Yaşlı Kadınlarda Cinsel Sağlık ve Hemşirelik Yaklaşımı
Özet
Nüfusun giderek yaşlanması dünya çapında gözlemlenen bir olgudur. Bu durum doğum ve ölüm oranlarındaki azalma ve beklenen yaşam süresindeki artış başta olmak üzere bazı sağlık göstergelerindeki değişimin bir yansımasıdır. Yaşam boyunca kadınlarda görülen fiziksel değişimler, erkeklere göre daha belirgindir. Hormonlarda azalma, kronik hastalıklar, beden imajı ve benlik saygındaki değişim kadınlar üzerinde yaşlanmanın bazı etkilerindendir. Yaşam döngüsündeki bu keskin değişimler alışılagelmiş cinsel yaşamı da değiştirmektedir. Yaşlanmanın fizyolojik özelliklerini anlamak, yaşlı kadınların cinselliklerinden daha memnun olmalarını sağlayabilir. Yaşlılık döneminde cinsel yaşamın sürdürülmesinin sağlık üzerindeki olumlu etkisi bilinse de toplum ve sağlık profesyonelleri tarafından önem verilen bir konu değildir. Bilgi ve danışmanlık yetersizliği ve toplumun önyargıları gibi pek çok husus yaşlıların cinselliği deneyimleme biçimini etkilemektedir. Hemşirelerin en önemli görevleri arasında olan bilgi sağlama ve danışmanlık verme rolü bu noktada önemlidir. Yaşlı kadınların cinsel sorunlarını anlamak ve çözümünde rehberlik etmek toplumda giderek artması olası olan yaşlanmaya bağlı cinsel sorunların çözümü için önem arz etmektedir.
Referanslar
Ambler, D. R., Bieber, E. J., & Diamond, M. P. (2012). Sexual function in elderly women: a review of current literature. Reviews in obstetrics & gynecology, 5(1), 16–27.
Archer, D. F., Labrie, F., Montesino, M., & Martel, C. (2017). Comparison of intravaginal 6.5mg (0.50%) prasterone, 0.3mg conjugated estrogens and 10μg estradiol on symptoms of vulvovaginal atrophy. The Journal of steroid biochemistry and molecular biology, 174, 1–8. https://doi.org/10.1016/j.jsbmb.2017.03.014
Athey, R. A., Kershaw, V., & Radley, S. (2021). Systematic review of sexual function in older women. European journal of obstetrics, gynecology, and reproductive biology, 267, 198–204. https://doi.org/10.1016/j.ejogrb.2021.11.011
Banke-Thomas, A., Olorunsaiye, C. Z., & Yaya, S. (2020). "Leaving no one behind" also includes taking the elderly along concerning their sexual and reproductive health and rights: a new focus for Reproductive Health. Reproductive health, 17(1), 101. https://doi.org/10.1186/s12978-020-00944-5
Basson, R., Berman, J., Burnett, A., Derogatis, L., et al. (2000). Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol, 163(3):888-893.
Basson, R., & Gilks, T. (2018). Women’s sexual dysfunction associated with psychiatric disorders and their treatment. Women’s Health, https://doi.org/10.1177/1745506518762664
Buttaro TM., Koeniger-Donohue R., & Hawkins J. (2014). Sexuality and quality of life in aging: implications for practice. The journal for nurse practitioners, 10(7), 480-485.
Carvalheira, A., Graham, C., Stulhofer, A., & Traen, B. (2020). Predictors and correlates of sexual avoidance among partnered older adults among Norway, Denmark, Belgium, and Portugal. European Journal of Ageing, 17(2), 175–184. https://doi.org/10.1007/s10433-019-00540-y
Copeland, K. L., Brown, J. S., Creasman, J. M., Van Den Eeden, S. K., Subak, L. L., Thom, D. H., Ferrara, A., & Huang, A. J. (2012). Diabetes mellitus and sexual function in middle-aged and older women. Obstetrics and gynecology, 120(2),331–340. https://doi.org/10.1097/AOG.0b013e31825ec5fa
Çıracı Yaşar, Y., & Hintistan, S. (2020). Yaşlılık–kadın ve cinsellik. İzmir kâtip çelebi üniversitesi sağlık bilimleri fakültesi dergisi, 5(1): 15-18.
