Week 6: Weekly Clinical Goal
My weekly schedule for clinicals will be Friday, Saturday, and Sunday from 8am to 8pm.
My clinical goal for the week is to see more patients with chronic diseases such as hypertension,
diabetes, and hypothyroidism. I would like to become more familiar also with treatment plans for
children with these chronic conditions. Although, I have seen numerous adult patients diagnosed with
these chronic diseases but would like to feel more confident in caring for children with hypertension,
diabetes, and hypothyroidism. Another goal for this week’s clinical is to see a child with a mental health
concern such as anxiety or depression. I would like the opportunity to treat a child with anxiety or
depression to learn how their treatment differs from older adult patients, even though our focus for this
week is older adults with urologic and sexuality issues.
The barriers or opportunities specific to my clinical site and preceptor I anticipate this week is increasing
my confidence level and communications skills being an active listener and be receptive to verbal cues
from children and parents when they present to the clinic with mental health issues. Increased visits for
school physicals also foster an opportunity to see children with chronic conditions and mental health
issues.
DISCUSSION:
The NAMS videos as mentioned earlier were interesting and made me aware of the GSM. Although I
knew that changes happen as women age and go through menopause, I was surprised to see that 1 in
every 10 women is affected by sexual disfunction problems. With this new gained knowledge, I will make
sure that a sexual history will be obtained on my patients including the mature and elderly patients’
population, if not done so, and routinely reassess their history for any changes that could affect sexual
health.
Discussion Questions:
What was the most surprising statement or topic that you heard in the videos? Explain why this was
surprising to you.
One thing that surprised me the most after watching the videos is that many health care providers do
not perceive sexual dysfunction as existentially real and being treated as a taboo accompanied by
feelings of embarrassment that some women may feel when discussing these concerns with the
provider. Discussions are not being initiated and open-ended questions are not being asked and one
cannot open up a discussion if the topic is not brought up. This enormous barrier can hinder the lives of
those affected and lead to decreased quality of life leading to depression and even anxiety. Another
thing that surprised me after watching the video, is that physician satisfaction ratings increase when the
discussion regarding sexual practices and dysfunctions are tackled. Patients may be embarrassed to
discuss sexual history and possible barriers that interfere with sexual activity, but it is our responsibility
as healthcare professionals to not only discuss but treat and manage symptoms that can pave the way
for a better quality of life. Until this course, clinical rotation, and the video from this week’s discussion, I
was not aware that there is a specific assessment/screening tool that can be utilized to unlock an
opportunity to discuss the patient’s concerns about sexual dysfunction. Sexual dysfunction ranges from
vaginal dryness to painful intercourse or complications that arise from urinary dysfunction (Hull &
Fournace, 2017). I found it interesting also that 1 in 10 women have sexual dysfunction problems. I
This study source was downloaded by 100000852681095 from CourseHero.com on 01-28-2023 05:41:26 GMT -06:00
https://www.coursehero.com/file/103930810/Weekly-Clinical-Goal-DISCUSSIONdocx/
, wouldn’t have thought that the number is escalating as stated in the video. It seems like a lot, but I can
see that women are not mentioned related to anything regarding their sexual health to their providers
and most of the time we as providers don’t ask them because we assume that the patients will initiate
the discussion and that is true for both genders, not just women.
What is GSM? What body systems are involved? How does GSM affect a woman's quality of life?
GSM is something I never heard of prior to watching the video. GSM stands for Genitourinary syndrome
of menopause that describes several signs and symptoms of menopause that not only include genital
symptoms like dryness, irritation, and burning, but also sexual symptoms like discomfort or pain during
intercourse and lack of lubrication as well as urinary symptoms like dysuria, urgency, recurrent UTIs (Kim
et al., 2015). According to Dr Shapiro in the NAMS (2016) video, the urinary and reproductive system is
involved in GSM. When reviewing the signs and symptoms associated with it, GSM can affect a woman’s
self-esteem, libido, sleep, intimacy with their partners, work/social activity, feminine role, sense of youth
and the overall enjoyment in their quality of life (Nappi et al., 2019). During sexual history taking or
physical assessment, when a patient complains of vaginal dryness, irritation, burning with or without
stimulation is means for diagnosis (Hodges et al., 2018). Upon physical examination, assessment findings
that will indicate GSM are a smaller, greyish looking labia majora/minora, the clitoris may be smaller and
even unable to find and with the presence of inflammation, the vagina may appear erythematous,
develop petechiae, or bleed easily (Hodges et al., 2018). The vaginal pH will be above 5.0 due to the
change in the vaginal canal and this places women at an increased risk for bacterial vaginosis (Hodges et
al., 2018). Recent studies point to the importance of addressing VVA/GSM as a potential early indicator
of poor general health in analogy with vasomotor symptoms and a standard of VVA/GSM care in elderly
women is desirable to enhance physical, emotional and mental well-being (Nappi et al., 2019).
