Show me some LOVE…XOXO

Show me some LOVE…XOXO
Lisa Mathis MSN, FNP-BC

February… the month of love. Red hearts, red roses, candy, and sappy cards adorn the shelves in every store. Romantic meals at expensive restaurants are planned and a dozen fragrant red roses are delivered. It is a great month for those Rom-Com
movies where someone finds romance and true love after a night of unbridled passion.

But those romantic feelings and that warm fuzzy feeling of love, that rush of adrenaline from that first kiss can quickly be forgotten when you get the gift that keeps on giving. “In a survey of gynecologists, 83.5% reported seeing vaginal injuries following consensual sexual intercourse at least once in their practice. The most common types of vaginal injuries include mucosal erosions, mucosa penetrating injuries, and injuries penetrating the vaginal wall. Active bleeding was observed in at least one case by 56.3% of respondents. Strained muscles are the most common form of injury men can face after
sex. A study found that most sex-related injuries are sustained while having sex in nontraditional settings, such as on stairs, over kitchen tables, or in closets.” (1) These are somewhat mild injuries but other more severe include fractured penis, torn anus, and foreign objects that are unable to be removed. These are emergencies, and surgery may be required in some cases. (Do not worry I will get to STIs in a moment, but let’s come back to something more intriguing, a fractured penis.)

As advanced care providers, we want to make sure our patients feel comfortable and can talk to us about anything. Sexual relationships, experimentation, and having a healthy, safe sex life can be difficult topics. If we see a female patient who has vaginal lacerations, bleeding, or rectal trauma, we need to educate them on proper lubricants. Samples in your office
are even better. Educate them that with proper lubrication, this type of trauma can be largely avoided. Strained muscles can be prevented by stretching those tense muscles and joints before the preverbal sexual marathon takes place. The more serious injuries such as a fractured penis, or a tear in the tunica albuginea is a urological emergency, as well
as a foreign body such as a sex toy that is stuck in the rectum. These should be referred to a specialist, or the ER immediately. Once again education is imperative, so this does not happen. Just like the George Micheal song, “Sex is natural, sex is fun” we need to be safe.

Now that we have discussed the mechanical issues, let’s talk about STIs. The most common sexually transmitted infections (STIs) in the United States are chlamydia, gonorrhea, genital herpes, trichomoniasis, and human papillomavirus (HPV). Chlamydia is a curable STI that is the most common in the US. Gonorrhea is a curable STI. Syphilis is a curable STI. Trichomoniasis also is a curable STI. Genital herpes is a viral infection that causes painful, blister-like sores on the skin and flare-ups can be quite distressing and painful. HPV is also a viral infection that often has no symptoms and can go away before a person knows they have it. HPV has been linked to cancers and is not curable. Other STIs include Hepatitis B, Hepatitis C, and Human immunodeficiency virus (HIV). (2) We do not want that night of love and romance over roses and chocolates to result in painful skin lesions, and a difficult-to-treat infection or virus that never goes away. Educate your
patients on the use of protection and being safe in those moments of passion and to screen their sexual partners. A few moments of pleasure are not worth a lifetime of pain. Let your patient know that with drainage, pain, and erythema or lesions come in and get tested asap. This will prevent the infections from worsening and spreading to others.

Your patients need to feel comfortable to call you with these hard topics and issues. Never appear to judge your patient, this will make them hesitant to trust you. If that housewife wants to spice her marriage up, be open to discussions and make her feel safe and comfortable talking to you about it. If you build these types of relationships with your patients, reach out to drug reps and companies to provide packets, and samples for you to give out and display in the exam rooms. When you do yearly exams don’t be afraid to ask your patients, “How is your sex life?” Open the door for them to discuss as this is often a hard topic to bring up. Some women feel when vaginal dryness starts from menopause their sex life is over which can lead to marital issues, depression, etc. So be sure to discuss sexual health and how to address these issues. 

One last thing… Valentines is not just for the young, and neither are STIs and sexual injuries. Many elderly people in nursing homes are lonely and like to sneak into each other's rooms for romance and fun. I love that idea, I am in support of elderly people having a good time, however, there are issues with those midafternoon “rolls in the hay”. They do
not use protection; they are under the assumption that since they cannot get pregnant, they don’t need condoms. Sexually transmitted infection (STI) rates in nursing homes are high and have been increasing over time. This is due to several factors, including older people being less likely to use condoms and a lack of STI education. So, to those APPs in the skilled nursing, and long-term settings, please provide a box of condoms, and lubricant and EDUCATE them. This will help with the alarming rate of increased STIs and vaginal injuries. You may want to discuss the risk of MI or CVA in those elderly patients but that’s another talk for another topic.
 

So, during this month of LOVE be encouraging and open to new things to help your patients enjoy a normal, safe, and healthy sex life.

L is for Lubricant, the slicker the better!
O is for Orgasm, we all need them!
V is for the Vagina, what a wonderful thing it is, be easy on her!
E is for Erection, more powerful than a sword so don’t break it!

"We love life, not because we are used to living but because we are used to loving.” - Friedrich Nietzsche

https://www.google.com/search?q=sex+related+injuries+statistics&rlz=1C5OZZY_enUS1124US1124&oq=sexual+related+inju&gs_lcrp=
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FMg0IBRAAGIYDGIAEGIoFMg0IBhAAGIYDGIAEGIoFMgoIBxAAGIAEGKIE0gEINjk5NmowajeoAgCwAgA&sourceid=chrome&ie=UTF8https://www.google.com/search?q=most+common+stis+in+the+united+states&sca_esv