臺灣博碩士論文加值系統

陰道症狀是個人隱私健康問題，國內探討停經婦女陰道症狀困擾及其自我處理經驗的研究仍較少見。本研究目的為探討停經婦女陰道症狀之困擾、頻率及其自我處理情況，以及婦女歷經此陰道症狀的主觀經驗。以期作為協助停經婦女於陰道症狀困擾照護之重要參考資料。
本研究利用三角交叉（Triangulation）檢視法，採質量性並行的研究方式。以立意取樣及利用滾雪球方式於96年12月至97年6月北區某區域教學醫院，對停經一年以上並有陰道症狀困擾婦女進行資料收集。量性方面：以停經婦女陰道症狀量表、自我處理陰道症狀及自覺成效量表，共收集51位婦女；此外，在51位婦女中，有19位婦女接受深入訪談其陰道症狀之主觀經驗。量性資料以SPSS16.0進行描述性統計分析，質性資料以內容分析法進行資料分析。
一、量性研究結果顯示：本研究對象平均年齡56.94歲，平均距最後一次月經時間為6.58年，有陰道症狀平均為2.64年；陰道症狀發生頻率及困擾為接近偶爾發生及輕度困擾；婦女常用之自我處理的方式，前6名依序為：只用清水洗滌，使用陰道保濕潤滑劑，穿100％純棉質內褲，吃食品改善體質，使用口服荷爾蒙製劑，穿寬鬆內褲。而這些方式之自覺成效為介於稍微有效和有效之間，其有效程度之前6名為：純棉質內褲、口服荷爾蒙製劑、寬鬆內褲、不含荷爾蒙的陰道軟膏、陰道保濕潤滑劑及清水洗滌。
二、質性研究結果顯示六大類屬及其次類屬為：（一）、自覺陰部不適感：刺痛感、閉合及乾癢感、疼痛感。（二）、不便啟齒的私密與內心感受：不輕易與人分享、自我私下處理、學習忍耐、害怕與無助。（三）、就醫求診意願低：曝露隱私的尷尬、拒絕只開荷爾蒙的醫生、症狀不嚴重到影響日常活動。（四）、日常生活的困擾：不敢公開抓癢會陰部、羞於公然購買會陰產品、出門無法簡便。（五）、自我尋求資源處理：求助專業人員、透過報章媒體獲得知識、嘗試自我處理陰部變化、參加團體尋求資源。（六）、性生活的衝擊與因應：對性生活意願低、與伴侶取得對性生活共識。
以上研究結果顯示停經婦女於陰道症狀困擾上的健康需求，婦女不輕易說出或求醫，影響性關係，但礙於隱私而選擇自我處置，卻無足夠資訊能供選擇等，醫療人員應主動察覺並提供有陰道症狀困擾之停經婦女對陰道症狀及自我處理方式的相關訊息，以增進婦女自我保健。

Vaginal symptoms are common health problems. However, these symptoms are involved with privacy for menopausal women who often treat them by self-management. Few studies about disturbance and self-management of vaginal symptoms among menopausal women were conducted in Taiwan. The purposes of this study were to explore the following issues:
1. Disturbance, frequency and self-management of vaginal symptoms among menopausal women
2. The subjective experiences of vaginal symptoms among menopausal women
In this study, triangulation research design was used. It was conducted by quantitative and qualitative approach. Data collected by purpose sampling and snowball from 2007 Dec to 2008 Jun in Taipei City. In quantitative approach, fifty-one women aged from 48 to 68 were recruited by questionnaires of menopausal vaginal symptoms scale, self-management and the effectiveness of management in vaginal symptoms. Nineteen of 51 women were interviewed for their subjective experiences of vaginal symptoms. The collected data were analyzed by the statistical software, SPSS 16.0 for quantitative data and content analysis for qualitative data.
