“The Change”: Not So Mysterious After All

Pamela Merritt

Menopause is a natural stage of a woman's reproductive life, a condition women go through as they grow older. Knowing the facts and having resources will help women prepare for, rather than dread, that change.

My grandmother often spoke of women going through "the change," but she refused to elaborate — she simply said that "the change" was something women suffer through if they are blessed to live long enough. This mysterious condition left my grandmother exhausted from lack of sleep. I remember seeing her rhythmically fanning her face while sipping ice water and fussing that someone must have turned the heat up. When I asked what "the change" was, exactly, she would reply that I should just keep on living and then I'd understand. Her reluctance to discuss "the change" reinforced my perception that it was an unavoidable condition women suffered through but preferred not to talk about.

The ‘change' my grandmother spoke of is menopause, which is not an ordeal but a natural stage of a woman's reproductive life. Recent news that hormone replacement therapy (HRT), when used as a treatment for menopause, is linked to an increased risk of women having an irregular breast scan highlights why menopause and treatment options for menopause are worthy of discussion. The alarming results of the new study join those of several others linking certain hormone replacement therapies with an increased risk of breast cancer, endometrial cancer and/or increased risk of heart disease. For all the studies linking HRT to increased health risks there are other studies pointing to the benefits of such therapies for menopausal women. These conflicting reports on the benefits and risks of hormone replacement therapy (HRT) illustrate the challenge of selecting a treatment with acceptable risks and identifiable benefits.

Menopause is a stage of a woman's reproductive life; a natural condition women go through as they grow older. It is often defined as the changes a woman experiences either just before or after she stops menstruating. Women are born with a finite number of eggs stored in the ovaries and the ovaries also produce the hormones estrogen and progesterone, which regulate menstruation and ovulation. Menopause usually occurs after the age of 40 when the ovaries no longer produce an egg every month and menstruation ceases.

Menopause can actually be broken up into three stages – perimenopause, menopause and postmenopause. Perimenopause begins several years before menopause as the ovaries gradually produce less and less estrogen. The perimenopause stage extends until the ovaries no longer release eggs and at that point menopause begins. The decrease in estrogen production accelerates in the final years of perimenopause and many women will begin to experience the symptoms of menopause. Menopause begins when a woman has her last menstrual period. The ovaries no longer release eggs and they stop producing most of their estrogen. Menopause is diagnosed when a woman has not had a period for 12 consecutive months. Postmenopause applies to the years after menopause and most menopausal symptoms ease for women during the postmenopause stage.

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Menopause is often explained through the symptoms associated with it which include but are not limited to hot flashes, fatigue, insomnia, irregular periods, a racing heart, depression, muscle and joint pain, headaches, bladder control problems, vaginal dryness and changes in a woman's sex drive. All women do not experience the full range of symptoms. There are also health implications related to menopause. Menopausal women are at risk for osteoporosis, heart disease and problems with bladder and bowel function.

HRT was once widely recommended to women to treat menopause, manage menopausal symptoms and prevent osteoporosis and heart disease. HRT is used to supplement the body with either estrogen, a combination of estrogen and progesterone or a combination of estrogen and androgen (a form of testosterone). Estrogen helps regulate how the body uses calcium and maintain healthy cholesterol levels. Progesterone is used if a woman still has her uterus to help her body shed endometrial cells and thus reduce the risk of developing endometrial cancer.

We now know that HRT carries with it an increased risk for breast cancer. The new study published in the Archives of Internal Medicine shows that HRT (combined estrogen and progesterone therapy) increases the risk of an abnormal breast scan or biopsy and that more breast cancers were diagnosed in those taking HRT despite the fact that mammograms were more likely to miss tumors in that group.

That doesn't mean short-term use of HRT is no longer an option. Women with severe menopausal symptoms may benefit from taking HRT for a few years and all women should include the new research in their decision making process. All women over 40 should get yearly mammograms regardless of whether they take HRT or not.

What these new findings do mean is that an understanding of menopause and how it fits into a woman's reproductive life should include an understanding of the risks and benefits of treatment options. There are resources available to help women prepare to discuss menopause with their healthcare provider, research alternatives to HRT and gain a better understanding of all the options before deciding what is best for them.

