Hot Flashes and Healthful Living: Health Concerns for Women Growing Older With HIV/AIDS
March 28, 2013
Do you find that your older women clients who are living with HIV are particularly reticent to speak about issues surrounding their periods and menopause? Do you find that you are often initiating that conversation, or does it usually flow pretty freely? Do you have any advice for any other providers working with older women, as far as starting those conversations?
Again, I think it gets back to the issue of women not taking care of themselves or advocating for themselves. They don't often bring the issue up, so I usually initiate the conversation. I know when the last period was for all of my women patients, even if it was 10 years ago.
We talk about the issues around getting older. What I find is that women will come in with questions about things that are happening to their body, and then want to know if it's because of HIV. Not having periods isn't one of them -- and I think because women hit a certain age and just expect their periods to stop. But they're not bringing up some of the symptoms that they're having as a result of periods stopping. They're just kind of trying to muddle through. They'll bring up the pain in their ankle, but they won't bring up symptoms of menopause, usually.
Are there any particular symptoms of menopause that women are more reticent to talk about?
Vaginal dryness is a big one. As women get older, their vaginas do get dry. If they do have a love life, it interferes with sexual activity. It makes them think something is wrong with them. It kind of feeds into that whole idea of, I'm getting old and I'm useless. Vaginal dryness is something that really has to be addressed.
We do our best to treat it with water-based lubricants. There are some plant-based hormonal vaginal inserts that can be used, and things like that. There are things that can be done.
It seems that vaginal dryness could also have some bearing on HIV prevention, because of the increased likelihood of the vaginal skin tearing during intercourse. Whether it's an HIV-negative woman who has a partner who's HIV positive, or vice versa, there's increased transmission risk for the HIV-negative partner, if there is one involved. It's great that that conversation happens around treating vaginal dryness.
And it's very important for women who are menopausal to continue using condoms. But they have to also make sure that there's plenty of lubrication there, so there are no tears, cuts or discomfort. Condoms can be a little harsh for some women. In addition to making sure their partner is using condoms, if it's a male-female relationship, they just want to make sure they're lubricated, as well.
I've heard that menopause often comes up, as far as older adults and HIV, as a reason why condoms aren't used. Is that correct?
Sometimes, an older woman might think, I'm going through menopause, so I'm not going to get pregnant; and of course, pregnancy is not the only concern with sex.
The other thing I just want to say in the case of people who may be using sex toys, the same thing is important: If there's vaginal drying, there needs to be plenty of lubrication that's being used so there is no injury to the tissue.
How do you start conversations with clients dealing with menopause about HIV and sexually transmitted diseases, and introduce condoms into the conversation?
My thing about being a middle-aged physician is that I can talk about whatever I want; and I don't get embarrassed. I just bring it up: "Are you sexually active?" I may introduce it by saying, "I want to talk to you about sex."
Patients really do want to talk about sex, but they're not going to initiate the conversation. So I'll open it up with, "I want to talk to you about sex. Do you have any questions for me?" And that opens up the conversation. But you have to put it out there to let them know it's OK to talk about, or they will never bring it up.
|HIV and Sexual Function in Women Over 50|
By Bethsheba Johnson, G.N.P.-B.C., A.A.H.I.V.S. (From TheBodyPRO.com)
"Where are the articles on women's sexual function -- and the sexual dysfunction drugs in the development pipeline -- as there are for men?" asked nurse practitioner Bethsheba Johnson in this blog entry from late 2011. She compiled a review of some of the recent literature looking into the sexual lives of women over 50 living with HIV. It's a resource that older women living with HIV may want to share with their own providers.
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