The Sexual Changes of Menopause
Book Excerpt from Great Sex: A Man's Guide to the Secret Principles of Total-Body Sex by Michael Castleman
Many men believe that menopause involves a few weeks of hot flashes around a woman's 50th birthday. Menopause actually happens gradually over many years. And while hot flashes -- sudden feelings of uncomfortable heat -- are a hallmark of menopause, there's a lot more to it, including important sexual implications.
Menopause is a perfectly natural passage, but some women have a harder time of it than others. You should know what to expect and how to help when the woman in your life goes through it. If you're well informed and supportive, you can help minimize the upsets of this life transition and minimize disruption of your lovemaking.
Medically, menopause marks the end of women's fertility. Production of the female sex hormone estrogen gradually declines. As this happens, her ovulation and menstrual periods become less regular, and eventually cease.
Menopause is a fairly new phenomenon. As recently as 1900, American women's life expectancy was around 48, so few women lived long enough to experience menopause. Today, women's life expectancy is about 80 years, so most women live for decades beyond menopause. For much of the 20th century, physicians mistakenly considered menopause an illness that required treatment. Some women do, indeed, benefit from treatment of its symptoms. But in the last 25 years, women's health activists have reclaimed menopause for what it really is: a normal transition into a new stage of life, often one of productivity, wisdom, and personal fulfillment -- including sexual satisfaction.
The first thing men need to know about menopause is that estrogen production begins to decline during a woman's late 30s or early 40s. During their 40s, most women notice some menstrual irregularity -- skipped periods, heavy periods, spotting between periods, periods lasting longer than 7 days, or periods happening more frequently than usual. After age 45, most women notice the beginnings of the two major menopausal complaints: hot flashes and vaginal dryness, which become increasingly noticeable as they approach 50.
The second thing men need to know is that a woman's menopausal experience is unique. About 20 percent notice no physical changes, other than a gradual cessation of menstruation. About half of women experience mild discomforts. And 30 percent endure considerable distress. The reason? Women's broad range of reactions to hormonal changes.
Then there's "chemical" or "surgical" menopause, sudden loss of estrogen because of chemotherapy, usually for breast cancer, or removal of both ovaries, usually during hysterectomy or for treatment of ovarian cancer. Because chemical and surgical menopause occur suddenly, they tend to cause more severe discomforts -- and often well before age 50.
Here's what often happens when a woman experiences menopause.
Hot flashes. These sudden feelings of heat occur without warning and last from 30 seconds to 5 minutes. Usually the face, neck, and chest are most affected. Hot flashes often cause significant sweating. They can strike anytime, day or night. At night, they often disrupt sleep, spurring women to kick off the covers. Women who develop significant hot flashes typically have them for a year or two, though some experience them for longer. The cause of hot flashes remains unclear, but it appears that the estrogen decline disrupts the temperature-control center in the brain.
Until recently, many doctors treated hot flashes with hormone replacement therapy (HRT). It does, indeed, minimize hot flashes, but since 2002, when studies at the National Institutes of Health showed that HRT increases risk of several serious conditions it was once thought to prevent -- notably heart attack and stroke -- its popularity has plummeted. Prolonged use of HRT (for 5 years or more) also increases the risk of breast and ovarian cancer. Fortunately, non-HRT approaches can help, among them: regular exercise, soy foods (tofu and soy protein), relaxation therapies, vitamin E supplementation, eating less meat and more plant foods, and taking the medicinal herb black cohosh.
Pain on intercourse caused by vaginal dryness and atrophy. As estrogen declines, women produce less natural vaginal lubrication. The vaginal wall also thins. The result is chafing and pain on intercourse.
If you don't already use a sexual lubricant, start now. Lubricants substitute for lost natural vaginal lubrication and usually eliminate menopausal women's discomfort during intercourse. Saliva is rarely enough. For women over 40, lubricants often mean the difference between enjoyable and painful intercourse. (For more on lubricants, see chapter 11.)
Vaginal dryness can also be alleviated with a topical estrogen cream or a plastic ring inserted into the vagina that releases estrogen over time. Both require prescriptions. If the menopausal woman in your life is weighing her options, you should know that estrogen creams get absorbed into the bloodstream and cause the same long-term effects as HRT. Rings have only local action and do not carry HRT's medical risks. And most women prefer them. In one British study, 43 percent of estrogen cream users called their results "excellent," but among ring users the figure was 84 percent.
As the vaginal wall thins, even generous use of lubricant, or estrogen creams or rings, may not prevent irritation, especially with vigorous intercourse. Be gentle. Experiment with a sexual mix that involves less intercourse and more genital massage and oral sex. "But don't stop having intercourse," Alperstein advises. "There's a use-it-or-lose-it aspect to vaginal atrophy. Compared with women who stop having intercourse, those who continue tend to experience less vaginal atrophy."
Less sexual sensation. With age, genital bloodflow gradually declines. In older men this can produce unreliable erections. In women, it may decrease sensation in the clitoris and vulva. Bloodflow to women's nipples also declines, resulting in some loss of firmness during sexual arousal. Check in with her about this. Postmenopausal women might want to compensate for diminished sexual sensitivity by requesting changes in erotic stimulation. In addition, a lubricant often helps.
Libido changes. With menopause, many women notice decreased libido. Possible reasons include: the discomfort of hot flashes, feeling "old," vaginal dryness and atrophy, and lower levels of androgens, the male sex hormones that fuel libido in both sexes. In addition to libido loss, symptoms of androgen deficiency include: fewer sex fantasies, loss of energy, and depressed mood. Androgen supplementation is controversial, but it may help. (For more information, read chapter 14.)
