2A
,Erectile Dysfunction (ED)
Pharmacological Interventions
● PDE-5 Inhibitors: Sildenafil, Tadalafil, Vardenafil.
○ Mechanism: Relaxes smooth muscle in the corpora cavernosa to increase penile blood
flow while compressing veins to trap it.
○ Timing: Take sildenafil and vardenafil 30 to 60 minutes before sexual intercourse.
Tadalafil works over a longer window.
○ Contraindications: Nitrates are an absolute contraindication (Nitroglycerin,
Isosorbide dinitrate & Isosorbide mononitrate). The concurrent use of vasodilators
and nitrates can drop blood pressure to dangerous, fatal levels and precipitate a
myocardial infarction. Avoid alcohol or grapefruit juice while taking these medications.
● Vasodilators (Penile Injections/Suppositories): Alprostadil, papaverine, phentolamine. Injected
20 minutes before sex; lasts up to an hour. Teach the patient to rotate injection sites to prevent
scarring. Suppositories are inserted into the urethra 10 minutes before intercourse.
Management of Care
● Always perform a thorough cardiovascular workup before initiating any pharmacological therapy
for ED.
● Advise lifestyle modifications that improve vascular health, including smoking cessation and
weight loss.
● Suggest using a condom during intercourse if the client is utilizing penile injections to prevent
infection at the site.
● Vacuum Constriction Device (VCD): Pulls blood into the penis using a vacuum, and a rubber
ring is placed at the base to maintain the erection.
Menopause
Clinical Manifestations & Stages
● Perimenopause: Direct decline in ovarian function and diminished ovarian stores, causing
hormonal imbalances. Lasts roughly 4 years; marked by irregular, anovulatory bleeding, breast
tenderness, joint pain, and forgetfulness.
● Menopause: Complete cessation of menses for 12 consecutive months, typically between ages 41
and 59. Caused by a steep decline in estrogen.
● Key Findings:
○ Vasomotor: Hot flashes, night sweats, sleep disturbances, and profound fatigue.
○ Genitourinary: Atrophic vaginitis, shrinking of labia, painful intercourse (dyspareunia),
increased vaginal pH, vaginal dryness, and urinary incontinence.
○ Systemic: Mood swings, joint pain, decreased skin elasticity, and decreased bone density.
○ Labs: Decreased estrogen and progesterone; markedly increased FSH; increased LDL
cholesterol and decreased HDL.
Pharmacological Interventions
● Hormone Therapy (HT): Used to manage severe vasomotor symptoms, prevent tissue atrophy,
and minimize bone fractures.
, ○ Client with an intact uterus: Must receive Estrogen AND Progestin/Progeston.
Estrogen-only therapy given to someone with a uterus leaves endometrial growth
unchecked, exponentially increasing the risk of endometrial/ovarian cancer.
○ Client without a uterus (Post-Hysterectomy): Estrogen alone is prescribed.
○ Risks: Long-term HT increases the risks of coronary heart disease, myocardial infarction,
stroke, deep vein thrombosis (DVT), and breast cancer.
○ Contraindications: History of breast cancer, uterine cancer, active liver impairment,
personal history of thrombosis/DVT, or undiagnosed abnormal uterine bleeding.
Nutrition & Health Promotion
● Nutrition: Instruct the client to consume a well-balanced diet low in calories and fat, but high in
fiber, whole grains, fruits, and vegetables. Drink 6 to 8 glasses of water daily.
● Bone Health: Recommend at least 30 minutes of weight-bearing physical activity 3 to 4 times per
week to preserve bone mass and prevent muscle loss. Discuss bisphosphonates and
calcium/Vitamin D therapy.
● Screenings: Enforce the necessity of routine health screenings: screening mammograms,
colonoscopies, bone mineral density measurements (DXA scans), and gynecologic exams.
Mandate immediate smoking cessation.
Management of Care
● Teach self-administration of HT creams or patches. For dyspareunia, instruct the use of
water-soluble lubricants, and explicitly warn against applying hormone creams immediately
before intercourse to keep their partner from absorbing the product.
● Address complementary and alternative medicine (CAM): Phytoestrogens (found in dandelion
greens, alfalfa sprouts, black beans, and soybeans) interact with estrogen receptors to decrease
manifestations. Vitamin E and B6 can reduce hot flashes.
Sexually Transmitted Infections (STIs)
Prevention & The 5 P's
● Nurses must maintain primary prevention via vaccination (HPV, Hepatitis B) and consistent,
correct condom use.
● Conduct a thorough, culturally sensitive sexual history centered on the 5 P's: Partners, Practices,
Protection from STIs, Past history of STIs, and Prevention of pregnancy.
1. Chlamydia
● Pathophysiology: Bacterial infection caused by Chlamydia trachomatis. Highly tracking
infection that is frequently completely asymptomatic in both sexes.
● Clinical Manifestations:
○ Female: Yellowish-green or gray-white mucopurulent endocervical discharge, vulvar
itching, dysuria, urinary frequency, and easily induced endocervical bleeding or postcoital
spotting.
○ Male: Watery or mucus-like penile discharge, dysuria, and unilateral testicular edema or
pain.
● Pharmacological Interventions: Doxycycline PO for 7 days (first-line) or a single oral dose of
Azithromycin, or Levofloxacin.
● Complications: Untreated chlamydia causes Pelvic Inflammatory Disease (PID), fallopian tube
scarring, infertility, ectopic pregnancy, and neonatal conjunctivitis.
