Archive for May, 2016

A study just came out in the journal Clinical Anatomy. The study reviewed the scientific literature regarding male and female anatomy with regard to sexual performance. While no new stones were unturned, the study has perhaps confirmed a few things we already suspected.

Most of us (gasp!) don’t orgasm with vaginal penetration alone, even though we may have tried mightily, maybe wondered what was wrong with us, and maybe pulled off a few (or more than a few) fakes. Something like 70 percent of us rarely orgasm with penetration alone and 10 percent of us don’t orgasm at all. Most of us need a little additional help in the form of clitoral stimulation.

However, this new study does add some anatomical clarity to what we’ve suspected all along. Turns out, the distance between our urinary opening and the clitoris is the critical anatomical feature determining whether we orgasm easily—or at all. And that feature, like our eye or hair color, was determined in utero, before we were born.

The critical number for orgasm with penetration is 2.5 centimeters—that distance still allows the clitoris to be stimulated by vaginal penetration. If the clitoris is farther from the urethra than that, orgasm without additional stimulation is difficult or impossible.

“It’s so strong a correlation that if you give us a woman who has a distance of 3 centimeters, we can very reliably predict she won’t have orgasm with intercourse,” said Elisabeth Lloyd, an affiliated faculty scholar with the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University-Bloomington inthis article.

(You and your partner can do the measurement yourselves to figure out how to finesse your style.)

So all that performance anxiety—and maybe those faked orgasms—had nothing to do with your sexual skill or appetite and everything to do with your anatomy.  Which is something you can’t change, but you can work with.

Bottom line for women—for all women the clitoris is the critical organ when it comes to orgasm. The closer it is anatomically to the vaginal action, the more likely you’ll orgasm. If it’s farther away, you may want to switch up your moves.

You can't change your anatomy, but you can work with it.The best sexual positions to stimulate that little hot button are the good old missionary and the “cowgirl” with you on top. Maybe you’ve already discovered that some positions, notable the “doggy” style (rear entry) doesn’t work so well because it tends to stimulate the rear wall of the vagina and leaves the action far from the clitoris. If you can grind a little on his bones, you’re nicely positioned for direct stimulation. Either you or your partner can also include a little extra hand, mouth, or sex toy action if necessary—or nice.

So—get nicely lubed; don’t neglect the languorous foreplay; and practice positions that strategically stimulate the clitoris. And drop the worry about that elusive vaginal orgasm-with-penetration. There might not be such a thing. “To put this banner of healthiness [about] having orgasm with intercourse kind of stacks the deck against these women who, because of their anatomy, cannot have orgasm with intercourse,” Lloyd said.

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First, let’s get the lay of the land, even though it’s probably all review to you. To identify whether you’re overweight, the best (although not perfect) determinate is your Body Mass Index (BMI). It’s a simple calculation of your weight-to-height ratio, and it’s a more accurate assessment than weight alone.

(Here’s a tool to determine your BMI.)

Generally, a BMI score between 25 and 29.9 is considered overweight and over 30 is obese. If you fall within that range, you’ve probably heard all the risk factors associated with obesity, so I won’t reiterate.

But there are a few facts about obesity and sexual function—and aging in general—that might be helpful to know. While there’s some hemming and hawing about whether menopause and aging cause weight gain, there’s general agreement that fat deposits tend to redistribute themselves around the belly during menopause. Also that we tend to lose both muscle mass and metabolic efficiency as we age, making it easier to gain weight and harder to lose it.

So, if you’re heading into your menopausal years packing too many pounds, this might be a good time to tackle the problem. You’re on the cusp of a cascade of hormonal, metabolic, and physical change that will only exacerbate it.

Beyond the risk factors you’ve already heard, probably many times, obesity carries some very specific issues regarding sexual health. The most obvious? Sexual health tracks overall physical health. If you’re in good health, you’ll probably have more sex and enjoy it more. (Consider more and better sex one tempting carrot for losing weight.) Plus, studies repeatedly show that sex, in and of itself, is good for your health and sense of wellbeing.

You probably know that obesity is linked to higher risk for cardiovascular problems. For men, this often compromises blood flow to the penis, resulting in difficulty with erection and, consequently, with libido. A similar problem occurs in women.

“We are beginning to see that the width of the blood vessels leading to the clitoris in women is affected by the same kind of blockages that impact blood flow to the penis,” says Susan Kellogg, PhD, in this article about sex and weight.