Dominguez, L.J., & Barbagallo, M. (2016). Ageing and sexuality. European geriatric medicine, 7(6): 512-518.
Dutra da Silva, G.M., Rolim Rosa Lima, S.M., Reis, B.F., Macruz, C.F., & Postigo, S. (2020). Prevalence of hypoactive sexual desire disorder among sexually active postmenopausal women with metabolic syndrome at a public hospital clinic in Brazil: a cross-sectional study. Sex Med, 8(3):545-553.
Faubion, S. S., & Rullo, J. E. (2015). Sexual Dysfunction in Women: A Practical Approach. American family physician, 92(4), 281–288.
Felippe, M. R., Zambon, J. P., Girotti, M. E., Burti, J. S., Hacad, C. R., Cadamuro, L., & Almeida, F. (2017). What Is the Real Impact of Urinary Incontinence on Female Sexual Dysfunction? A Case Control Study. Sexual medicine, 5(1), e54–e60. https://doi.org/10.1016/j.esxm.2016.09.001
Fışkın, G., & Kızılkaya Beji, N. (2018). Pelvik organ prolapsusu ve cinsel yaşam üzerine etkileri. FNJN, 26(3): 211-218.
Flynn, T. J., & Gow, A. J. (2015). Examining associations between sexual behaviours and quality of life in older adults. Age and ageing, 44(5),823–828. https://doi.org/10.1093/ageing/afv083
Gandhi, J., Chen, A., Dagur, G., et al. (2016).Genitourinary syndrome of menopause: anoverview of clinical manifestations, pathophysiology, etiology, evaluation, andmanagement. Am J Obstet Gynecol, 215(6):704–711.
Gillespie B. J. (2017). Sexual synchronicity and communication among partnered older adults. Journal of sex & marital therapy, 43(5):441–455. https://doi.org/10.1080/0092623X.2016.1182826
Gillespie, B.J., Hibbert, K. & Sanguinetti, A. (2017). A Review of Psychosocial and Interpersonal Determinants of Sexuality in Older Adulthood. Curr Sex Health Rep, 9:150–154. https://doi.org/10.1007/s11930-017-0117-2
Granville, L., & Pregler, J. (2018). Women's sexual health and aging. Journal of the American Geriatrics Society, 66(3), 595–601. https://doi.org/10.1111/jgs.15198
Hayes, R. D., Dennerstein, L., Bennett, C. M., Koochaki, P. E., Leiblum, S. R., & Graziottin, A. (2007). Relationship between hypoactive sexual desire disorder and aging. Fertility and sterility, 87(1), 107–112. https://doi.org/10.1016/j.fertnstert.2006.05.071
Hughes, A. K., Rostant, O. S., & Pelon, S. (2015). Sexual problems among older women by age and race. Journal of women's health, 24(8):663–669. https://doi.org/10.1089/jwh.2014.5010
Kahveci, M., Cirban Ekrem, E., & Demirel Bozkurt, Ö. (2022).Obezitede cinsel yaşam ve hemşirelik yaklaşımı. Androl Bul, 24:199−203. https://doi.org/10.24898/tandro.2022.84755
Kao, A., Binik, Y. M., Kapuscinski, A., & Khalife, S. (2008). Dyspareunia in postmenopausal women: a critical review. Pain research & management, 13(3):243–254. https://doi.org/10.1155/2008/269571
Karpuz, H. Yaşlı kardiyovasküler hastalarda cinsel yaşam. Turk kardiyol dern ars, 2017;45(5): 134–137.
Limpawattana, P., Kongbunkiat, K., Sawanyawisuth, K., & Sribenjalux, W. (2015). Help seeking behaviour for urinary incontinence: Experience from a university community. Int J Urol Nurs, 9:143 148.