Review one aspect of treatment that Dr Shapiro recommends for GSM and include an EBP journal
article or guideline recommendation in addition to referencing the video in your response.
In the NAMS video, Dr. Shapiro mentioned nonpharmacological treatment options for GSM that include
vaginal moisturizers, lubricants, and pelvic PT. Another treatment that she revealed during her interview
with Dr. Shifren was the pharmacological use of low dose vaginal estrogen. Vaginal estrogen therapy has
been shown to provide women with symptomatic relief of urogenital symptoms associated with
perimenopause and menopause (NAMS, 2016). They come in 3 different forms including vaginal ring,
tablets and creams. Choosing which form to use for the treatment of GSM should be made in
conjunction with the patient for better treatment adherence. As mentioned by Dr. Shapiro, low dose
vaginal estrogen therapy is usually safe for most women but is contraindicated in women with estrogen-
dependent neoplasia.
According to Dr. Shifren vaginal moisturizers, lubricants, and hormones are considered first line therapy
and can offer relief, but to receive optimal effect, should be applied routinely and this was also
confirmed by Hodges et al. (2018). In the video, Dr. Shifren discusses three forms of local vaginal therapy.
This low dose vaginal estrogen will not bump up a women’s estradiol level and for those with
hypertension, cardiovascular disease or history of DVT/PE and it is safe to use. Current evidence
suggests that vaginal estrogen administration in postmenopausal women with a history of breast cancer
is not associated with systemic absorption of sex hormones and may provide indirect evidence for the
safety of their use (Pavlović et al., 2019). The American College of Obstetricians and Gynecologists
(ACOG) recommends the decision to use vaginal estrogen may be make in coordination with a woman’s
This study source was downloaded by 100000852681095 from CourseHero.com on 01-28-2023 05:41:26 GMT -06:00
https://www.coursehero.com/file/103930810/Weekly-Clinical-Goal-DISCUSSIONdocx/
My weekly schedule for clinicals will be Friday, Saturday, and Sunday from 8am to 8pm.
My clinical goal for the week is to see more patients with chronic diseases such as hypertension,
diabetes, and hypothyroidism. I would like to become more familiar also with treatment plans for
children with these chronic conditions. Although, I have seen numerous adult patients diagnosed with
these chronic diseases but would like to feel more confident in caring for children with hypertension,
diabetes, and hypothyroidism. Another goal for this week’s clinical is to see a child with a mental health
concern such as anxiety or depression. I would like the opportunity to treat a child with anxiety or
depression to learn how their treatment differs from older adult patients, even though our focus for this
week is older adults with urologic and sexuality issues.
The barriers or opportunities specific to my clinical site and preceptor I anticipate this week is increasing
my confidence level and communications skills being an active listener and be receptive to verbal cues
from children and parents when they present to the clinic with mental health issues. Increased visits for
school physicals also foster an opportunity to see children with chronic conditions and mental health
issues.
DISCUSSION:
The NAMS videos as mentioned earlier were interesting and made me aware of the GSM. Although I
knew that changes happen as women age and go through menopause, I was surprised to see that 1 in
every 10 women is affected by sexual disfunction problems. With this new gained knowledge, I will make
sure that a sexual history will be obtained on my patients including the mature and elderly patients’
population, if not done so, and routinely reassess their history for any changes that could affect sexual
health.
Discussion Questions:
What was the most surprising statement or topic that you heard in the videos? Explain why this was
surprising to you.
