MENOPAUSE AND THE FEMALE SEXUAL RESPONSE
The following articles appear below:
PERIMENOPAUSE, MENOPAUSE AND SEX
Robert W. Birch, Ph.D. Sexologist & Adult Sexuality Educator PERIMENOPAUSE
Menopause is a gradual process that will occur in every woman at some point in her life. The initial phase of this process leading up to menopause is called the perimenopause, which usually lasts about five years. The perimenopause is a normal transition in a woman's life, although each woman's experience can be different. Most women, however, experience a decreased ability to become pregnant as her ovaries begin to change. During the perimenopause a woman's menstrual periods are likely to become irregular and sometimes heavy. A woman should talk to her health care professional if she is experiencing heavy vaginal bleeding, long intervals of spotting, or has gone more than two months without a period.
In addition to changes in a woman's menstrual cycle, variations in breast tenderness or fullness is common. It is during the perimenopause that about three-quarters of all women begin to experience hot flashes and night sweats. These might be associated with a reddening of the skin, chills, a clammy feeling, heart palpitations or a tingling sensation.
For most women, the perimenopause is not difficult, usually experienced simply as a normal transition in their lives. During this time of life, mood swings are not unusual among both men and women. This is a time in life when children are leaving home, parents are growing older, financial demands might be increasing, and career changes might be occurring. Thus the moodiness of the perimenopausal woman might not be totally the result of perimenopausal hormonal changes.
Furthermore, hormonal shifts during this time can cause sleep disturbances, and lack of sleep can lead to fatigue, irritability and a decreased sense of well-being. Migraine headaches may become more frequent. Loss of sleep and frequent headaches can easily influence moods. While there is no clear evidence showing a direct link between perimenopause and all the behavioral problems or emotional symptoms that occur during this transition, some women do experience mood swings similar to what they experienced during their menstrual cycle, although more unpredictably.
Perimenopause is a time of decreasing ability to become pregnant. Although less likely than when a woman is in her twenties or thirties, it is still possible. About two-thirds of women between the ages 40 and 44 still ovulate regularly and are therefore at risk for an unintended pregnancy. Unfortunately, the medical risks associated with pregnancy increase dramatically at this time and as the woman ages. To avoid an unintended pregnancy, contraception should remain an important part of woman's sexual behavior.
Most women do not experience major changes in their sex lives during the perimenopause. A woman's sex life will probably be the same after the perimenopause as it was before. She might, like 20% of menopausal women notice more vaginal dryness during the perimenopause, even when feeling aroused. This is the body's normal response to a decreased level of the hormone estrogen, but can make sex play and intercourse uncomfortable. More prolonged non-genital foreplay may be required, and for additional lubrication, a safe, water soluble sexual lubricant (such as Astroglide or K-Y Liquid) can be used.
Some women do experience a decrease in sexual desire during perimenopause or after the menopause. However, this may be due to a number of different factors that are not always physical. One of the most damaging factors is how the woman feels about her partner. It there are negative feeling that go back over years and over many different issues, the impact will be far more powerful at any stage of life than the woman's hormonal changes of the menopause. On the positive side, with children gone a couple has time to work on their relationship, to create more romance, and to leisurely enjoy their sexuality.
The role of hormones in a perimenopausal or menopausal woman's sexual response cycle cannot be denied. As mentioned, a decrease in estrogen is likely to impact a woman's ability to lubricate. In addition, it has been found that a woman's testosterone levels start to fall well before menopause. Women in their early forties have about half the testosterone of women in their early twenties. For most women this is enough, but for others, sex drive, energy levels, motivation, and muscle strength suffer. A woman who has lost her sexual desire, the motivation for sex, should discuss this with her physician and ask about having hormone levels assessed.
MENOPAUSEMenopause is marked by a woman's last monthly period, representing the ending of the active functioning of her ovaries. The onset of the process leading to the menopause typically occurs between the ages of 45 and 55, but every woman follows her own biologic clock. As mentioned above, the perimenopause can last up to 5 or more years. For most women, the menopause will occur around 51 years of age, though for some it will be as early as 40 and for others as late as 60.