Maciel, M., & Lagana, L. (2014). Older women's sexual desire problems: biopsychosocial factors impacting them and barriers to their clinical assessment. BioMed research international, 107217. https://doi.org/10.1155/2014/107217
Mitchell, K. R., Geary, R., Graham, C. A., Datta, J., Wellings, K., Sonnenberg, P., Field, N., Nunns, D., Bancroft, J., Jones, K. G., Johnson, A. M., & Mercer, C. H. (2017). Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey. BJOG : an international journal of obstetrics and gynaecology, 124(11):1689–1697. https://doi.org/10.1111/1471-0528.14518
Muliira, J. K., & Muliira, R. S. (2013). Sexual Health for Older Women: Implications for nurses and other healthcare providers. Sultan Qaboos University medical journal, 13(4), 469–476. https://doi.org/10.12816/0003304
Naumova, I., & Castelo-Branco, C. (2018). Current treatment options for postmenopausal vaginal atrophy. International journal of women's health, 10:387–395. https://doi.org/10.2147/IJWH.S158913
Özcan, H., & Kızılkaya Beji, N. (2018).Kadın cinsel fonksiyon bozuklukları: 2018 güncelleme. Androl Bul, 20:133−137. https://doi.org/10.24898/tandro.2018.42204
Polat, C. (2019). Cinsel işlev bozuklukları ve depresyon. Yaşam becerileri psikoloji dergisi, 3(6), 223-228.
Portman, D. J., Brown, L., Yuan, J., Kissling, R., & Kingsberg, S. A. (2017). Flibanserin in Postmenopausal Women With Hypoactive Sexual Desire Disorder: Results of the PLUMERIA Study. The journal of sexual medicine, 14(6):834–842. https://doi.org/10.1016/j.jsxm.2017.03.258
Portellos, A., Claire, C.L., & Joosten, A. (2023). Sexuality and ageing: A mixed methods explorative study of older adult’s experiences, attitudes, and support needs. British Journal of Occupational Therapy, 86(7).
Ricoy-Cano, A. J., Obrero-Gaitán, E., Caravaca-Sánchez, F., & Fuente-Robles, Y. M. (2020). Factors Conditioning Sexual Behavior in Older Adults: A Systematic Review of Qualitative Studies. Journal of clinical medicine, 9(6), 1716. https://doi.org/10.3390/jcm9061716
Ringa, V., Diter, K., Laborde, C., & Bajos, N. (2013). Women's sexuality: from aging to social representations. The journal of sexual medicine, 10(10), 2399–2408. https://doi.org/10.1111/jsm.12267
Sevinç C. (2021). Yaşlı hastalarda pelvik organ prolapsus yönetimi. Kontinans ve nöroüroloji bülteni, 8: 80-86.
Silva, G. M. D. D., Lima, S. M. R. R., Reis, B. F. D., Macruz, C. F., & Postigo, S. (2019). Evaluation of Obesity Influence in the Sexual Function of Postmenopausal Women: A Cross-Sectional Study. Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 41(11): 660–667. https://doi.org/10.1055/s-0039-1700795
Smith, L., Yang, L., Forwood, S., Lopez-Sanchez, G., et al. (2019). Associations between sexual activity and weight status: Findings from the English longitudinal study of ageing. PLoS ONE, 14(9): e0221979. https://doi.org/10.1371/journal.pone.0221979
Sohn, K., Ki Lee, C., Shin, J., & Lee, J. (2018). Association between female urinary ıncontinence and geriatric health problems:results from Korean longitudinal study of ageing (2006). Korean J Fam Med, 39:10-14
Souza, C.L., Gomes, V.S., Silva, R.L., Santos, E.S., et al. (2019). Aging, sexuality and nursing care: the elderly woman’s look. Rev Bras Enferm, 72(2):71-78. http://dx.doi.org/10.1590/0034-7167-2018-0015.
Srinivasan, S., Glover, J., Tampi, R. R., Tampi, D. J., & Sewell, D. D. (2019). Sexuality and the Older Adult. Current psychiatry reports, 21(10), 97. https://doi.org/10.1007/s11920-019-1090-4
Srisukho, S., & Chinthakanan, O. (2017). Treatment of pelvic organ prolapse in a patient with a thermal burn wound caused by hot stone therapy, a traditional thai treatment. Case Reports in Obstetrics and Gynecology, 2017, 1–3.
United Nations (UN). World Population Ageing - 2017 Highlights. New York; 2017. Report No.: ST/ESA/SER.A/397. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdf.