The Results showed as follows:
1.Quantitative Research:
The mean age of the women was 56.9 years. The mean period after last menstrual period was 6.58 years. The mean duration of vaginal symptoms was 2.64 years. In terms of frequency, most vaginal symptoms occurred occasionally. The disturbance of vaginal symptoms were mild degree. The first six methods ranked by frequency in women's self-management for vaginal symptoms were washing vaginal area with water, using vaginal lubricants , wearing 100％ cotton quality underwear, eating healthy food to improve body constitution, taking oral hormone therapy and wearing loose pants. The first six managements ranked by effectiveness were wearing 100％ cotton quality underwear, taking oral hormone therapy, wearing loose pants, applying non-hormonal vaginal cream, vaginal lubricants moisture and washing vaginal area with water.
2.Qualitative research:
Six categories and their sub-categories as listed as follows:（1）. self-awareness of the of vaginal symptoms included stinging pain, dryness and itchiness and soreness;（2）. hestate to share with this private issues and feelings included no sharing with others, self-management, learning to endure, fear and helplessness; （3）. unwillingness to visit physicians because of shyness to expose the private area, disapproval to take HRT and symptoms not so serious to influence daily life;（4）. disturbances in daily life included avoiding touching the itching vagina in public, shyness to buy vaginal products, inconvenience outdoors; （5） self-seeking resources to deal with symtpoms included ask for help of health professionals or supporting club, seeking knowledge from newspapers and trying self-management;（6）. impact and coping style on sexual life including of low willingness of sexual life, try to obtain consensus with sexual partners.
Vaginal symptoms had impacts on the distress of physical, mental and sexual life for menopausal women. However, these symptoms are private issues for women. Most women would choose self manage instead of seeking for medical help. Health providers should be more alert to vaginal symptoms in menopausal women and more aggressive to provide health education for awareness and self-management about vaginal symptoms in such women.

目 次
誌謝...............................................................I
中文摘要..........................................................II
英文摘要......................................................... IV
目次.............................................................VII
表次...............................................................X
圖次..............................................................XI
第一章 緒論.......................................................1
第一節 研究動機與重要性.......................................1
第二節 研究目的及意義.........................................4
第三節 研究問題...............................................5
第四節 名詞界定...............................................6
第二章 文獻探討...................................................7
第一節 陰道對女性的意義.......................................7
第二節 停經婦女陰道症狀及症狀困擾之相關研究...................9
第三節 停經婦女自我處理其健康問題相關研究....................13
第三章 研究方法..................................................16