Bladder problems affect about 40% of women over 45 years of age. Lower estrogen levels might be involved in this decreased bladder control. There can be the need to urinate more frequently, or the leakage of a small amount of urine during a sneeze, cough or laughter. Often a woman is advised to do the Kegel exercises to improve their bladder control. The Kegel exercises also tone up the pelvic floor muscles, and these are the muscles that contract during orgasm. Theoretically, the better the muscle tone, the more intense the orgasms. This is important, as some women report a decrease in orgasmic intensity as they approach and enter their menopause. (A number of free articles on female orgasm can be found on Dr. Birch's larger educational and sex help site.)
It is important to maintain a wide variety of sexual activity during the perimenopausal phase and into menopause. This should include lots of touching, hugging, massage, erotic fantasy, and non-intercourse sex play such as oral and manual stimulation of the genitals. The only things that would limit an aging couples sex play is the mutual loss of interest, commitment, and imagination. The old "use it or lose it" adage applies to both the aging male and aging female.
There are, of course, special sexual challenges as we age. Often through divorce, hospitalization, death, or lifelong singlehood, individuals do not have a regular partner. Masturbation is a normal and healthy option for those comfortable with self exploration, pleasuring, and satisfaction.
Modern medicines and hormone replacement therapies add years to our life, and life to our years. Who says sexuality is just for the young, healthy, and able-bodied?
©2002 Robert W. Birch, Ph.D.
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THE KEGEL EXERCISES
Robert W. Birch, Ph.D. Sexologist & Adult Sexuality Educator A band of muscles stretch between the legs of both men and women, stretching from the pubic bone in front to the coccyx (tail) bone in back. Playfully, we could say that with out these muscles, all of our internal organs would fall out! Along their way, this sling of muscles includes the sphincter of the bladder, the sphincter of the anus, and, in a woman, the sphincter surround the opening of her vagina. These muscles are clinically known as the pubococcygeus (pronounced pew-bo-kak-se-gee'-us) muscles, but this group of muscles is more commonly called the "PC muscle." To talk as though there is just one muscle is an over-simplification, for there are actually a number of muscle groups that collectively make up this pelvic floor sling. We'll use the plural and call them the PC muscles.
Many younger women have been introduced to their PC muscles during a pregnancy or during a postpartum exam when they were advised to exercise these muscles in order to restore muscle tone following childbirth. Many older women have been introduced to their PC muscles because these are the muscles that are exercised to correct the condition known as urinary incontinence (the involuntary loss of urine when coughing, sneezing, etc.). In fact, the exercise of these PC muscles as a medical treatment for urinary incontinence was first proposed in1950 by the surgeon Arnold Kegel, for whom the exercises have been named.
In 1952, Dr. Kegel published a report in which he claimed that the women doing his exercises were becoming more easily, more frequently and more intensely orgasmic! As these are the muscles that contract rhythmically during orgasm in both males and females, it is not surprising, therefore, that sex therapists have emphasized the importance of these pelvic floor muscles that surround the vaginal opening and play a major role in the orgasmic response.
Thirty years after Dr. Kegel's article, sex therapist Bryce Britton wrote a book titled "THE LOVE MUSCLE," calling her publication "Every Woman's Guide to Intensifying Sexual Pleasure." Many people still refer to the PC muscles as the love muscle. Now, almost 50 years after Dr. Kegel published his discovery, and after several decades of "prescribing" the Kegel exercises as a component in teaching women to become orgasmic (or more easily orgasmic), what can we say about "Kegeling" the love muscle? We can say that doing the exercises will tone up the sphincter of the bladder and might tighten the muscles around the opening of the vagina. We can also assume that any well-toned muscle will contract more powerfully than would a flabby muscle, and hence the likelihood of stronger orgasms with stronger PC muscles. We can report with confidence that some women squeeze their PC muscles, forcing blood down into their genital tissue, and in so doing turn themselves on. A very small minority of women might even be able to bring themselves to orgasm exclusively with voluntary pelvic floor contractions. Finally, it is safe to say that a woman can add novelty to a sexual encounter by voluntarily squeezing her well-toned vaginal sphincter around her partner's penis, and this might be fun for both giver and receiver.
