What Your Woman in Menopause is Going Through

 by Margaret Aranda, MD, Ph.D.


What are some important things that every husband should know about menopause and how it affects a woman? (Hint: it has to do with how a man is affected) Well, I think the most important thing is that it can cause vaginal dryness, which leads to pain on intercourse. Some women complain that having sex feels 'like a knife stabbing me'. Really. It HURTS, and that's no fun for either partner. And there are other issues, too. Besides the frustration, humiliation, and resentment, and rage that festers. This is discussed in more length in my newest book, out NOW and available on www.drmargaretaranda.tateauthor.com/other-works). Men, want to stop feeling like you work, take pre-teens driving as a carpool, pay for this and that, and your wife is sweating so much that she has to sleep on another bed? In another room? 

Menopause = 1) male manopause, after prostatectomy  +/- irradiation/chemotherapy/orchiectomy; 2) female menopause, after hysterectomy with uterus and ovaries removed (that's a whole different story); and 3) oophorectomy (ovaries removed due to ovarian cancer).

I have noticed, for example, that a postmenopausal woman can be talking to me at night, and indeed let's make that a ~ cool ~ night with a breeze.  Her upper lip and forehead are covered with sweat.  In fact, her upper eyebrows and neck glisten in the moonlight.  I innocently ask (during our conversation on menopause), "Do you get hot flashes?"

She says, "No, I never get hot flashes."

So I ask, "Do you have pain with intercourse?"  Well, no big response there.  I persist, "Do you enjoy sex?"  She scoffs, "I could take it or leave it." She practically explodes at me!" " I just have sex to make my husband happy, but if it was up to me, I wouldn't even have sex.  And I would not miss it."  She smiles ever so gently. "Ugh!"

So I back up again, "Well, why don't you enjoy it?"  

She thinks.  

She hesitates.  

I wait, patiently.  

"Well, I guess that it just doesn't feel good."  

Results are in from Menopause, The Blog, which you can Click Here to Read.  While millions of women in the USA may have vaginal atrophy from a decrease of estrogen production after menopause, only about an estimated 7% are getting treatment!  This is simply astounding to me!  If you are a husband and your wife is complaining that having sex hurts during menopause, then this affects you as a man.

Studies show that a woman is reluctant to discuss the situation with her doctor, and doctors are reluctant to discuss it with their patients. So what is a man to do?

Firstly, we are reminded once again that with education comes empowerment. Now that you know that your wife could be having this problem, it may be good to talk to her about it. It could be that a woman does not realize that she has vaginal dryness.  The change could have happened so gradually over the perimenopausal years, that she does not realize that she actually has pain on intercourse, or dyspareunia.   So let's just step back a moment and realize that vaginal dryness, vaginal atrophy, and pain on intercourse ~ all these things can happen.  It's ok.  It can happen overnight from surgery, or it can happen over 15 years of natural menopause, naturally, as the ovaries are still secreting hormones. This is when the woman is most likely to be unaware that she is even IN menopause!

Men and Women just need to realize, like the perspiring woman who says she does not get hot flashes, that a woman's body continues to change with time. Men need to continue to be attuned to their woman's body.  Why?  Because menopause can riddle a woman's life with insomnia, restlessness, agitation, depression, hot flashes by day, sweats by night, pain on intercourse, vaginal dryness, dry skin, and general irritability. To name a few. And does that affect a man's sex life? Uhh.

Women can spend fully one-third of their lives in menopause.  

That's a long time to suffer unnecessarily. 

I know it affects you, because it has to affect you.

So we'd better get 'good' at being IN menopause, yes?  

Let's do!

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Articles by Margaret Aranda, MD, Ph.D.

Promoting the Concept of Having it All

Understanding Low Sexual Desire in Women

My! What Long Telomeres You Have!
Eating for Anti-Inflammatory Benefit: The IF Tracker
What a Man Should Know about Menopause

Male Menopause: Andropause
Eating for Anti-Inflammatory Benefit: The IF Tracker

The Waist-to-Hip Ratio: To Save or to Kill

Heart Attacks in the USA: Call 911

The History of the Low-Glycemic Index Diet

The Prostate: Genetic Marker for Cancer

Medical Disclaimer: Nothing on this website is meant to diagnose, treat, or practice medicine. You must be seen in person by a physician for appropriate and individual medical treatment. If you have an emergency, call 9-1-1 in the USA.

Link Disclaimer: We are not responsible for any links that go outside of this website.