第一節 研究設計..............................................16
第二節 研究對象..............................................17
第三節 研究工具..............................................18
第四節 參與者之權利維護......................................20
第五節 資料收集與分析........................................21
第六節 嚴謹度................................................24
第七節 準備性研究............................................26
第四章 資料分析與結果............................................28
第一節 停經婦女陰道症狀之困擾及其頻率和自我處理之效能........28
第二節 停經婦女對於陰道症狀之困擾及其自我處理情況的主觀經驗..35
第五章 討論......................................................56
第一節 停經婦女陰道症狀之困擾及其頻率和自我處理之效能........56
第二節 停經婦女對於陰道症狀之困擾及其自我處理情況的主觀經驗..61
第六章 結論與建議................................................67
第一節 結論..................................................67
第二節 應用與建議............................................69
第三節 研究限制..............................................75
參考文獻..........................................................76
附錄一、參與錄音訪談同意書........................................82
附錄二、參與問卷調查研究同意書參與問卷調查研究同意書.... .........83
附錄三、訪談指引..................................................85
附錄四、訪談指引修訂版..............................................86
附錄五、專家效度名單...............................................87
附錄六、停經婦女陰道症狀量表、自我處理陰道症狀及自覺成效量表.......88

台灣更年期醫學會（2007，8月13日）．2007年台灣更年期醫學會荷爾蒙治療指引．2008年5月23日取自http://ebpg.nhri.org.tw/(A(tA3yRk-MyAEkAAAAZTZmM2U0MDItNGZlMS00Mzk3LTliY2EtNTM3ZTQ5ZjJjMTNmFK3RO8P0PGg3vuPpvmyuaQHDJwY1))/Module/GuideLine.aspx?pid=9
台灣女人連線2006V-Day台北「創意陰道新印象」作品發表記者會（ 2006，3月5日），2007年10月30日取自http://www.twh.org.tw/12/07-11.html
安奇（2005）‧婦科門診個別諮詢介入對更年期婦女之更年期症狀困擾、健康行為及自覺健康狀況成效之探討‧未發表的碩士論文，台北：國立台北護理學院護理研究所。
牟珊珊、陳志明（2007）．停經症候群之處理．基層醫學，22（12），450-455。
余玉眉、田聖芳、蔣欣欣（1991）．質性研究—田野研究法於護理學之應用．台北：巨流。
李逸（1995）．婦女因應停經之自我照顧行為．未發表的碩士論文，高雄：高雄醫學院護理學研究所。
李逸、王秀紅(2000)．中年婦女之停經經驗與自我照顧行爲．護理研究，8（1），71 -84。
李麗燕（2001）．化學治療後乳癌婦女的性功能影響因素探討．未發表的碩士論文，台北：台北醫學院護理學研究所
林瓊華（2002）．社區更年期婦女生活品質及其相關因素之探討．未發表的碩士論文，台北：國立台北護理學院護理研究所。
周蒨、劉曉璦(2005)．經陰道補充雌激素的臨床研究進展．國外醫學計劃生育/生殖健康分冊24（5），225-228。
梁文倩（2003）．停經過程婦女性生活滿意度之探討-以高雄市楠梓區婦女為例．未發表的碩士論文，台北：國立台北護理學院護理研究所。
張珏、周松男、陳芬苓、張菊惠(1995)．一般經期舆更年期自述症状的研究．中華公共衛生雜誌，14（2），191-200。
黃文三（1999）．近三十年來我國青少年性別角色研究的回顧與分析．教育學刊，14，231-274。
黃建勳（2004）．更年期婦女接受荷爾蒙補充療法決定因素與行為意願關係之研究．未發表的碩士論文，桃園：元智大學。
莊義利（2005）．台灣地區民國91年國民健康促進知識態度與行為調查--縣市衛生保健議題分析研究成果彙編．台北：行政院衛生署國民健康局。
游淑香（2004）．拋出我的女性健康隱私～青少女婦女健康問題求醫經驗．未發表的碩士論文，台北：國立台北護理學院護理研究所。
曹麗英（1998）．台灣婦女更年期經驗之探討－處於健康多變化的時期．護理研究，6（6），448-460。
曹麗英、蘇美禎、邱小鳳（2002）．中醫及西醫門診求醫婦女更年期症狀困擾情況之探討．長庚科技學刊，1，91-102。
鄭丞傑（2005）．面對更年期的性生活．中華民國內膜異位症婦女協會會刊，12（2），7-8。
劉政賢、黃月嬌（2004）．淺談更年期乾燥症的辨證論治．中醫婦科醫學雜誌4，64-68。
潘淑滿（2003）．質性研究：理論與應用．台北：心理。
賴裕和（1998）‧門診接受化學治療病人之症狀困擾及居家照顧護理需求之探討‧護理研究，6（4），279-288。
盧孳艷、楊舒琴、林雪貴（2002）．更年期婦女的健康．護理雜誌，49（2），17-21。
蕭淑代（2003）．婦科門診更年期護理諮詢方案成效探討．未發表的碩士論文，台北：臺北醫學大學護理研究所。
韓令愈（2004）．針對規律運動對停經後婦女心肺耐力、更年期困擾、生活品質、及骨質密度影響之探討．未發表的碩士論文，台北：台北醫學院護理學研究所。
蘇美禎、黃璉華、曹麗英、周松男(2003)．更年期婦女健康需求．台灣醫學，7（5），708-716。
關蓮娟(2007)．更年期女性聰明健康飲食觀．中華民國內膜異位症婦女協會會刊14（2）卷期，10-10。
Ensler, E. (2000)．陰道獨語（陳蒼多譯）．台北：新雨。（原著出版於1998）
Topp, E., & Livoti, C. (2006)．Vaginas 陰道：使用者手冊（陳美君譯）．台北：商周。（原著出版於2004）
Bachmann G. A. (1995). Influence of menopause on sexuality. International Journal of Fertility and Menopausal Studies, 40(1), 16-22.