Emotional upsets. The myth is that women become moody during menopause. The truth is that emotional reactions vary. Some women experience no mood changes, while others become depressed, nervous, irritable, and sometimes suffer insomnia. There's no way to predict who will experience menopausal emotional changes, but experts suggest that women with histories of significant premenstrual syndrome or postpartum depression earlier in life are at greatest risk because these conditions involve emotional reactions to hormonal changes.
Urine leakage. As a woman ages, her urinary sphincter may lose its ability to close completely, especially during orgasm, which can be embarrassing. Women can do the Kegel exercises mentioned in chapter 2. Added bonus: Kegels also enhance the pleasure of orgasm.
To help a woman cope with menopause:
--Ask about it. Don't wait for her to announce "I'm having a hot flash." If she's over 40, raise the issue. Ask her to keep you informed of her passage through menopause and her feelings as the process unfolds. Regular conversations not only provide you with valuable information, but also show her that you care. Discussions of menopause can deepen intimacy at a time when many women need reassurance that they are still attractive, valued, loved, and sexy.
--Listen to what she says. If she's not experiencing significant discomfort, she may not say much. But if she is uncomfortable, she may want to discuss her situation at some length. Listen to her. Menopause marks a significant personal change, and as such, it means a change in your relationship. Be ready for it. Be there for her.
--Gently correct misconceptions. The information here won't transform you into a menopause expert. But men aren't the only ones in the dark about it. Many women are more familiar with menopause mythology than with the facts. Just because her best friend had a rough passage doesn't necessarily mean she will. You might suggest she read -- or better yet, buy her -- a book that contains good information, for example, Women's Bodies, Women's Wisdom by Christiane Northrup, M.D. It contains an excellent discussion of menopause, including both mainstream and alternative treatments of its discomforts.
"No one wants to grow old," Weston explains, "but menopause rubs women's noses in the fact that they are aging. In addition to understanding how to cope with its symptoms, it really helps when men are kind, loving, and understanding. Emphasize sensuality, not just during lovemaking, but in your daily life together. Give her a back rub. Massage her feet or her scalp. Brush her hair. For most women, a little hands-on caring goes a long way."
(Reprinted from Great Sex: A Man's Guide to the Secret Principles of Total-Body Sex by Michael Castleman, Rodale Inc., Hardcover, $24.95. Permission granted by Rodale, Emmaus, PA 18098. Available wherever books are sold.)
Copyright © 2004 Michael Castleman.
Excerpted by permission from Great Sex: A Man's Guide to the Secret Principles of Total-Body Sex.Do you want to be a great lover and enjoy consistently great sex? Would you like reliable erections that don't wilt in the middle of lovemaking? Would you like superb ejaculatory control? Would you like your penis to be as large as it can possibly be? Do you want women to sing your sexual praises? All these sexual benefits can be yours if you read Great Sex and take its message to heart.
Author Michael Castleman is the nation's top journalist specializing in men's sexuality. He has been a sex educator, counselor, and writer for 30 years, including 5 years as the expert who answered the sex questions submitted to the Playboy advisor. Written with the help of an advisory board that includes some of the nation's leading sex therapists, Great Sex is certain to help you overcome your sex problems; become a better, more confident lover; and enjoy the sex of your dreams.
Castleman's message is surprisingly simple: Stop imitating the rushed, all-genital sex you see in pornography. Instead, cultivate the opposite: leisurely, playful, total-body, massage-based lovemaking that includes the genitals, of course, but is not focused on them.
Sex inspired by pornography is a major reason why men think their penises are too small and why they have erection and ejaculatory problems. With wit, wisdom, and down-to-earth sympathy for men, Castleman discusses his own penis -- like yours, it's a little too small -- and his own struggles with balky erections, rapid ejaculation, and not expressing orgasm at all. Then, based on state-of-the-art sex therapy techniques, leading sexology texts, and almost 400 medical journal articles, he reveals how to overcome these issues and enjoy a satisfying and exciting sex life.
What's more, the sexual style Castleman advocates is the way most women prefer to make love. Take Castleman's advice and you'll benefit by having a lover who is more arousable, responsive, enthusiastic, and complimentary. In other words, when you embrace sensual, creative, whole-body lovemaking, everybody wins. You have fewer sex problems. The woman you love gets what she wants in bed. And you both enjoy sex that's hotter, more erotic, and more fulfilling.
Author: Michael Castleman has been a sex and health writer since 1973. Library Journal calls him "one of the nation's leading health writers." His first book, Sexual Solutions, a self-help guide to men's sex problems, published in 1980, has since sold more than 500,000 copies. From 1991 to 1995, he answered sex questions submitted to the Playboy magazine Advisor. He has answered sex questions for Xandria.com, the nation's largest marketer of sex toys. He has written about sexuality for Reader's Digest, Men's Health, Men's Fitness, Men's Journal, Good Housekeeping, Family Circle, Redbook, Glamour, Ladies' Home Journal, Psychology Today, Self, Cosmopolitan, and Salon.com, among other publications. In 1996, he was nominated for the National Magazine Award for his coverage of breast cancer. Castleman is the author of nine other consumer health books. He graduated Phi Beta Kappa from the University of Michigan in 1972. He received a master's in journalism there in 1995 and 1996. Castleman lives in San Francisco with his wife (a family physician) and their two children.