Visser, E., de Bock, G. H., Berger, M. Y., & Dekker, J. H. (2014). Impact of urinary incontinence on sexual functioning in community-dwelling older women. The journal of sexual medicine, 11(7):1757–1765. https://doi.org/10.1111/jsm.12544
Winkley, K., Kristensen, C., & Fosbury, J. (2021). Sexual health and function in women with diabetes. Diabetic medicine : a journal of the British Diabetic Association, 38(11), e14644. https://doi.org/10.1111/dme.14644
World Health Organization (WHO). Defining sexual health Report of a technical consultation on sexual health. https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexual-health
Zhu, Y., Yang, X., Fan, X., Sun, Y., Tan, C., Wang, Y., Zhu, W., & Ren, D. (2021). Decreased Sexual Desire among Middle-Aged and Old Women in China and Factors Influencing It: A Questionnaire-Based Study. Evidence-based complementary and alternative medicine, 6649242. https://doi.org/10.1155/2021/6649242
Tayyeb, M., & Gupta, V. (2023). Dyspareunia. In StatPearls. StatPearls Publishing.
Referanslar
Ambler, D. R., Bieber, E. J., & Diamond, M. P. (2012). Sexual function in elderly women: a review of current literature. Reviews in obstetrics & gynecology, 5(1), 16–27.
Archer, D. F., Labrie, F., Montesino, M., & Martel, C. (2017). Comparison of intravaginal 6.5mg (0.50%) prasterone, 0.3mg conjugated estrogens and 10μg estradiol on symptoms of vulvovaginal atrophy. The Journal of steroid biochemistry and molecular biology, 174, 1–8. https://doi.org/10.1016/j.jsbmb.2017.03.014
Athey, R. A., Kershaw, V., & Radley, S. (2021). Systematic review of sexual function in older women. European journal of obstetrics, gynecology, and reproductive biology, 267, 198–204. https://doi.org/10.1016/j.ejogrb.2021.11.011
Banke-Thomas, A., Olorunsaiye, C. Z., & Yaya, S. (2020). "Leaving no one behind" also includes taking the elderly along concerning their sexual and reproductive health and rights: a new focus for Reproductive Health. Reproductive health, 17(1), 101. https://doi.org/10.1186/s12978-020-00944-5
Basson, R., Berman, J., Burnett, A., Derogatis, L., et al. (2000). Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol, 163(3):888-893.
Basson, R., & Gilks, T. (2018). Women’s sexual dysfunction associated with psychiatric disorders and their treatment. Women’s Health, https://doi.org/10.1177/1745506518762664
Buttaro TM., Koeniger-Donohue R., & Hawkins J. (2014). Sexuality and quality of life in aging: implications for practice. The journal for nurse practitioners, 10(7), 480-485.
Carvalheira, A., Graham, C., Stulhofer, A., & Traen, B. (2020). Predictors and correlates of sexual avoidance among partnered older adults among Norway, Denmark, Belgium, and Portugal. European Journal of Ageing, 17(2), 175–184. https://doi.org/10.1007/s10433-019-00540-y
Copeland, K. L., Brown, J. S., Creasman, J. M., Van Den Eeden, S. K., Subak, L. L., Thom, D. H., Ferrara, A., & Huang, A. J. (2012). Diabetes mellitus and sexual function in middle-aged and older women. Obstetrics and gynecology, 120(2),331–340. https://doi.org/10.1097/AOG.0b013e31825ec5fa
Çıracı Yaşar, Y., & Hintistan, S. (2020). Yaşlılık–kadın ve cinsellik. İzmir kâtip çelebi üniversitesi sağlık bilimleri fakültesi dergisi, 5(1): 15-18.
Dominguez, L.J., & Barbagallo, M. (2016). Ageing and sexuality. European geriatric medicine, 7(6): 512-518.
Dutra da Silva, G.M., Rolim Rosa Lima, S.M., Reis, B.F., Macruz, C.F., & Postigo, S. (2020). Prevalence of hypoactive sexual desire disorder among sexually active postmenopausal women with metabolic syndrome at a public hospital clinic in Brazil: a cross-sectional study. Sex Med, 8(3):545-553.
Faubion, S. S., & Rullo, J. E. (2015). Sexual Dysfunction in Women: A Practical Approach. American family physician, 92(4), 281–288.