One thing that surprised me the most after watching the videos is that many health care providers do
not perceive sexual dysfunction as existentially real and being treated as a taboo accompanied by
feelings of embarrassment that some women may feel when discussing these concerns with the
provider. Discussions are not being initiated and open-ended questions are not being asked and one
cannot open up a discussion if the topic is not brought up. This enormous barrier can hinder the lives of
those affected and lead to decreased quality of life leading to depression and even anxiety. Another
thing that surprised me after watching the video, is that physician satisfaction ratings increase when the
discussion regarding sexual practices and dysfunctions are tackled. Patients may be embarrassed to
discuss sexual history and possible barriers that interfere with sexual activity, but it is our responsibility
as healthcare professionals to not only discuss but treat and manage symptoms that can pave the way
for a better quality of life. Until this course, clinical rotation, and the video from this week’s discussion, I
was not aware that there is a specific assessment/screening tool that can be utilized to unlock an
opportunity to discuss the patient’s concerns about sexual dysfunction. Sexual dysfunction ranges from
vaginal dryness to painful intercourse or complications that arise from urinary dysfunction (Hull &
Fournace, 2017). I found it interesting also that 1 in 10 women have sexual dysfunction problems. I
This study source was downloaded by 100000852681095 from CourseHero.com on 01-28-2023 05:41:26 GMT -06:00
https://www.coursehero.com/file/103930810/Weekly-Clinical-Goal-DISCUSSIONdocx/
, wouldn’t have thought that the number is escalating as stated in the video. It seems like a lot, but I can
see that women are not mentioned related to anything regarding their sexual health to their providers
and most of the time we as providers don’t ask them because we assume that the patients will initiate
the discussion and that is true for both genders, not just women.
What is GSM? What body systems are involved? How does GSM affect a woman's quality of life?
GSM is something I never heard of prior to watching the video. GSM stands for Genitourinary syndrome
of menopause that describes several signs and symptoms of menopause that not only include genital
symptoms like dryness, irritation, and burning, but also sexual symptoms like discomfort or pain during
intercourse and lack of lubrication as well as urinary symptoms like dysuria, urgency, recurrent UTIs (Kim
et al., 2015). According to Dr Shapiro in the NAMS (2016) video, the urinary and reproductive system is
involved in GSM. When reviewing the signs and symptoms associated with it, GSM can affect a woman’s
self-esteem, libido, sleep, intimacy with their partners, work/social activity, feminine role, sense of youth
and the overall enjoyment in their quality of life (Nappi et al., 2019). During sexual history taking or
physical assessment, when a patient complains of vaginal dryness, irritation, burning with or without
stimulation is means for diagnosis (Hodges et al., 2018). Upon physical examination, assessment findings
that will indicate GSM are a smaller, greyish looking labia majora/minora, the clitoris may be smaller and
even unable to find and with the presence of inflammation, the vagina may appear erythematous,
develop petechiae, or bleed easily (Hodges et al., 2018). The vaginal pH will be above 5.0 due to the
change in the vaginal canal and this places women at an increased risk for bacterial vaginosis (Hodges et
al., 2018). Recent studies point to the importance of addressing VVA/GSM as a potential early indicator
of poor general health in analogy with vasomotor symptoms and a standard of VVA/GSM care in elderly
women is desirable to enhance physical, emotional and mental well-being (Nappi et al., 2019).
Review one aspect of treatment that Dr Shapiro recommends for GSM and include an EBP journal
article or guideline recommendation in addition to referencing the video in your response.
In the NAMS video, Dr. Shapiro mentioned nonpharmacological treatment options for GSM that include
vaginal moisturizers, lubricants, and pelvic PT. Another treatment that she revealed during her interview
with Dr. Shifren was the pharmacological use of low dose vaginal estrogen. Vaginal estrogen therapy has
been shown to provide women with symptomatic relief of urogenital symptoms associated with
perimenopause and menopause (NAMS, 2016). They come in 3 different forms including vaginal ring,
tablets and creams. Choosing which form to use for the treatment of GSM should be made in
conjunction with the patient for better treatment adherence. As mentioned by Dr. Shapiro, low dose
vaginal estrogen therapy is usually safe for most women but is contraindicated in women with estrogen-
dependent neoplasia.
According to Dr. Shifren vaginal moisturizers, lubricants, and hormones are considered first line therapy
and can offer relief, but to receive optimal effect, should be applied routinely and this was also
confirmed by Hodges et al. (2018). In the video, Dr. Shifren discusses three forms of local vaginal therapy.
This low dose vaginal estrogen will not bump up a women’s estradiol level and for those with
hypertension, cardiovascular disease or history of DVT/PE and it is safe to use. Current evidence
suggests that vaginal estrogen administration in postmenopausal women with a history of breast cancer
is not associated with systemic absorption of sex hormones and may provide indirect evidence for the
safety of their use (Pavlović et al., 2019). The American College of Obstetricians and Gynecologists
(ACOG) recommends the decision to use vaginal estrogen may be make in coordination with a woman’s
This study source was downloaded by 100000852681095 from CourseHero.com on 01-28-2023 05:41:26 GMT -06:00
https://www.coursehero.com/file/103930810/Weekly-Clinical-Goal-DISCUSSIONdocx/