,Erectile Dysfunction (ED)
Pharmacological Interventions
● PDE-5 Inhibitors: Sildenafil, Tadalafil, Vardenafil.
○ Mechanism: Relaxes smooth muscle in the corpora cavernosa to increase penile blood
flow while compressing veins to trap it.
○ Timing: Take sildenafil and vardenafil 30 to 60 minutes before sexual intercourse.
Tadalafil works over a longer window.
○ Contraindications: Nitrates are an absolute contraindication (Nitroglycerin,
Isosorbide dinitrate & Isosorbide mononitrate). The concurrent use of vasodilators
and nitrates can drop blood pressure to dangerous, fatal levels and precipitate a
myocardial infarction. Avoid alcohol or grapefruit juice while taking these medications.
● Vasodilators (Penile Injections/Suppositories): Alprostadil, papaverine, phentolamine. Injected
20 minutes before sex; lasts up to an hour. Teach the patient to rotate injection sites to prevent
scarring. Suppositories are inserted into the urethra 10 minutes before intercourse.
Management of Care
● Always perform a thorough cardiovascular workup before initiating any pharmacological therapy
for ED.
● Advise lifestyle modifications that improve vascular health, including smoking cessation and
weight loss.
● Suggest using a condom during intercourse if the client is utilizing penile injections to prevent
infection at the site.
● Vacuum Constriction Device (VCD): Pulls blood into the penis using a vacuum, and a rubber
ring is placed at the base to maintain the erection.
Menopause
Clinical Manifestations & Stages
● Perimenopause: Direct decline in ovarian function and diminished ovarian stores, causing
hormonal imbalances. Lasts roughly 4 years; marked by irregular, anovulatory bleeding, breast
tenderness, joint pain, and forgetfulness.
● Menopause: Complete cessation of menses for 12 consecutive months, typically between ages 41
and 59. Caused by a steep decline in estrogen.
● Key Findings:
○ Vasomotor: Hot flashes, night sweats, sleep disturbances, and profound fatigue.
○ Genitourinary: Atrophic vaginitis, shrinking of labia, painful intercourse (dyspareunia),
increased vaginal pH, vaginal dryness, and urinary incontinence.
○ Systemic: Mood swings, joint pain, decreased skin elasticity, and decreased bone density.
○ Labs: Decreased estrogen and progesterone; markedly increased FSH; increased LDL
cholesterol and decreased HDL.
Pharmacological Interventions
● Hormone Therapy (HT): Used to manage severe vasomotor symptoms, prevent tissue atrophy,
and minimize bone fractures.
, ○ Client with an intact uterus: Must receive Estrogen AND Progestin/Progeston.
Estrogen-only therapy given to someone with a uterus leaves endometrial growth
unchecked, exponentially increasing the risk of endometrial/ovarian cancer.
○ Client without a uterus (Post-Hysterectomy): Estrogen alone is prescribed.
○ Risks: Long-term HT increases the risks of coronary heart disease, myocardial infarction,
stroke, deep vein thrombosis (DVT), and breast cancer.
○ Contraindications: History of breast cancer, uterine cancer, active liver impairment,
personal history of thrombosis/DVT, or undiagnosed abnormal uterine bleeding.
Nutrition & Health Promotion
● Nutrition: Instruct the client to consume a well-balanced diet low in calories and fat, but high in
fiber, whole grains, fruits, and vegetables. Drink 6 to 8 glasses of water daily.
● Bone Health: Recommend at least 30 minutes of weight-bearing physical activity 3 to 4 times per
week to preserve bone mass and prevent muscle loss. Discuss bisphosphonates and
calcium/Vitamin D therapy.
● Screenings: Enforce the necessity of routine health screenings: screening mammograms,
colonoscopies, bone mineral density measurements (DXA scans), and gynecologic exams.
Mandate immediate smoking cessation.
Management of Care
● Teach self-administration of HT creams or patches. For dyspareunia, instruct the use of
water-soluble lubricants, and explicitly warn against applying hormone creams immediately
before intercourse to keep their partner from absorbing the product.
● Address complementary and alternative medicine (CAM): Phytoestrogens (found in dandelion
greens, alfalfa sprouts, black beans, and soybeans) interact with estrogen receptors to decrease
manifestations. Vitamin E and B6 can reduce hot flashes.
Sexually Transmitted Infections (STIs)
Prevention & The 5 P's
● Nurses must maintain primary prevention via vaccination (HPV, Hepatitis B) and consistent,
correct condom use.
● Conduct a thorough, culturally sensitive sexual history centered on the 5 P's: Partners, Practices,
Protection from STIs, Past history of STIs, and Prevention of pregnancy.
1. Chlamydia
● Pathophysiology: Bacterial infection caused by Chlamydia trachomatis. Highly tracking
infection that is frequently completely asymptomatic in both sexes.
● Clinical Manifestations:
○ Female: Yellowish-green or gray-white mucopurulent endocervical discharge, vulvar
itching, dysuria, urinary frequency, and easily induced endocervical bleeding or postcoital
spotting.
○ Male: Watery or mucus-like penile discharge, dysuria, and unilateral testicular edema or
pain.
● Pharmacological Interventions: Doxycycline PO for 7 days (first-line) or a single oral dose of
Azithromycin, or Levofloxacin.
● Complications: Untreated chlamydia causes Pelvic Inflammatory Disease (PID), fallopian tube
scarring, infertility, ectopic pregnancy, and neonatal conjunctivitis.
