for help and effective prevention and intervention for risky adolescent behaviors, unintended pregnancy among young adult women, barriers to IPV among pregnant women, a holistic approach to middle-age female sexuality and the un-addressed sexual needs of older women add to other misconceptions, which take a toll on sexual health and fulfillment. In turn, the imbalance adversely affects national health.

Introduction

The Problem and Its Significance

Health histories are the rational foundations for clinical reasoning and sound patient care management. Assessments are modified according to the patient's age, gender, race, lifestyle and other specific aspects. Conducting a realistic sexual health assessment among women requires distinct assessments of the different stages of a woman's life cycle. The significance of the study is the knowledge to be used as basis for formulating more effective and responsive strategies to address the separate issues in the various stages of women's sexual health and life.

Literature Review

Surgeon General's Call

Scientific evidence shows that the current sexual health of the nation poses a serious public health that demands immediate action (Satcher, 2001). In its report, the Office of the Surgeon General said that what is done about it will have critical impact in the present as well as the future of the nation. Solutions are complex but the promotion of sexual health and responsible sexual behavior is a necessary first (Satcher).

Most Mature Adults are Sexually Active

Part of the evidence is the conclusion reached by the Global Study of Sexual Attitudes and Behaviors of 27,500 men and women aged 40 -- 80 in 29 countries, representing many world regions in 2000-2001 (Laumann et al., 2009). Of this number, 1491 respondents were from the United States, 69.3% of them women. It found that the large majority of American respondents engage in sexual activity into the middle age and beyond. It also found that many of them confronted sexual problems but less than 25% sought help from a health professional. The most common sexual problems in men were early ejaculation at 26.2% and erectile difficulties at 22.5% and a lack of sexual interest at 32% and lubrication difficulties at 21.5% in women. The other countries surveyed were Austria, Canada, Germany, Spain, Italy, the United Kingdom and Israel. The study population assumed that it was generally representative of the American population (Laumann et al.).

The findings furthermore indicated that the majority of the respondents did not consider their sexual problems so severe as to lead them to seek help from health professionals (Laumann et al., 2009). Moreover, the doctors seldom monitored or inquired into patients' sexual health during routine consultation. Most patients would have welcomed the initiative and been encouraged to present their sexual health difficulties. Untreated sexual disorders and unaddressed sexual problems can adversely affect the quality of life. Improved functioning will also enhance doctor-patient relationship. The study concluded that most middle-aged and elderly people in the United States continue to be sexually active despite sexual dysfunctions. However, few of them do not seek medical assistance for the dysfunctions in the belief that these are not serious enough. It recommended proper educational initiatives in increasing awareness and understanding of sexual health. This will, in turn, encourage patients to seek help for a more fulfilling sexual life (Laumann et al.).

Changes in Women's Sexual Functioning

A recent longitudinal study showed that sexual functioning changes as women transition through the menopausal period (Avis et al., 2009). It found that sexual functioning in 75% of 3,302 42-52-year-old women decreased because of increased pain during intercourse. This, in turn, led to lowered sexual desire in them (Avis et al.).

The Study of Women's Health across the Nation or SWAN found that sexual desire among the majority of the respondents decreased with an increase in painful intercourse during late peri-menopause (Avis et al., 2009). It observed that the changes were related to the importance of sex among the respondents, psychological status, physical health and relationship between the partners. Vaginal dryness was associated with pain and reduced arousal, emotional satisfaction and physical pleasure. This link reinforced results of earlier studies that peri-menopausal or post-menopausal women experienced greater pain and lower sexual desire or interest. Estrogens are necessary for urogenital maturation and lower estrogen levels tend to decrease vaginal secretions during sex. This could reduce sexual pleasure from arousal and disturb the intimacy in sexual response. The results, thus, pointed to the importance of linking social, health and relationship factors in addressing menopause and sexual functioning. Feelings for the partner and the start of a new relationship were also identified as significant factors (Avis et al.).

National Strategy

Sexual health and responsible sexual behavior are among the Surgeon General's public health priorities and an essential part of the Healthy People 2010 initiative of the Department of Health and Human Services (Satcher, 2001). To address the issue, they set up strategies to increase awareness, implement and strengthen interventions, and expand research base. Increasing public awareness would be in the form of a national dialogue, presenting the opinions of leaders, providing proper sex education, offering health and social interventions and investing in research on the issue. The Surgeon General's call to action was primarily to induce the holding of a mature national dialogue on the issues surrounding sexual behavior and sexual health. The dialogue may be initiated by individuals, families, communities, the media or government and non-government entities. The idea is for all sectors to share in the responsibility to promote sexual health and responsible sexual behavior (Satcher).