Our Bodies Ourselves has published a new book on menopause that is an excellent resource with excerpts from the book and links to additional resources on menopause and women's health online. The Midlife and Menopause section is an informational gold mine with several links to excerpts from the book. The book is also helps readers understand research results and relative versus absolute risk (excerpt available online). Our Bodies Ourselves: Menopause explores the role diet, weight, stress, exercise and family history play in menopause in a comprehensive woman centered way unburdened by commercial bias.

Menopause may be a change of life but it is a natural transition. Knowing the facts and having resources to help us make sense of the change will help women prepare for, rather than dread, that change.

Commentary Sexual Health

Of Ducks and Women: For Us, Sex Should Not Hurt

Martha Kempner

The Internet has been abuzz with discussions of painful sex among our animal friends after astrophysicist Neil deGrasse Tyson mistakenly suggested that any species for whom sex hurt would already be extinct. Unfortunately, many women know all too well that on this subject, deGrasse Tyson was way off the mark.

The Internet has been abuzz with discussions of painful sex among our animal friends after astrophysicist Neil deGrasse Tyson mistakenly suggested in a tweet, “If there were ever a species for whom sex hurt, it surely went extinct a long time ago.” Twitter users and journalists leapt at the chance to tell one of the world’s leading astrophysicists that he was wrong about biology, and that there are a lot of members of the animal kingdom for whom the act of mating doesn’t appear to be all that pleasant.

Take the duck. Apparently, a female duck’s vagina corkscrews in the opposite direction from the corkscrew on the male’s penis, which may help her ward off unwanted advances but seems as if it could make desired sex uncomfortable for both of them. And ducks aren’t the only ones for whom copulation may be painful—to name just a few other examples, a male cat has barbs on his penis which can scrape his partner’s vagina, a male bed bug inseminates his female partner by piercing a hole in her abdomen, and female praying mantises eat their male partners when the deed is done.

It seems that humans are among the lucky ones for whom sex can feel so good that we do it more often for recreation than we do for procreation. But humans, women in particular, can feel pain during penetrative sex too. In fact, the American Congress of Obstetricians and Gynecologists notes that nearly three out of four women have felt pain during intercourse at some point during their lives. Unfortunately, sex education classes in schools often spend very little time talking about pleasure, and women especially—who frequently grow up around whispers of how much the “first time” hurts—may think they just have to put up with a little unwanted pain or discomfort during sexual experiences. (While some people can experience penile pain, often as the result of an infection, it generally is not related to sexual behavior in the same way.)

Sex should not hurt. If it does, look at that as your body’s way of sending you a signal that something is not quite right.

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Before we get into specifics, however, it’s important to acknowledge some caveats.

First, it is important to note that we are talking about issues that lead to pain during consensual sexual activity. The issues involved during and after sexual assault or any kind of nonconsensual sex are very different, and we’re not going to attempt to address them here. If you suspect those circumstances might apply to you, you may want to consult your health-care provider, a mental health expert, or the Rape, Abuse & Incest National Network, which operates phone and online hotlines.

Also, this is not meant as professional medical advice. This article can give you ideas from my perspective as a sexuality educator, but it can’t give you a diagnosis. Again, only your health-care provider can do that.

With that in mind, there are many possible reasons that sex could be less than fun.

It Could Be Desire

Sex is a physical activity, to be sure, but there is a big mental component as well. Your state of mind matters. If you feel guilty, embarrassed, afraid, or even just distracted by what’s going on in the rest of your life, you might not be able to relax and become aroused. Stress and exhaustion can also get in the way of arousal, as can relationship issues, including an unequal interest in sex.

Painful sex can result from any one of these emotional factors, or a combination thereof. Take a minute to try and figure out if anything was bothering you before or during sex, and what you might be able to change so that this doesn’t happen again. It’s always good to start by talking to your partner and seeing if you can figure it out together. If the issue is ongoing, you might consider talking to a mental health expert or a sex therapist.