Blood flow—and thus sensitivity—to the genitals often decrease during menopause, so coupled with excessavoirdupois, sexual sensitivity receives a double whammy.

The solution?

We need to learn to love ourselves first, in all our glory and our imperfections.A little targeted exercise to improve genital blood flow (as well as muscle mass in general) is a good place to begin. You don’t have to work out like Jane Fonda—a little of the right stuff goes a long way. “Any activity that increases blood flow to the large muscle groups in the thighs, buttocks, and pelvis—such as yoga, brisk walking, or cycling for 20 minutes three times a week is also going to bathe the genitals with better circulation,” Kellogg says.

Additionally, don’t neglect your pelvic floor. Excess weight puts extra stress on those overlooked muscles that hold a bunch of your abdominal organs in place. With menopause women tend to lose muscle tone as well, further affecting the pelvic floor. Lots of Kegel exercises will help increase circulation and tone that critical area.

To target blood flow to the genital area, you could also try a clitoral pump, of which I like the Fiera for ease of use. These devices use vibration or suction to improve circulation, and the Fiera in particular is easy to incorporate before foreplay.

Aging and the menopausal transition pose challenges to any woman’s self-image. As we’ve mentioned before, it’s hard to feel sexy when you’re focused on sags, bags, wrinkles, and cellulite. For obese women, body image can become a serious hurdle to pleasurable sex—or to having sex at all.

There are two ways to skin this cat, and they’re not mutually exclusive. You can begin to address with your overall health issues—and you don’t have to be the Biggest Loser to see significant improvement. Baby steps count, too. Small weight loss and a steady, gradual approach to improving your health can yield significant improvement in quality of life and improved self-image.

“I’ve noted that very often when patients start to take better care of themselves, they also report a substantial increase in their interest in sex. I think participation in a healthy lifestyle really helps, even if you don’t lose the extra pounds,” says Martin Binks, PhD, director of behavioral health at Duke University’s Diet and Fitness Center in Durham, North Carolina.

And you can also work on your self-image from within. If you feel sexy, you are sexy. “Don’t buy into society’s idea of the perfect sexual body, and do allow your own sexuality and sensuality to thrive inside the body you have,” says Abbie Aronowitz, PhD.

To that end, all the tips and tricks here on MiddlesexMD to jump-start libido and help you feel sexy are a click away.

A lot more research is needed to tease out the connections between obesity, aging, sexual desire, and performance. The hormonal dance in women is delicate and not well understood, and that may be compounded for those who go into menopause with extra weight. The good news is that small gains reap big rewards, both for sex and life in general.

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Satisfaction depends upon the health of both partners

Sexual satisfaction has many components, involving the emotional and physical health of both partners. Premature ejaculation is a common condition that can frustrate both, and can be difficult to talk about. Women who’ve had relatively few partners may not recognize premature ejaculation, and men sometimes respond to our cultural cues by pretending it hasn’t happened. So when Dr. Zvi Zuckerman MD offered to contribute an article on the topic, I accepted! (And I do note that couples who can talk about changes in their sex lives are well-equipped to navigate menopause.)

Premature ejaculation can have both physical and emotional ramifications for partners, as well as on men experiencing it. Women dealing with a partner’s premature ejaculation typically report reduced sexual satisfaction, loss of desire and orgasms, and an increase in both distress and interpersonal difficulties.

The abrupt end to sexual intercourse that accompanies premature ejaculation can result in a woman’s inability to climax, even from clitoral stimulation. Especially when not recognized and talked about, this can lead to resentment and anger, and even the refusal to engage in intimate relations.

So what exactly is premature ejaculation?  According to the medical definition, premature ejaculation is ejaculation that always or almost always occurs within one minute of vaginal penetration; it’s also the inability to delay ejaculation in all or nearly all vaginal penetrations. But these days more and more sex therapists describe premature ejaculation as ejaculation that occurs before the male wants it to occur. According to an extensive review published in the International Journal of Impotence Research: the Journal of Sexual Medicine, about 30 percent of men worldwide suffer from premature ejaculation.

If you are considering asking your partner to treat his premature ejaculation (PE), it is important that you understand the reasons underlying it and the importance of your role in the treatment.

