1.

Erectile Dysfunction

 After the inability-----

 Although incidence rates increase with age, erectile dysfunction is not a
normal outcome of aging, but rather due to causes such as alcoholism,
diabetes, dyslipidemia, hypertension, hypogonadism, multiple sclerosis,
renal failure, spinal cord injury, thyroid conditions, and psychological
factors.

 After a variety----

 Some of the erectile drugs can have side effects that may contraindicate
their use for some individuals; therefore, careful risk evaluation is essential
before these types of drugs are prescribed.

TIP:

Older men do have a reduced ability to raise an erection solely with a

sexual thought, and they require more direct physical stimulation to
become erect. They also are more likely to lose an erection if disturbed
during intercourse by a noise or other interruption. These experiences do
not mean the man has erectile dysfunction. If the man has the ability to
become erect by masturbating, he most likely does not have erectile
dysfunction.

2. Benign Prostatic Hyperplasia

 After most older men-----

 Symptoms of this problem progress slowly but continuously, as the
enlarging prostate puts pressure on the urethra; they begin with hesitancy,
decreased force of urinary stream, frequency, and nocturia as a result of
obstruction of the vesical neck and compression of the urethra that causes
a compensatory hypertrophy of the detrusor muscle and subsequent outlet
obstruction.

 After dribbling-----
 As the hyperplasia progresses, the bladder wall loses its elasticity and
becomes thinner, leading to urinary retention and an increased risk of
urinary infection.

 Unfortunately, some men are reluctant or embarrassed to seek prompt

medical attention and may develop kidney damage by the time symptoms
are severe enough to motivate them to be evaluated.

3. Cancer of the Prostate

 Benign hypertrophy should be followed closely because it is thought to be

associated with prostatic cancer, the symptoms of which can be similar.

 After PSA-------

 If metastasis has not occurred, treatment may consist of monitoring,

irradiation, or a radical prostatectomy; the latter procedure will result in
impotency

 After hormones----

 General principles associated with these therapeutic measures are

applicable to the older patient. Many men are able to continue sexual
performance after orchiectomy and during hormone therapy; the physician
should be consulted for specific advice concerning the expected outcomes
for individual patients.

4. Tumors of the Penis, Testes, and Scrotum

 After cancer-----

 The resemblance of this growth to a chancre can cause a misdiagnosis or

reluctance on the part of the patient to seek treatment.

 After testicular---
  Chemotherapy, irradiation, and orchiectomy are among the treatment
measures.

 After scrotal-----

 As with any reproductive system problem, counseling regarding self-care

practices, body image, and sexual activity is important.

Chapter Summary

The health of the reproductive system has an impact on total body health.
Conditions of the reproductive system can be related to undiagnosed disease
processes that require attention, such as diabetes and infections. Changes
associated with aging contribute to infections of the vulva and vagina. Cancers of
the female reproductive tract occur less frequently with age, except for ovarian
cancer, which increases in incidence with age. The incidence of breast cancer
increases with age; because older women are the least likely group to receive
mammograms and breast examinations by a professional or to perform self-
examinations of their breasts, patient education in this area is important.
Dyspareunia is a common problem in older women. Many older men have erectile
dysfunction. Nurses can benefit by guiding a sensitive discussion of ways to
manage these problems and promote satisfying sexual activity. The close
relationship and trust that patients often have with nurses can enable patients to
more comfortably share concerns and symptoms related to the reproductive
system more openly with nurses than with other members of the health care
team. Nurses should include a review of the reproductive system in their
assessments of patients and assure abnormal findings and symptoms are referred
for evaluation and treatment.