What can most confidently be said about the entire "PC muscle controversy" is that in doing Dr. Kegel's exercises, a woman will achieve closer contact with her pelvis, is more likely to take ownership of her internal and external genitalia, will strengthen the muscles that contract during orgasm, and is probably making an investment in her lifelong urinary control! Is it a major component in a woman becoming orgasmic? Probably not, but it is certainly something non-orgasmic women should include in their quest for the "Big O." It is a part of the learning package.
DOING THE KEGEL EXERCISES
In getting started with the Kegel exercise of the PC muscles, the first task for many women is to locate them. The best advice for finding the muscles is to do so while urinating. Sitting on the toilet with legs slightly spread, try to interrupt the flow of urine without bringing your legs together. Stop and start the flow, trying to sense those muscles that are involved. Once you can control the flow of your urine and can also find and squeeze them when not on the toilet, you have identified this band of important pelvic floor muscles.
Remember, these muscles are not located in your abdomen, nor are they in your thighs! Try to isolate the muscles so you can tighten them without flexing your "abs" and without putting tension in your legs. It might take time to fine-tune your ability to find, isolate and contract the muscles, so do not become discouraged if you have difficulty at first.
Once you know you have found your PC muscles, you will find that you can flex them ("Kegeling") most any time you choose and without being noticed by others who might be around you. Doing a series of Kegel exercises each day in the course of typical activities is most helpful. For women who drive or ride to and from work each day, a practical plan is to do a series of contractions at each red light encountered, or at each gas station passed, or in response to some other reminder. While watching TV, squeeze your PC muscles during each commercial. Contract the muscles and hold them tight for a slow count to five. At first you might not make it to five, but keep trying. As with any muscle, the more you exercise that muscle, the less effort is required to tighten it and the longer you will be able to keep them tight.
In addition to taking advantage of opportunities in your daily life, set aside specific times when you can be alone at home. Lay down and relax. Starting with a warm bath might help. In your mind, find those PC muscles. Then begin tightening and relaxing five times, each time holding the contraction for a slow count of five. Your goal over a period of time is to increase the number of contractions and the length of time held (although there is a limit to which the PC muscles can be tightened before they automatically begin to relax). Work at it, each time striving to improve your count. If the muscles feel tired, stop and relax for a few seconds and then start in again.
While on your back, also try to do a series of quick Kegels, tightening and relaxing the PC muscles as rapidly as possible, initially five times. Relax for a minute and then do another series of these quick rapid contractions. Work to increase the number of contractions in each series, and work to increase the number of series. You might think of this as "fluttering" your PC muscles. Rest when you need to.
It is important to exercise often and it is helpful to add a variety of physical positions. It has also been suggested that it would be helpful to pull in the entire pelvic floor, imagining that you are able to draw water up into your vagina. Then bear down as though you are pushing this imaginary water out. Do that five times to start, and more often as you gain strength.
Initially you might want to do the exercises clothed (certainly those series performed on your way to work). At home, however, when you will be comfortable and will have the time, it might be helpful to begin doing the exercises nude. Combine your "Kegeling" with other activities designed to increase body awareness and sexual sensitivity. You might find that doing your Kegels while masturbating increases the level of your arousal and might even trigger an orgasm.
KEGELING WITH YOUR PARTNER
With a partner present and with sufficient arousal and lubrication, have your partner insert two fingers into your vagina. Once inside, your partner should open the fingers up like scissors, and you try to close them with your vaginal sphincter muscles. Repeat this five times on each occasion that you do it. If you are uncomfortable with two fingers, have your partner put in just one and then curl this finger upward. You try to straighten it out!
If you are a heterosexual woman with a partner, you might also want to use the PC muscles that surround the opening of your vaginal during intercourse. Grip and relax, grip and relax five times, saying nothing to see if your partner will acknowledge feeling you tighten around him. You could think of it as a flirtatious "vaginal wink." Have fun learning about your pubococcygeus muscles and share!!
This article is an adaptation of a chapter in the Appendix of PATHWAYS TO PLEASURE: A Woman's Guide to Orgasm (2000) by Sexologist Robert W. Birch, Ph.D. & Sexuality Counselor Cynthia Lief Ruberg, M.S.Ed. PATHWAYS TO PLEASURE is available on the Sex-Help.com site hosted by Dr. Birch.
©2002 Robert W. Birch, Ph.D.
Photograpy c. 1915 Anonymous
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