Premature ejaculation is not a choice. It is important to know that PE is not dependent on your partner’s willingness; he most likely is interested in satisfying you and making you feel good. It is most likely that your partner truly wants to control his ejaculation, enjoy sex, and pleasure you but it just doesn’t happen. It is neither his fault nor yours. The inability to control the ejaculation reflex is a common problem among men. Why does it happen? The commonly accepted explanation is a connection between PE and the level of serotonin in the brain. If this level is too low (and, unfortunately, there is currently no way to measure this level in the brain), it might lead to this symptom. Your partner simply has no control over it. Given cultural norms, he’s probably insecure about it; talking about it at all can be perceived as criticism, which makes it a tough problem to solve.

PE can be resolved through practice. There is a treatment for premature ejaculation with a success rate of up to 90 percent. The treatment includes masturbation and full-penetration exercises for maintaining control over the ejaculation reflex. The results are long term and do not require the use of medication or chemicals. The treatment can be obtained in up to 12 clinical sessions with a sex therapist, or alternatively, at home with an online program that we have developed – the PE Program. The treatment will change your sexual relations: the erotic touch will become natural. His anxiety about PE will be a thing of the past and both of you will be able to give and take pleasure in your renewed sexual relationship.

The treatment is important to your partner’s self-esteem, your sexual relations and your relationship as a whole. Research shows that women in relationships with men who suffer from PE experience less sexual satisfaction. As important, the man’s anxiety can lead to the loss of intimacy and, especially if unexplained, stress in the relationship. Within up to three months of consistent practice of the exercises mentioned above, you can overcome this problem. The satisfaction that you will feel will improve not only your sex life but also the relationship itself, leading to greater intimacy and increasing your man’s self-esteem.

Talking about sex equips couples to navigate menopause.Be caring, supporting and loving toward your partner. You will benefit from the treatment by caring for your man, showing patience and openness, and being genuine in placing the aim of the treatment as your goal. If you are caring, loving and supportive toward your partner during the exercises, you increase your partner’s success in overcoming the problem. PE can cause men anxiety, frustration, and embarrassment in sexual encounters. As a supporting and loving anchor, you can help your partner to reclaim your love life together. Show understanding toward him; addressing PE requires that he make himself vulnerable. Avoid criticism and negative comments; encourage him and show empathy. He can gain better control over the ejaculation reflex, and make intimacy more satisfying for both of you.

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In the last couple of posts we talked about the significant subset of women who suffer from debilitating emotional swings during the menopausal transition—and also about their loved ones who suffer right along with them.

It’s a Catch-22. You truly can’t control the hormonal storm that lashes you with sudden waves of uncontrollable rage, sadness, irritation, anxiety, and depression. Yet, you really can’t unleash these emotions on the people closest to you. People whom you love and have no wish to harm.

If you are caught in that cycle, there is work to be done, stat, to stabilize your emotions and allow you to get through this transition without further disruption to your life or hurt to your closest relationships.

I’m going to lay out your options, but you also need to have a conversation with your doctor, who will assess your risk factors and monitor your response to treatment.

Before you consider medications, you must lay a foundation of good health habits, if you haven’t already. I’ve mentioned this, oh, maybe a thousand times before, but that’s because it’s so important. Good health hygiene is even more critical now because some of those bad habits could be messing with your mood.

Exercise regularly. Just 30 minutes of moderate daily exercise improves circulation, relieves stress, improves sleep, makes your heart stronger, and more to the point, improves mood by releasing endorphins, which gives you a little euphoric lift.

Bad habits could be messing with your mood.You also have to eat moderately and healthfully. That means cutting down on sugar and caffeine, which causes mood and energy to peak and crash. In Great Britain, fish and veggie-eating folks had fewer depressive episodes than their junk-food-eating colleagues. In Spain, those who filled up on nasty trans-fats from pastries and fast food were 48 percent more likely to be depressed than those who ate good fat, such as olive oil. (And these folks weren’t even menopausal!) Magnesium is also linked to mood and sleep, so a magnesium supplement might be in order.

At the risk of being an absolute killjoy, you also have to stop smoking and cut back on alcohol, both of which affect mood. Alcohol, of course, is a depressant. I’m not talking about a glass of wine with dinner, but about regular and/or heavy drinking.

A further brick in that health foundation is to develop a strategy for relieving stress—meditation, yoga, mindfulness practice, or another religious practice that is meaningful meditation, yoga, mindfulness practice, or another religious practice that is meaningful to you. These are known to relieve stress, stabilize mood, relieve pain, including psychic pain, and generally make life more hopeful.