It Could Be Technique

No one wants to be told that they’re “doing it wrong,” and, of course, there is no right or wrong way to “do it.” That said, vulvas and vaginas are sensitive, and it is possible for them to be touched in a way that feels, well, not great. Every person is different: A technique that may make one partner feel fantastic may just be irritating to another. The same goes for sexual positions—what one person likes may make another one uncomfortable.

Here, communication is important. Give your partner some ideas and advice. Subtle clues like moaning when they get it right are great, but you may have to be more directive. It’s okay to ask someone to speed up, slow down, or move a little to the left. Be gentle and funny if you think that will help, but don’t be afraid to say what you like.

Of course, in order to do this, you have to know what you like. If your partner is game, this can be a fun team project, but spending some quality time figuring it out on your own (i.e., masturbating) can also be very useful.

It Could Be Lubrication (Or a Lack Thereof)

Blood rushes to the vagina upon arousal in a process called vasocongestion, which in turn causes the vagina to produce lubrication. This wetness helps protect against chafing and irritation when the vulva is touched or the vagina is penetrated. Without sufficient lubrication, sexual activity can be uncomfortable.

It can be helpful to figure out why there isn’t enough lubrication. Sometimes it’s because you haven’t gotten turned on enough, and spending just a little more time on foreplay could be all that’s necessary. It could also be the result of hormone changes—dryness is common in women who are going through or have gone through menopause, for instance—or certain medications. Or it could just be the natural state of your body; some people just produce less lubrication than others.

Regardless of the cause, dryness issues can be fixed by using lubricants. The truth is almost everyone can benefit from a little extra lube. A quick trip to the pharmacy will show just how many options there are when it comes to lube—from the tingly to the flavored to the vegan. Try one or try them all.

Just a few quick notes: If you’re using condoms for birth control or the prevention of sexually transmitted infections (STIs), avoid oil-based lubes because oil breaks down latex—intead, use water-based or silicone-based lubes. Also, if you’re using sex toys, you may also want stick to water-based lubes, because silicone can cause some of them to deteriorate. Read the label of whatever lube you choose; it should let you know what is and isn’t compatible.

It Could Be Medical

There are also a number of medical explanations for what might be behind the discomfort. The catch-all phrase for things that cause inflammation of the vagina—and the itching, burning, and pain during sex that goes with it—is vaginitis. STIs cause vaginitis, but so do other things like yeast infections. The truth is that the vagina has a pretty delicate system of naturally occurring bacterial and fungi that are usually kept in balance. When this equilibrium is disrupted—which can happen when a woman is taking an antibiotic, uses a fancy new soap, or has even just has sex—things can get uncomfortable.

Pain upon penetration can also be caused by certain gynecological problems, such as endometriosis (an inflammation of the lining of the uterus), pelvic inflammatory disease, or cysts on the ovaries. Many of these medical problems that cause pain are easily treated once diagnosed.

For some individuals, however, vulvar and vaginal pain can become chronic and may not be limited to during sex. These people are often diagnosed with vulvodynia—a term that basically means painful vulva. There are different theories about what causes this condition, and there isn’t one method that seems to work for everyone who has it. But there are treatments: Some individuals respond to certain medications that are thought to interrupt the pain signals the body is sending, and others do well with physical therapy and biofeedback.

The purpose here is not to give an exhaustive list of conditions that lead to painful sex, but to say that pain during intercourse is often a sign of an underlying medical problem. If it persists, you should get checked out.

Whatever You Do, Don’t Close Your Eyes and Think of England

In previous generations, women were taught not to expect sexual pleasure—sex was something for men to enjoy and women to endure. Thankfully, we now know enough to consider this absurd (not to mention sexist and infuriating). And yet, some vestiges of these views seem to have hung around and left some women with the impression that a little bit of pain during sex is just to be expected.

It’s not.

The basic rule is pretty simple. If your vulva or vagina itches, burns, or hurts—get it looked at by a health-care professional. If you have a bump or a sore—get it looked at by a health-care professional. If it hurts when someone touches it or if penetration is painful—go see a health-care professional. If you’ve ruled out physical ailments—consider talking to a therapist about what else might be going on. And if the pain becomes chronic—go back and tell that professional it is still hurting.