The Adolescent Female

According to recent studies, the majority of adolescents 15-19 years old in the United States and Canada had had sexual intercourse at least once (Hall et al., 2004). Approximately half of the surveyed American female adolescents had had 2 or more sexual partners in the preceding year. More recent data also said that the incidence of syphilis in this age group had risen from 6.4 per 100,000 persons; gonorrhea from 571.8; and Chlamydia at 1131.6. In addition to sexually transmitted disease is the risk of unplanned pregnancy at approximately 40% in this age group. These figures indicated that the American adolescent engages in high sexual activity, which puts her at risk for sexually transmitted disease and unwanted pregnancy (Hall et al.).

Most of older American adolescents are sexually active and do not take precaution against unwanted pregnancy and sexually transmitted infections (Hall et al., 2004). This attitude seems to stem from a perception of personal invulnerability and inclination to focus only on immediate concerns and motives. Strategies for assessing and managing the American female adolescent behavior and health consist in an emphatic stance towards the issue, supportiveness towards her autonomy, identifying and owning her own values, familiarization with available resources and consulting with mental health practitioners when appropriate. The emphatic stance sees her sexual behavior as not inherently negative but naturally reflecting her physical and social development. Providing her with clear norms about the risks of unprotected sexual intercourse would likely reduce the chances of engaging in it. The tendency to avoid it is enhance if the family, friends, communities and institutions within it are supportive. Other interventions are the use of contraceptives, information on risks and how to avoid them, modeled communication, negotiation and refusal skills and the "authoritative" parenting style. Parents who are clear about rules on acceptable behavior but remain accepting and responsive to the child practice this style of parenting. They are likely to raise children who more psychologically healthy and socially adjusted, according to studies. Clinicians are advised to consider these strategies (Hall et al.).

Instead of encouraging sexual activity, counseling teen-agers on sexual matters enables them to make informed decisions and avoid consequences (Pray & Pray, 2003). Those who choose to be sexually active need accurate information about protection from unwanted pregnancy and sexually transmitted disease. They need to realize that the only proven method for both problems is sexual abstinence. They need to protect themselves from these even if they have a committed relationship and their partner is health. All the myths they are told or believe about preventing these problems are not true. Condoms work well if used correctly and may protect against some STDs but not all. Adolescents should be advised to choose a contraceptive method or a combination of methods, which will protect against the two problems and to use them correctly each time that they sex. If female adolescents suspect they or their partner has STD or they may be pregnant, they should consult a physician (Pray & Pray).

The Young Adult Woman

Much attention is given female adolescents over sexual behavior and sexual health yet most unintended pregnancies occur in adult women (Nettleman et al., 2007). A series of focus groups was conducted to identify the reasons why the women engaged in unprotected intercourse and build a framework of interventions. A sampling of 32 adult unmarried women aged 18 to 39, not currently pregnant or desiring to be and who recently engaged in sexual intercourse without the use of effective contraception. Half of them were white and half were African-American. Young adult women belonged to this broad age-range group. The 146 reasons given were categorized into four, namely method-related, user-related, partner-related, and cost/access-related. This result suggested the need for multidimensional interventions in effectively reducing the rate of unintended pregnancy (Nettleman et al.).

Side effects and health-related concerns deterred contraceptive use in many respondents (Nettleman et al., 2007). They experienced these side effects themselves or related to them by friends or family. They avoided a particular method because it did not work for them or for someone they knew. Their erroneous perception needs to be corrected by accurate information not only on an individual level but also through social networks of friends and family. Other respondents refrained from contraceptive use because of less common side effects like cancer and stroke. The rest did not desire pregnancy but did not think it would be a problem if their partners or family would extend economic and emotional support. The variety of reasons showed that intending pregnancy is not an absolute condition (Nettleman et al.).

This collection of findings puts health providers in a special position to help women make informed choices in the use of contraception according to their needs (Nettleman et al., 2007). Health providers can provide accurate information and correct misconceptions about contraception methods. They need to be sensitive to women's concerns about contraception .They also need to consider that interpersonal and social relations and individual life experiences affect the incidence of unprotected sexual intercourse (Nettleman et al.).

