Question

Debra is perimenopausal at age 52, and her husband, Roberto, is 59. She has been feeling tired in the afternoon and moody at times. At her annual women’s health visit, Debra tells you that she feels a lower level of sexual desire than she used to. Debra says, “I chalk it up to being very busy at work and yet still having so many demands on my time and energy with the care of our three kids and housework.” Debra is physically active, exercising four times a week, and is in good general health. She takes no medication and is within 15 pounds of her normal weight. Debra still has her period, but the flow is very heavy and cramping is more uncomfortable than it ever had been. Recently, Debra has noticed that Roberto has been taking longer to achieve an erection, and his erection is not as firm as it used to be. He is in general good health except for high blood pressure and high blood cholesterol levels. He takes medication for both conditions.

THINKING

Knowledge (Factual Information): What are the common physical and emotional manifestations occurring with perimenopause?

Critical Thinking (Analyzing Alternatives, Deciding What to Do): How would you respond to Debra when she asks for information and support regarding her husband’s erectile dysfunction? Debra asks you whether her desire for sexual intimacy will continue to decline after she goes through “the change of life.” Describe in detail what you would tell her.

DOING

Practical Knowledge: What general topics would you explore with Debra to assess her sexual history? What questions would you ask Roberto to assess his sexual history?

CARING

Self-Knowledge: What might you be feeling if you were in Debra’s situation? Ethical Knowledge: What are one or two things you would do to help Debra and Roberto feel cared for and cared about?

**Note: We are not asking you what you would do; rather, consider and describe how you would feel.

Answer 1

What are the common physical and emotional manifestations occurring with perimenopause?

• Hot flashes
• Breast tenderness
• Worse premenstrual syndrome
• Lower sex drive
• Fatigue
• Irregular periods
• Vaginal dryness; discomfort during sex
• Urine leakage when coughing or sneezing
• Urinary urgency (an urgent need to urinate more frequently)
• Mood swings
• Trouble sleeping
• Irritability and feelings of sadness are the most common emotional symptoms of menopause

How would you respond to Debra when she asks for information and support regarding her husband’s erectile dysfunction?

Erectile dysfunction can take a toll on a relationship. So, support and encourage your partner as he manages his condition. It’s also important to take care of yourself, too.

My advice for Debra is to start with these strategies.

1. Learn as much as you can about ED. The more you know, the better prepared you'll be able to help your partner. You can talk about the lifestyle changes and medical treatments that could help.
2. Let him know how much you value him. Remind him that ED isn’t a reflection on his masculinity, and that it hasn’t changed how you feel about him. Assure him that you’ll get through this together.
3. Talk about how you feel. You’re affected, too. Just like anything else that’s going on in your relationship, it can help to talk about it.
4. Stay positive. Discuss what you and your partner want and need and how to achieve it. Also, keep in mind that the condition is common and can be treated.
5. Adjust your sex life. Find other ways to please and satisfy each other so that he doesn’t feel pressured to perform.
6. Offer to go with him to the doctor.

Debra asks you whether her desire for sexual intimacy will continue to decline after she goes through “the change of life.” Describe in detail what you would tell her.

Erectile dysfunction (ED) doesn’t have to signal the end of your sex life. Many cases of it respond well to lifestyle changes, medications, surgery, or other treatments.

Even if your efforts to treat ED are unsuccessful, you and your partner can still enjoy physical intimacy and a satisfying sexual life.

Communication is key: The most important tool for a satisfying sex life is communication with your partner, especially when you’re coping with erectile dysfunction or other challenges. Talk openly about your desires and your fears.

Try to relax: Anxiety is one of the biggest contributors to reducing sex desire. When you’re worried that you won’t be able to perform or enjoy yourself in bed, you’re less likely to enjoy yourself. It’s a self-fulfilling cycle. Massage techniques may also bring you simple pleasure and relaxation through touch. The more relaxed you are, the more ready you’ll be for a fulfilling and stress-free sexual experience.

Rediscover each other: Do you remember when you and your partner first started dating and every touch you shared was exciting? Try to relive that time together. Kiss and laugh and experiment. Take your mind off the clock and enjoy your time together.

Avoid unhealthy habits: Certain lifestyle habits can have a healthy sex life:

• quit smoking
• avoid heavy drinking
• avoid illicit drugs, such as marijuana, cocaine, heroin, and amphetamines

Lose weight and exercise regularly: Losing excess weight and getting regular exercise may improve your sex life.

Don’t give up: For most people, physical intimacy is an important part of a happy and satisfying relationship. It’s possible to have a fulfilling sexual relationship even if you can’t maintain an erection.For a truly satisfying and sustainable sex life, it’s important to take care of your overall health and practice good communication with your partner. Adjust your sexual expectations, adopt healthy habits, and find creative ways to satisfy each

What general topics would you explore with Debra to assess her sexual history?

General health of both the partner

· Sexual experiences

· Any health issue interfering sexual life.

· History of medication.

· Personal issues affecting sexual life.

What questions would you ask Roberto to assess his sexual history?

Questions related to Sexual history are asking information about your sexual health and sexual experiences. This could include how many times you've had sex, any sexual related problem, any sexually transmitted infection (STI) you've had, and whether or not it was treated.

What might you be feeling if you were in Debra’s situation?

If I were in Debra’s place I would feel the same as she do. It is common to feel tired and moody at times. Due to my age factor I will fell lower level of sexual desire but will never give up with my partner and I would feel like supporting him in any situation

What are one or two things you would do to help Debra and Roberto feel cared for and cared about?

Both Debra and Roberto need support for sexual health and understanding the situation so I would like to give proper counselling needed to help them both acknowledge the condition.

Guidance will be given to overcome their problems which are part of life changes due to age factor and part of normal process of life. Encouraged not to give up and to have a happy and satisfying relationship.