Don’t just grin and bear it.

We are not ducks, we are not bed bugs, and we are not antechinuses (a marsupial whose males have so much sex they start to bleed internally and go blind). We are human beings, and we deserve sex that is not just pain-free, but feels really good.

Commentary Sexuality

There Really Isn’t Any Bad News for People Who Like to Masturbate

Martha Kempner

A recent Maxim article warned readers that masturbation may be harmful in the long run if they do it too often or the wrong way. Thankfully, the article is based on pseudoscience and misunderstandings—there is no reason to stop the activity.

Masturbation is such an under-appreciated form of sexual activity. It has been blamed in urban legends for everything from hairy palms to lack of productivity, and has a reputation of being reserved for those who can’t find anyone else to have sex with them. But that’s just not true. Most people masturbate. It feels good. It carries no risk of pregnancy or disease. It can take as much or as little time as you have. And it’s relaxing. So why have media outlets warned readers that they might be doing it too much or the wrong way?

Recently, in a December 15 article titled “We’ve Got Bad News for People Who Love Masturbating,” Maxim’s Ali Drucker tells readers: “If you or someone you love frequently enjoys doing the five-finger shuffle, there’s a study that suggests they might face negative effects over time.” The article actually points to three pieces of “research” that seem to suggest masturbation isn’t as good as other forms of sexual behavior, that one can become addicted to it, and that the “grip of death” can make men incapable of experiencing pleasure any other way.

Well, Rewire has good news—these conclusions are largely based on junk science and misunderstandings.

The first study Drucker cites, originally published in Biological Psychology, is called, “The post-orgasmic prolactin increase following intercourse is greater than following masturbation and suggests greater satiety.” Prolactin is a hormone that is released by the pituitary gland. Its main function is to stimulate milk production when a woman is lactating, but it also plays a role in the sexual response cycle. According to the study, which was first published about ten years ago, prolactin is released after orgasm as a way to counteract the dopamine released during arousal. Some scientists believe that the more satisfying the experience is, the more prolactin levels will go up afterward.

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For this study, Stuart Brody and his colleagues compared data showing prolactin levels after penile-vaginal sex to those after masturbation and found that levels after intercourse were 400 percent higher than after masturbation. They interpreted this to mean that intercourse is more physiologically satisfying than masturbation.

On the surface, this conclusion isn’t surprising. Many people don’t view masturbation as the same as a shared experience with a partner. It doesn’t tend to produce the same physical or psychological feelings. But that doesn’t mean it’s not a fun and satisfying way to spend a few minutes (or hours, if you’re ambitious or bored).

When I read the study, I did not interpret it to say that intercourse was better than masturbation, just that our biological reactions to different sexual behaviors were different. I had never read anything by Professor Brody before and reached out to him, assuming that people were overstating his results and that he did not mean to discourage masturbation. I thought, what sex researcher would ever want to discourage masturbation?

However, he replied, “Instead of any fresh quotes, I attach my review paper on the evidence regarding health differences between different sexual behaviors.” He sent me a different article, a literature review in which he says in no uncertain terms that penile-vaginal intercourse (PVI) is the best kind of sex and that “sexual medicine, sex education, sex therapy, and sex research should disseminate details of the health benefits of specifically PVI.”

As a sex educator, I can’t imagine telling anyone that penile-vaginal sex is inherently better. For one thing, not everyone is in a couple, and not all couples have a penis and a vagina between them. And even for cisgender heterosexual couples, PVI is only one of countless potentially pleasurable behaviors. Moreover, many women find it less satisfying and less likely to end in orgasm than behaviors that incorporate clitoral stimulation.

But Brody not only thinks it’s the best form of sex—he thinks we sometimes do it wrong. He writes that “PVI might have been modified from its pure form, such as condom use or clitoral masturbation during PVI.” He also explains that Czech women who were vaginally orgasmic were more likely than their peers who didn’t have orgasms through PVI to have been taught during childhood that the vagina is “an important zone for inducing female orgasm,” concluding that “sex education should begin to be honest” about sexual behaviors.