Pregnant Women

The Centers for Disease Control and Prevention recently reported that approximately 1.5 million women become victims of intimate partner violence each year (Cox, 2008). The risk is greatest during women's reproductive years at 35.6% higher in pregnant women than in non-pregnant women. The prevalence of intimate partner violence or IPV is 4-8% greater during pregnancy. Pregnant women who are victimized by their intimate partners also tend to delay seeking out prenatal care. They, thus, confront increased risk of poor maternal and infant health, pregnancy complications and pre-term delivery or low birth weight of their child. Pregnancy complications include low maternal weight gain, infections, high blood pressure and vaginal bleeding, The Healthy People 2010 initiative linked IPV with 8 of 10 leading health indicators. Violence both affects and is affected by these leading health issues. In comparison with non-abused women, IPV women victims are less likely to practice responsible sexual behavior. They face increased risk for mental health disorder and substance abuse and have less access to care. These women come from all social strata, races and ethnic groups. They are also likely to be young, unmarried, with little education and have low household incomes (Cox).

The first realistic step towards IPV prevention or intervention is accurate screening, especially by the local health department or LHD (Cox, 2008). The American College of Obstetrics and Gynecology recommended that all healthcare providers should regularly screen patients for violence. Screening should be conducted during routine annual examinations, pre-conception visits, once per trimester of pregnancy and during postpartum examinations. However, there is as yet no universal screening for IPV. And according to a national survey, routine IPV is conducted by only 17% of prenatal providers and only 5% make follow-up visits. Yet LHDs play a crucial role in identifying, intervening into and preventing IPV. That role goes beyond setting up a crisis hotline or shelter for abused women and extends to identifying the risk and offering protection. Common barriers, however, stand on the way to fulfilling this role. These include incomplete data on IPV women victims, lack of enhanced training and education on IPV and related resources, promoting screening and assessment tools, and low-level communication with clients (Cox).

In tackling the problem of incomplete data, LHDs may secure these on a State level or enter into data-sharing agreements with local law enforcement or emergency medical services (Cox, 2008). LHDs need to connect with networks, keep updated information on community resources and maintain and strengthen relationships with partners in the community, such as shelters and advocacy organization. Screening for IPV among pregnant women should be a priority that all healthcare and social service providers should be made to understand as their responsibility. As a consequence, it can be incorporated into settings, such as family planning, primary care, prenatal care and pediatric clinics. In the absence of universal screening protocols, LHDs can make use of community resource guides or pocket reference cards. They can look for assessment tools appropriate for the community. LHDs and public health professionals play a critical and key role in preventing IPV during pregnancy, a time of increased risk of violence. It is the best opportunity for both intervention and prevention. Despite insufficient resources, IPV screening is feasible. LHDs must elicit the cooperation of staff, providers and the community to treat IPV prevention as a priority and to establish appropriate policies and procedures. This multi-level cooperation will improve overall maternal and child health conditions in the community (Cox).

The Middle-Aged Woman

A recent cross-section study of the sexual activities and behaviors of 3,005 men and women aged 57-85 across the U.S.A. remained sexually active (Eden & Wylie, 2009). Of this number, 73% were aged 57-64, 53% aged 65-74, and 26% aged 75-85. Respondents reported that the most frequent barrier to sexual activity was a health problem in the male at 64% and the female's lack of interest in sex at 51%. The study concluded that sexual activity seemed to decline with age and that sexually inactive women tend to view sex as less important. The women respondents are beyond the age of menopause but confirmed that most of them remained sexually active, considered sex an important life aspect and expressed satisfaction in their sexual lives. The study led to further investigation into problems, linked with female sexuality, which, in turn, interfere with their sexual activity and well-being (Eden & Wylie).

The most common menopause-linked sexual distresses or FSDs include the lack of desire and low libido, decreased sexual arousal and dyspareunia (Eden & Wylie, 2009). Hormonal physiological changes in menopause, such as decreased serum estrogens, seem to explain these distresses. Stress, relationship status and attitude towards aging affect the overall quality of life of middle-aged. Thus, their sexual life and behavior, far more than physical symptoms linked to menopause, such as vasomotor and urogenital symptoms. Psychological and psychosocial changes in midlife assert significant impact on the quality of sexual life in women. These are personal and cultural attitudes towards menopause and sex, life role changes, and relationship factors. The freedom from menstruation, pregnancy and child care creates a positive attitude that tends to improve the quality of their sexual life. But other factors occurring at this period can bring about either improvement or detriment changes (Eden & Wylie).