Felippe, M. R., Zambon, J. P., Girotti, M. E., Burti, J. S., Hacad, C. R., Cadamuro, L., & Almeida, F. (2017). What Is the Real Impact of Urinary Incontinence on Female Sexual Dysfunction? A Case Control Study. Sexual medicine, 5(1), e54–e60. https://doi.org/10.1016/j.esxm.2016.09.001
Fışkın, G., & Kızılkaya Beji, N. (2018). Pelvik organ prolapsusu ve cinsel yaşam üzerine etkileri. FNJN, 26(3): 211-218.
Flynn, T. J., & Gow, A. J. (2015). Examining associations between sexual behaviours and quality of life in older adults. Age and ageing, 44(5),823–828. https://doi.org/10.1093/ageing/afv083
Gandhi, J., Chen, A., Dagur, G., et al. (2016).Genitourinary syndrome of menopause: anoverview of clinical manifestations, pathophysiology, etiology, evaluation, andmanagement. Am J Obstet Gynecol, 215(6):704–711.
Gillespie B. J. (2017). Sexual synchronicity and communication among partnered older adults. Journal of sex & marital therapy, 43(5):441–455. https://doi.org/10.1080/0092623X.2016.1182826
Gillespie, B.J., Hibbert, K. & Sanguinetti, A. (2017). A Review of Psychosocial and Interpersonal Determinants of Sexuality in Older Adulthood. Curr Sex Health Rep, 9:150–154. https://doi.org/10.1007/s11930-017-0117-2
Granville, L., & Pregler, J. (2018). Women's sexual health and aging. Journal of the American Geriatrics Society, 66(3), 595–601. https://doi.org/10.1111/jgs.15198
Hayes, R. D., Dennerstein, L., Bennett, C. M., Koochaki, P. E., Leiblum, S. R., & Graziottin, A. (2007). Relationship between hypoactive sexual desire disorder and aging. Fertility and sterility, 87(1), 107–112. https://doi.org/10.1016/j.fertnstert.2006.05.071
Hughes, A. K., Rostant, O. S., & Pelon, S. (2015). Sexual problems among older women by age and race. Journal of women's health, 24(8):663–669. https://doi.org/10.1089/jwh.2014.5010
Kahveci, M., Cirban Ekrem, E., & Demirel Bozkurt, Ö. (2022).Obezitede cinsel yaşam ve hemşirelik yaklaşımı. Androl Bul, 24:199−203. https://doi.org/10.24898/tandro.2022.84755
Kao, A., Binik, Y. M., Kapuscinski, A., & Khalife, S. (2008). Dyspareunia in postmenopausal women: a critical review. Pain research & management, 13(3):243–254. https://doi.org/10.1155/2008/269571
Karpuz, H. Yaşlı kardiyovasküler hastalarda cinsel yaşam. Turk kardiyol dern ars, 2017;45(5): 134–137.
Limpawattana, P., Kongbunkiat, K., Sawanyawisuth, K., & Sribenjalux, W. (2015). Help seeking behaviour for urinary incontinence: Experience from a university community. Int J Urol Nurs, 9:143 148.
Maciel, M., & Lagana, L. (2014). Older women's sexual desire problems: biopsychosocial factors impacting them and barriers to their clinical assessment. BioMed research international, 107217. https://doi.org/10.1155/2014/107217
Mitchell, K. R., Geary, R., Graham, C. A., Datta, J., Wellings, K., Sonnenberg, P., Field, N., Nunns, D., Bancroft, J., Jones, K. G., Johnson, A. M., & Mercer, C. H. (2017). Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey. BJOG : an international journal of obstetrics and gynaecology, 124(11):1689–1697. https://doi.org/10.1111/1471-0528.14518
Muliira, J. K., & Muliira, R. S. (2013). Sexual Health for Older Women: Implications for nurses and other healthcare providers. Sultan Qaboos University medical journal, 13(4), 469–476. https://doi.org/10.12816/0003304
Naumova, I., & Castelo-Branco, C. (2018). Current treatment options for postmenopausal vaginal atrophy. International journal of women's health, 10:387–395. https://doi.org/10.2147/IJWH.S158913
Özcan, H., & Kızılkaya Beji, N. (2018).Kadın cinsel fonksiyon bozuklukları: 2018 güncelleme. Androl Bul, 20:133−137. https://doi.org/10.24898/tandro.2018.42204
Polat, C. (2019). Cinsel işlev bozuklukları ve depresyon. Yaşam becerileri psikoloji dergisi, 3(6), 223-228.