I am not for a minute saying that an honest self-improvement plan will be easy or immediate—in fact, it’s a lifelong endeavor. I’m also not saying that good health alone will adequately address your menopausal mood swings. But I can assure you that getting in shape, eating well, and implementing a spiritual practice will absolutely help, both now and later.

Now let’s address the medical options. Your healthcare provider will need to work with you to find the best treatment. So it’s time for a heart-to-heart with your doctor. Ask her about:

  • Hormone Therapy (HT). We’ve learned a lot about HT over the last decade. For many women, it’s hormone fluctuations that lead to disruptive symptoms. Using hormones systemically to counter that can be a good choice for some women. Reviewing your health status and risks can help determine whether you’re a good candidate for HT. It’s even possible that going on a birth control pill for the hormonal effect might bring relief.
  • Mood medications. This approach, using anti-anxiety, sleep aid, or antidepressant medications, works on your brain rather than your hormones, and many women find them effective during this menopausal transition. Antidepressants work because the brain has many estrogen receptors, and when you lack estrogen, the feel-good neurochemical, serotonin, tends to break down. So, the class of antidepressant that may give you relief is called a selective serotonin reuptake inhibitor (SSRI), such as Prozac, Zoloft, or Celexa. Antidepressants can dampen libido, which is the last thing you need right now, so work closely with your healthcare provider to find the right medication and the right dosage. And addressing lack of sleep or an excess of anxiety can break the cycle just enough for some breathing room for taking control in other ways.

Medication isn’t a substitute for those common-sense efforts to improve your overall quality of life, but they can help you get through this bad patch.

This is a long journey, ladies, accompanied by a lot of turbulence and change. Life will be different—and very likely better—on the other side.

Traveling mercies.

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My friend has a story that her family laughs at now. She was a young adolescent when her mother hit menopause. She recalls tiptoeing to her mom’s bedroom with breakfast on a tray, opening the door very carefully, and sliding the tray through on the floor.

Then she braced for the explosion. Sometimes it came; sometimes it didn’t.

While this story became just a funny anecdote about mom’s menopausal years—part of the family lore—sometimes, the damage of menopausal misbehavior cuts deeper. Rather than a fond and humorous memory, when severe menopausal symptoms go unacknowledged and unrestrained, they can tear a family apart.

As I mentioned in my last post, many women suffer from sudden and uncontrollable emotional extremes. They truly can’t control the overwhelming depression, anger, and anxiety. But for every woman I see who is suffering from difficult menopausal symptoms, a family is often suffering right along with her. And just as often, this family consists of teens in the throes of their own hormonal stew and a spouse who may be confronting a mid-life transition as well.

The family doesn’t understand what’s happening to mom, and information is scarce as aphids on ice cream.

GPs have leaflets on everything... why not this?In the book, Sex, Meaning and the Menopause by British author Sue Brayne, one husband lamented, “I wanted to know about these hot flushes, so I trawled the internet. All I could understand is that the menopause is tied up with a system failure of some kind, which can end up with a hysterectomy. I’ve read virtually nothing about how relationships can become difficult at this time. GPs have leaflets on everything from bunions to teeth whitening, so why not this?”

Forums on the Internet sag under the weight of sad or angry comments about the state of life at home. “My mother’s menopause was the worst two years of my life,” writes one woman. “Unfortunately, it coincided with my being a teenager and living with her.”

“Our house is like a war zone,” writes another. “My mum behaves like a woman possessed… nothing seems to get through to her anymore.”

In her book, Brayne spoke with four men about their experience with menopausal wives. Of the four, one had become divorced, another had had an affair, which he ended. All four spoke with deep feeling about how the menopausal years had affected them.

And often, the most poignant regret has to do with sex.

“Sometimes it got so bad that I thought our marriage was over,” said one man. “I didn’t want to go near her. It was too dangerous because I never knew what response I would get.”

“The word I would use is despair,” said another. “It’s the recognition that, at the age of 62, I’ve had the best of my sex life. I don’t feel ready to give it up and I don’t want to give up my marriage either.”

“But sex was the glue that bound us together,” said yet another. “It helped us to feel warm towards each other. When that went, we were thrown back on our differences.”

... we tend to drop our pretenses and lose the filters.The misery in these comments is mirrored in statistics. While divorce rates among younger people have stabilized, rates among those over 50 have tripled in the last 10 years and are mostly initiated by women.

