Physicians—ARHP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education (CME) for physicians. ARHP designates this continuing medical education activity for 2 credit hours in Category 1 of the Physician’s Recognition Award of the American Medical Association.

Nurses and Nurse Practitioners—This educational activity has been approved by the Continuing Education Approval Program of the National Association of Nurse Practitioners in Women’s Health for 2.4 contact hours, including 0.8 pharmacology hours. Credit can be applied toward the nursing continuing education requirements of most professional organizations and State Boards of Nursing.

Nurse Midwives—ACCME credit hours in Category One are accepted by the Continuing Competency Assessment Program of the American College of Nurse Midwives for programs relevant to nurse midwifery. Nurse Midwives completing this activity may report up to 2 hours of credit.

Physician Assistants—The American Academy of Physician Assistants accepts Category One CME approval from organizations accredited by the ACCME. Physician Assistants completing this activity may report up to 2 hours of credit.

This publication is intended for physicians, nurse practitioners, nurse midwives, registered nurses, pharmacists, physician assistants, researchers, public health professionals, and health educators in the field of reproductive health.

ARHP is a non-profit, 501(c)(3) educational organization with a membership of obstetrician/gynecologists and other physicians, advanced practice clinicians, researchers, educators, and other professionals in reproductive health.

Please direct all inquiries to:

ARHP
2401 Pennsylvania Avenue, NW, Suite 350
Washington, DC 20037-1730 USA
Phone: (202) 466-3825 • Fax: (202) 466-3826
E-mail: arhp@arhp.org • Web: www.arhp.org

Objectives

After completing this Clinical Proceedings, participants will be able to:

1. Describe healthy female sexuality and two models of female sexual response.
2. Incorporate assessment of sexual function into the routine health care of women in midlife and beyond.
3. Develop three communication skills to talk about sexuality with women in midlife and beyond.
4. List four changes in female sexual function that occur with aging, menopause, and disease.
5. Name three ways to provide appropriate treatment, counseling, or referral to patients experiencing problems with sexuality.

ARHP Clinical Proceedings^® is a publication of the Association of Reproductive Health Professionals (ARHP). Use and reproduction of this publication for educational purposes is permitted and encouraged without permission, with proper citation. This publication may not be used for commercial gain. Suggested citation: Association of Reproductive Health Professionals. Women’s Sexual Health in Midlife and Beyond. Washington, DC; 2005.

The health care profession has entered a new era of interest in sexuality, particularly for women. Talk about sexuality is ubiquitous and mainstream in our society today—the most prominent hallmarks being television shows like “Sex and the City,” magazines like Cosmopolitan, Glamour, Playboy, and Maxim, sexually evocative advertising, and the thousands of titles published in book form. Women are concerned about their sexual functioning and health, and about the health of their male or female partner, and are searching for ways to improve their sex lives.

Although everyone is talking about sex, healthy sexuality and sexual problems remain areas of controversy, especially in regard to midlife and older women. The reasons are numerous and include an early, incorrect assumption by Masters and Johnson that the female sexual response proceeds in much the same linear way as the male sexual response, as well as a dearth of data, and extrapolation of much of the existing data from research findings in men. Other reasons include the absence of objective, sensitive, and reliable criteria for evaluating female sexual response and a prevailing belief that older adults lose their interest in sex.

The advent of pharmacological treatments for erectile dysfunction has had a significant impact on male and female sexual functioning and is now bringing older women into the provider’s office complaining of sexual issues (e.g., low desire, lack of lubrication, and pain with intercourse). Yet, many patients are reticent to discuss sexual issues, and many providers feel ill equipped to respond to sexual complaints. It is time to encourage providers to talk about sexuality as part of the routine patient encounter and to help providers and patients feel more comfortable discussing these issues with the goal of enhancing patients’ quality of life.

This Clinical Proceedings is part of the Nurture Your Nature initiative, a joint program of ARHP and the National Women’s Health Resource Center (NWHRC) to raise awareness about sexuality as a natural and valued aspect of American women’s lives, with a focus on menopausal women. This issue provides a review of the research and theories compiled to date, the variables affecting female sexual function, the evolving definitions, classifications, and treatments for female sexual disorders, and techniques for improving your skills in talking with patients about sexuality issues. We hope you find it of use in your practice.

Wayne C. Shields
President and CEO
Association of Reproductive Health Professionals

Amy Niles
President and CEO
National Women’s Health Resource Center