Barclay, L., & Vega, C. (2007, May 15). New guidelines issued for treatment of vaginal atrophy. Retrieved Nov 19, 2007, from http://www.medscape.com/viewarticle/556471
Barnabei, V. M., Grady, D., Stovall, D. W., Cauley, J. A., Lin, F., Stuenkel, C. A., Stefanick, M. L., & Pickar, J. H. (2002). Menopausal symptoms in older women and the effects of treatment with hormone therapy. Obstetrics & Gynecology, 100(6), 1209-1218.
Chow, S. N., Huang, C. C., & Lee, Y. T. (1997). Demographic characteristics and medical aspects of menopausal women in Taiwan. Journal of the Formosan Medical Association, 96(10), 806-811.
Clark, N. M., Becker, M. H., Janz, N. K., Lorig, K., Rakowski, W., & Anderson, L. (1991). Self-management of chronic disease by older adults. Journal of Aging and Health, 3, 3-27.
Dennerstein, L., Randolph, J., Taffe, J., Dudley, E., & Burger H. (2002). Hormones, mood, sexuality, and the menopausal transition. Fertility and Sterility, 77, 42-48.
Fiddes, P., Scott A., Fletcher J. & Glasier, A. (2003).Attitudes towards pelvic examination and chaperones: A questionnaire survey of patients and providers. Contraception, 67, 313-317.
Ganz, P. A., Desmond, K. A., Belin,T. R., Meyerowitz, B. E. & Rowland, J. H. (1999 ). Predictors of sexual health in women after a breast cancer diagnosis. Journal of Clinical Oncology, 17 (8), 2371-2380.
Holmes, S. (1991). Preliminary investigations of symptom distress in two cancer patient populations：Evaluation of a measurement instrument. Journal of Advanced Nursing, 16(4), 439-446.
Katz, A. (2007). When sex hurts: Menopause-related dyspareunia, vaginal dryness and atrophy can be treated. American Journal of Nursing, 107(7), 34-39.
Knobf, M. T. (2001). The menopausal symptom experience in young mid-life women with breast cancer. Cancer Nursing, 24(3), 201-210.
Leining, M.G., Gelber, S., Rosenberg, R., Przypyszny, M., Winer, E. P., & Partridge, A. H. (2006). Menopausal-type symptoms in young breast cancer survivors. Annals of Oncology, 12, 1777-1782.
Lincoln, Y. S., & Guba, E. G. (1985). Establishing trustworthiness. In Naturalistic Inquiry (pp. 289 331). Beverly Hills: Sage.
Lorig, K. (1993). Self-management of chronic illness: A model for the future. Generations, 17(3), 11-14.
Maartens, L. W., Leusink, G. L., Knottnerus, J. A., Smeets, C. G., & Pop, V. J. (2001). Climacteric complaints in the community. Family Practice, 18, 189-194.
McCoyand, N. L., ＆ Davidson, J. M. (1985). A longitudinal study of the effects of menopause on sexuality. Maturitas, 7(3), 203-210.
Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis. Thousand Oaks, CA: Sage.
Mishra, G., & Kuh, D. (2006) Sexual functioning throughout menopause: The perceptions of women in a British cohort. Menopause, 13(6), 880-890.
NIH State-of-the-Science Panel (2005). National Institutes of Health State-of-the-Science Conference statement: Management of menopause-related symptoms. Annals of Internal Medicine, 142(12 Pt 1), 1003 1013.
North American Menopause Society (2007). The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. Menopause, 14 (3 Pt 1), 357-369.
Sandelowski, M., David, D. H., & Harris, B. G. (1989). Artful design: Writing the proposal for research in the naturalist paradigm. Research in Nursing & Health, 12, 77-84.
Stenberg, A., Heimer, G., Ulmsten, U., & Cnattingius, S. (1996). Prevalence of genitourinary and other climacteric symptom in 61- year-old women. Maturitas 24, 31-36.
Theroux, R. (2002). Bypassing the middleman: A grounded theory of women's self-care for vaginal symptoms. Health Care for Women International, 23(5), 417-431.
Tsao, L. I. (1997). Living with changing health: Perimenopause among Chinese women in Taiwan. Unpublished doctoral dissertation, School of Nursing, University of San Diego.