During menopause we tend to drop our pretenses and lose the filters. Doing what’s expected of us no longer seems as important as reclaiming who we are. These are all good things. But when our behavior is abusive, out-of-control, and damaging to our family, well… we wouldn’t allow our hormonal teens to act out like that, would we?

No matter how we feel, it isn’t okay to unleash our hormonal rage on those closest to us just because they have to take it. It isn’t okay to deny the damage or blame the hormones or model that behavior for our children.

And it’s critically important to keep the sex alive. You’ll find lots of solid information, suggestions, and products to help with that on this site. In the next post, we’ll talk about treatment options and strategies for dealing with out-of-control hormones.

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Menopause may not be a breeze, but for most of us, it is endurable. Our thermometer is out of whack; we lie awake listening to the bathroom faucet drip; sex is iffy and sometimes laborious. But we soldier on. We get through.

For some of us, however, menopause is a descent to an unexpected and torturous realm. For some few of us the emotional swings, the moodiness, paranoia, depression, along with all the other garden-variety menopausal symptoms, can be crippling.

“I don’t know why there isn’t disability for those of us who can’t get through this,” a patient said to me recently.

Almost assuredly (unless you work for me), your colleagues won’t understand, and there is certainly no quarter given for bad-estrogen days. In fact, you could be labeled as emotionally fragile and unreliable, as Rachel describes in this article:

I was upset at how I was being treated, and upset that in a testosterone-fuelled environment they might see me as a silly, weak female.

I cried in the loo several times, upset at the way people behaved to each other, and to me. When they had rows it really affected me, but there was no way I was going to tell male colleagues I was a hot hormonal mess so please be nice.

We may hang on by the skin of our teeth at work, but home is where the hormones rage. Is this because they have to love us anyway? Or because a pressurized vessel will burst at its weakest point? I don’t know, but tales from the home front are littered with collateral damage, as this hormonal mom describes:

I have never come so close to being mentally ill as when I experienced the roller coaster of hormone fluctuations and it scared the livin’ crap out of me. I would scream at my kids and immediately be remorseful, in tears and inconsolable as my ex lovingly shepherded the kids away from me, and then I’d turn right around and do it again. Free floating anxiety was a way of life and the irrational outbursts were like an out-of-body experience that I truly could not control.

Or this from a husband:

I had a few years where patience was the central character of my personality. If she said it was too hot, I would agree and turn the air- con down. If she thought she was growing a tail (yes, this happened) I would physically examine her and afterwards suggest we go see the GP to see what could be done.

Obviously, hormones are not to be trifled with. The hormonal changes we experience during menopause can be unpredictable and powerful. And they can take years to sort themselves out. This is not to suggest that you are a complete victim to your chemical malfunction. In fact, I’d like to stress three things:

Hormonal changes can be unpredictable and powerful.You aren’t alone. Some 1.3 women in the US reach menopause every year. About 10-20 percent of them have severe emotional responses or are considered depressed. That’s a lot of women! You can’t go around quizzing every harried woman of a certain age about her mental health, but it sure helps to find someone with whom to share the joy.

Rachel, for example, found a friend who was going through the same thing. They’d text each other at work with status updates:  “6/10 today, not too bad.” “I’m only a 4. Might jump off the balcony.”

You can find help. Granted, the path isn’t clear, and it isn’t easy. There is no magic bullet, but you may be able to cobble together a makeshift flotation device. Start with the basics: eat well and healthfully. Exercise moderately and regularly. Try to decrease bad habits, such as smoking or drinking. This may sound like a matchstick in a hurricane, but look at it as laying a foundation to build on for the rest of your life.

Create a support staff. In this case, you need a few good friends, an excellent healthcare provider, and the understanding of your family. You may have to sit your family down and explain that you’re in the midst of a transition that could take some time. That the going may be rough for a while. That you’ll try as hard as possible not to take your mood swings out on them, and they are not to take it personally if you slip up.

Your healthcare provider is a critical brick in your foundation. Many doctors aren’t well-informed about this tricky state of life, and it’s easier to pat you on the head than to work with you to sort out a solution.

Seek out an ob/gyn who specializes in menopause or an endocrinologist. Alice Chang, a Mayo Clinic endocrinologist, says in this article, “You need to find a doctor who will really talk to you and listen to your concerns. The doctor should assess your risk factors and understand the benefits and risks you face. Right now, people just don’t know enough about the data, and it is easier for doctors not to prescribe at all.”