Portman, D. J., Brown, L., Yuan, J., Kissling, R., & Kingsberg, S. A. (2017). Flibanserin in Postmenopausal Women With Hypoactive Sexual Desire Disorder: Results of the PLUMERIA Study. The journal of sexual medicine, 14(6):834–842. https://doi.org/10.1016/j.jsxm.2017.03.258
Portellos, A., Claire, C.L., & Joosten, A. (2023). Sexuality and ageing: A mixed methods explorative study of older adult’s experiences, attitudes, and support needs. British Journal of Occupational Therapy, 86(7).
Ricoy-Cano, A. J., Obrero-Gaitán, E., Caravaca-Sánchez, F., & Fuente-Robles, Y. M. (2020). Factors Conditioning Sexual Behavior in Older Adults: A Systematic Review of Qualitative Studies. Journal of clinical medicine, 9(6), 1716. https://doi.org/10.3390/jcm9061716
Ringa, V., Diter, K., Laborde, C., & Bajos, N. (2013). Women's sexuality: from aging to social representations. The journal of sexual medicine, 10(10), 2399–2408. https://doi.org/10.1111/jsm.12267
Sevinç C. (2021). Yaşlı hastalarda pelvik organ prolapsus yönetimi. Kontinans ve nöroüroloji bülteni, 8: 80-86.
Silva, G. M. D. D., Lima, S. M. R. R., Reis, B. F. D., Macruz, C. F., & Postigo, S. (2019). Evaluation of Obesity Influence in the Sexual Function of Postmenopausal Women: A Cross-Sectional Study. Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 41(11): 660–667. https://doi.org/10.1055/s-0039-1700795
Smith, L., Yang, L., Forwood, S., Lopez-Sanchez, G., et al. (2019). Associations between sexual activity and weight status: Findings from the English longitudinal study of ageing. PLoS ONE, 14(9): e0221979. https://doi.org/10.1371/journal.pone.0221979
Sohn, K., Ki Lee, C., Shin, J., & Lee, J. (2018). Association between female urinary ıncontinence and geriatric health problems:results from Korean longitudinal study of ageing (2006). Korean J Fam Med, 39:10-14
Souza, C.L., Gomes, V.S., Silva, R.L., Santos, E.S., et al. (2019). Aging, sexuality and nursing care: the elderly woman’s look. Rev Bras Enferm, 72(2):71-78. http://dx.doi.org/10.1590/0034-7167-2018-0015.
Srinivasan, S., Glover, J., Tampi, R. R., Tampi, D. J., & Sewell, D. D. (2019). Sexuality and the Older Adult. Current psychiatry reports, 21(10), 97. https://doi.org/10.1007/s11920-019-1090-4
Srisukho, S., & Chinthakanan, O. (2017). Treatment of pelvic organ prolapse in a patient with a thermal burn wound caused by hot stone therapy, a traditional thai treatment. Case Reports in Obstetrics and Gynecology, 2017, 1–3.
United Nations (UN). World Population Ageing - 2017 Highlights. New York; 2017. Report No.: ST/ESA/SER.A/397. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdf.
Visser, E., de Bock, G. H., Berger, M. Y., & Dekker, J. H. (2014). Impact of urinary incontinence on sexual functioning in community-dwelling older women. The journal of sexual medicine, 11(7):1757–1765. https://doi.org/10.1111/jsm.12544
Winkley, K., Kristensen, C., & Fosbury, J. (2021). Sexual health and function in women with diabetes. Diabetic medicine : a journal of the British Diabetic Association, 38(11), e14644. https://doi.org/10.1111/dme.14644
World Health Organization (WHO). Defining sexual health Report of a technical consultation on sexual health. https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexual-health
Zhu, Y., Yang, X., Fan, X., Sun, Y., Tan, C., Wang, Y., Zhu, W., & Ren, D. (2021). Decreased Sexual Desire among Middle-Aged and Old Women in China and Factors Influencing It: A Questionnaire-Based Study. Evidence-based complementary and alternative medicine, 6649242. https://doi.org/10.1155/2021/6649242
Tayyeb, M., & Gupta, V. (2023). Dyspareunia. In StatPearls. StatPearls Publishing.
