Goldstein M K, Teng N N
Division of Endocrinology, Gerontology, and Metabolism, Stanford University School of Medicine, California.
Clin Geriatr Med. 1991 Feb;7(1):41-61.
Older women may experience sexual dysfunction due to many different causes. Some problems related to menopausal hormonal change may be easily treated with estrogen supplements. Other problems involve intricate interpersonal relations between the woman and her sexual partner and may require a combination of medical therapy and sexual counseling. Gynecologic cancer and cancer treatments are often accompanied by problems in sexual functioning. These problems may then impair relations and self-image, leading to a vicious circle of deteriorating social function. Some recommendations for the clinician follow. The clinician should maintain an attitude of openness to the possibility of sexual concerns in older women. Such concerns should be taken seriously and should not be dismissed as part of aging. Routine periodic health examinations can include a question such as "Do you have any concerns about your sexual life that you would like to discuss?" In follow-up visits for procedures with a high likelihood of causing sexual dysfunction, questions that would open the door to a discussion of sexuality should be asked. Sexual dysfunction should be recognized as a couple-oriented phenomenon. A woman's anxiety about her appearance, postoperative depression, or dyspareunia may be perceived by her partner as a sexual rejection and may initiate a cycle of decreasing contact or may even lead to erectile dysfunction. Sexual counseling should include both partners. When a surgical procedure that will probably have an impact on sexual function is contemplated, provide the patient and her partner with advance counseling. Descriptions of surgery should not be simply a statement of body parts to be removed but should specifically address the anticipated sexual effects. Counseling should include a description of basic anatomy and function of the genital organs. Illustrations and appropriate demonstration during the physical examination should be used to ensure the patient's understanding. Descriptions should be accurate without being either frightening or falsely reassuring. The patient should be counseled about the benefits of including her partner in discussions. Then, when possible, the sexual partner of the patient should be invited to sessions of advance counseling on contemplated procedures. Clinicians should remain open to the possibility that the sexual partner will be a nontraditional one, e.g., an unmarried male partner or another woman. The clinician should be alert to remediable causes of dysfunction. For example, decreased vaginal lubrication may be managed with use of water-soluble lubricants.(ABSTRACT TRUNCATED AT 400 WORDS)
老年女性可能由于多种不同原因而出现性功能障碍。一些与绝经后激素变化相关的问题，使用雌激素补充剂可能很容易得到治疗。其他问题则涉及女性与其性伴侣之间复杂的人际关系，可能需要药物治疗和性咨询相结合。妇科癌症及癌症治疗常常伴随着性功能方面的问题。这些问题进而可能损害人际关系和自我形象，导致社会功能恶化的恶性循环。以下是给临床医生的一些建议。临床医生应秉持开放的态度，认识到老年女性可能存在性方面的问题。此类问题应予以认真对待，不应将其视为衰老的一部分而不予理会。常规的定期健康检查可以包含这样一个问题，比如“你对自己的性生活有任何想要讨论的担忧吗？”在针对极有可能导致性功能障碍的手术进行随访时，应提出能够开启关于性方面讨论之门的问题。性功能障碍应被视为一种涉及伴侣双方的现象。女性对外表的焦虑、术后抑郁或性交困难，可能会被其伴侣视为性拒绝，这可能引发接触减少的循环，甚至可能导致勃起功能障碍。性咨询应包括伴侣双方。当考虑进行可能会对性功能产生影响的手术时，要提前为患者及其伴侣提供咨询。对手术的描述不应仅仅是说明要切除的身体部位，而应具体提及预期的性方面的影响。咨询应包括对生殖器官基本解剖结构和功能的描述。体格检查时应使用图片及适当的演示，以确保患者理解。描述应准确无误，既不吓人也不给予虚假的安慰。应向患者说明让其伴侣参与讨论的益处。然后，在可能的情况下，邀请患者的性伴侣参加关于拟行手术的提前咨询 sessions。临床医生应接受性伴侣可能是非传统类型的可能性，例如未婚男性伴侣或另一名女性。临床医生应留意性功能障碍的可补救原因。例如，阴道润滑不足可以通过使用水溶性润滑剂来解决。（摘要截选至400词）