It will end. The menopausal transition (called perimenopause) takes time—years, actually. This is a significant hormonal change from your fertile, child-bYou aren't alone. You can find help. It will end.earing years to a mature female elder. No other mammal goes through this transition. It’s an important transition to mark, and even celebrate (if you weren’t too sweaty, moody, sleep-deprived, and bloated). But you might also consider the alternative—being fertile until you die!

But I digress.

The point is, menopause can be a wild, scary, and unpleasant ride, but at some point, your menses will end, and your hormones will settle down. After 12 months without a period, you are officially post-menopausal. And this could be a time of great contentment.

Here’s how one blogger describes it, “…the days of eye-bulging, vein-popping, scream-until-you’re-hoarse type of moods swings are long gone.  In fact, they are so far removed from my day to day life now, that I can hardly believe I ever went through them.”

Wait for it. Peace will come.

In the meantime, understand that the emotions driving you aren’t due to character, discipline, or genetic weakness. They’re an effect of fluctuating estrogen and progesterone. Period. While you may need help to get through, it isn’t because you’re flawed or willfully out-of-control.

As a healthcare provider told our hysterically sobbing, menopausal blogger, “This is not a control issue. It’s about your biology.”

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This is the sixth post in our occasional series inspired by the results of a survey we co-sponsored withPrevaLeaf, makers of natural products for intimate wellness. You can read our first post here, and catch up from there: You spoke. We’re listening.

Years ago, after the birth of her first child, a friend’s daughter challenged her mom, “Why didn’t you tell me all this stuff was going to happen?” The “stuff”my friend’s daughter was referring to were the very natural and often enduring effects of childbirth: hemorrhoids, incontinence, stretch marks, weak abs. You knowWhy didn't they tell me all this stuff was going to happen?, the insults we learned to live with long ago.

Preparing her daughter for these commonplace but distressing changes never occurred to my friend. She’d forgotten the shock she had felt when she looked at her own ravaged body after the birth of her first child… because life goes on.

I mention this because a couple of your comments in our survey about vaginal dryness reminded me of this incident:

I am all about health, nutrition, and exercise, so menopausal symptoms were not too severe—until the vaginal dryness. That came as a surprise, and I am still a little bit angry about that. Sex is supposed to be playful, fun and a stress release… not this much work to keep things going.


When vaginal secretions dried up I felt betrayed. Creams help but are no cure-all. I was not prepared for loss of libido. I naively thought retirement would be a chance to catch up from all of the missed sex due to overwork and exhaustion. Now I have the time but not the interest. Cruel trick.

These respondents are right on both counts: sex during (and after) menopause should be playful, fun, a stress-reliever. Something that you finally have time for. But loss of libido and vaginal dryness are some of the most common effects of menopause, and they very effectively  suck the joy right out of sex. Maybe a cruel trick, yes, but also totally normal. To be expected. And, like the effects of childbirth, effects we can learn to work around. If we know about them and can prepare.

I’m thinking that if “someone” had told us what to expect, sexually speaking, during menopause, maybe there would be less shock, dismay, disappointment, and frustration. I’m not sure who that “someone” should be—mothers, older sisters, friends? But certainly it’s time for a greater cultural awareness and openness for straight talk about sex after menopause. (Well, at all stages, really.)

Which brings me to another comment from our survey:

I am 71 years old, married 44 years. I was told practically nothing about sex. My mom did not talk about getting older, and I am sorry because I am finding out things I could have known to expect, like dryness, hair loss, the need to cultivate intimacy. Our daughter is 42 and has never been comfortable mentioning women’s issues so I just tell stories about what my mom did, how I interpreted that, and how I experience it now. Hopefully she will have some thoughts about what to expect.

We need to tell our friends and daughters the stories.Every woman experiences menopause uniquely. The effects can creep up gradually and may last for a long time—the rest of your sexual life, in the case of vaginal dryness. So it’s hard to prepare for exactly how you will experience “the change,” just as you couldn’t prepare, exactly, for how you would experience childbirth. But for childbirth, at least, you probably read books and attended classes to learn as much as you could. Shouldn’t we do the same for menopause?

For each of the life passages unique to women, there is a well-trodden path to mark the journey. And in the case of menopause, it’s clearly one that women need to know more about ahead of time.

We need to tell our friends and daughters the stories.

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