I thought we’d moved on from the idea that we should all be having heterosexual, penile-vaginal sex in its “pure form” (missionary position?) and that women who couldn’t orgasm this way were both bad at sex and shit out of luck.

Colleagues in the field told me that many of them ignore Brody’s studies because he makes wild inferences based on soft science and, as implied by his research, is wedded to the idea that for sex to have the most benefits it needs to include PVI.

Nicole Prause, a researcher who has written critiques of Brody’s work, told me via email that, “His work almost exclusively uses data from other researchers, not his own, meaning the design is never really appropriate for the claim he is actually trying to make.” She went on to say that Brody’s studies on orgasm are often based on self-report, which is notoriously unreliable. Although the study Maxim cites was based on blood tests, “He has never once verified the presence of orgasm using a simple physiological measure designed for that purpose: anal EMG. Many women are thought not to be able to reliably distinguish their orgasm, so his purely self-report research is strongly suspect. If this is his area of focus, he should be studying it better than everyone else,” she concluded.

But Brody’s research on prolactin isn’t the only questionable science that Maxim relies on for its cautionary tale on masturbation. The article goes on to discuss the role of oxytocin and dopamine and points out that there’s less oxytocin released during masturbation. This is probably true—oxytocin is known as a bonding hormone and is triggered by contact with other people, so it’s not surprising that it’s not released when you’re orgasming alone. The Maxim article, however, argues that if the brain is flooded with dopamine (a neurochemical) during masturbation without the “warm, complacent, satisfied feeling from oxytocin,” you can build up a dopamine tolerance, or even an addiction, and get into “a vicious cycle of more masturbation.”

David Ley, PhD, a clinical psychologist and sexuality expert, explained in an email that many people describe dopamine as the “brain’s cocaine,” but this is an overly simplistic way of looking at it. It doesn’t mean we’re at risk of desensitizing our brain or getting addicted to jerking off. Ley wrote:

It appears that there are many people whose brains demonstrate lower sensitivity to dopamine and other such neurochemicals. These people tend to be “high sensation-seekers” who are jumping out of airplanes, doing extreme sports, or even engaging in lots of sex or lots of kinky sex. These behaviors aren’t caused by a development of tolerance or desensitizing, but in fact, the other way around—these behavior patterns are a symptom of the way these peoples’ brains work, and were made.

OK, dopamine isn’t cocaine and neither is masturbation: We’re not going to get addicted if we do it “too” much.

But, wait, Maxim throws one more warning at us—beware the “death grip.”

Though the article describes this as “the idea that whacking off too much will damage your dick,” the term, which was coined by sex advice columnist Dan Savage, is more about getting too accustomed to one kind of stimulation and being unable to reach orgasm without it. There is some truth to this—if you always get off using the same method, you can train your body to react to that kind of stimulation and it can be harder (though rarely impossible) to react to others. There are two solutions, neither of which involve giving up on masturbation: Retrain your body by taking some time off from that one behavior and trying some others, either by yourself or with a partner, or incorporate that behavior into whatever else you’re doing to orgasm (like clitoral masturbation during intercourse).

In fairness, the Maxim article ends by acknowledging that masturbation can have benefits, but I still think it did its readers a disservice by reviewing any of this pseudoscience in the first place. As Ley said in his email, “This article, targeted towards men (because we masturbate more), is still clearly pushing an assumption that there is a ‘right kind of sex/orgasm’ and that masturbation is just a cheap (and potentially dangerous) substitute … That’s a very sexist, heteronormative, and outdated belief based on a view of sex as procreative only.”

So for a different take on it all: Sure, there might be more prolactin and oxytocin produced during intercourse than masturbation, but that does not mean that masturbation isn’t enjoyable or worthwhile. You won’t become addicted to it, but you might want to mix up how you get to orgasm or just incorporate your preferred stroke into all other sexual activity.

What you shouldn’t do is view the Maxim article—or any of the research it cites—as reasons not to stick your hands down your own pants.

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