Archives of the Vagina: A Journey through Time

by Dr. Margaret Aranda

For my Caring Friends, here's a preview of my newest book, written before the doctor dropped me on the floor in March, 2013. I wrote this book (many of you will understand) because I'm not sure if I'll live long enough to see my daughter live through all the stages of womanhood: the maiden, the mother, and the crone. It will be certain to help husbands understand their wives go through menopause, and help their daughters go through menstruation. Especially if both are happening at the same time.

                                   Book Cover Photo. Archives of the Vagina: A Journey through Time.

The book starts with my first period, and is very tongue-in-cheek humorous, because all girls know where they were when they started their first period. Then I go through history, sociology, anatomy, and the endocrinology of the ovaries.

I discuss what Aristotle thought of menstruation and menopause, how William T. Stead is a hero we never hear about for rescuing children out of prostitution in London's brothels. This book is filled with the sociology of menstruation, including whether women on their periods can fly a plane, and whether women who are camping on their periods attract bear attacks that lead to death.

One of the most surprising statistics that I learned in my research and interviews of women is that in the USA, in women over 45 years old, 40% have had a hysterectomy. Of these, nearly 50% have had normal ovaries removed without proper Informed Consent. I dedicate an entire chapter to "Ovarian Conservation" (i.e., keeping your ovaries), and give you all the risk factors you need to know so you can put yourself on the Chart to see if you are at risk for ovarian cancer, and hence should get them removed. So my next book will be Hysterectomy can be Hell. I hope to get an Army behind me on this one, because it will take a Movement to change our culture. And changing a culture always means that people won't like you. Believe me. I've been there before.

I discuss the HPV vaccination for girls aged 11-12, starting your period, how to put in a tampon, and introduce what most people don't know: the menstrual cup, and the nondisposable pad. I promote a certain program that helps girls in Africa obtain menstrual pads so they don't have to miss school, be drop-outs, get pregnant, contract HIV, attain a lower socioeconomic status, and die earlier than the girls that are more educated. So expect a Movement there, too.

I go through the Women's Health Initiative and basically tear it to shreds, because it had, in my opinion, no application to women in menopause suffering symptoms of vaginal dryness and hot flashes. I let you skip a very medical chapter if you would like, but I also put it in there for medical personnel to evaluate it for themselves. I dissect menopause and give the man's perspective, too, hopefully leading you to more self-discovery and compassionate understanding. Pretty funny stories there, too, my friend.

I have spoken to men who have had over 1,000 sexual partners and still do not know where the woman's urethra is. So I depict it for you explicitly, and explain why you should stay away from it so your woman does not get a urinary tract infection (UTI). Same thing for rectal sex; the rectum is filled with E.Coli bacteria and if you put the penis back into the vagina after rectal sex and it rubs onto the urethra (where the pee comes out), your woman can develop a whopping and bloody UTI. So, save the rectal sex for last. There's more, and it's all in this comprehensive Reference Book.

The last half of the book is dedicated to such things as Invisible Diseases, the Low Glycemic Diet, Immunonutrition and Fish Oil, Telemeres, Living for not only Health & Wellness but also for Quality of Life, Caregiving (and the effects on women, by ethnicity), Long-Term care, and death and dying. I empower you to ask questions, eat Spoon by Spoon, and Don't Fall when you are elderly. I tired of seeing women come into the Operating Room for hip fractures from a fall. You need to know your bone density, and take your Vitamin D or Calcium.

The role of an Endocrinologist in your care can not be underestimated. I also believe that Cenegenics has an excellent program for Concierge Medicine, private pay by cash, that is mostly utilized by Presidents and CEOs of companies. They are mostly men. This needs to change, because there are plenty of millionaire women out there (and wives of CEO men). And women need to stop spending all their time nurturing others, and start spending some time nurturing themselves. So I took all this knowledge in my head and told it to you before my traumatic brain injury and DI occurred; and I thank God that I did it.

There. I said it. My opinion rings throughout this book, and it is backed up by over 200 Stanford-quality references that are NIH-funded. I list them all for you, and many of them are dated in 2012 and 2013. Nothing but the best for you, my friends. Nothing but the best. Be prepared to learn, to grow, and to  ROCK your WORLD. You can ORDER the book at www.drmargaretaranda.tateauthor.com/other-works/

God Bless You in all that you do.

What Aristotle thought of Menopause

Excerpt from Archives of the Vagina: A Journey through Time

A student of Plato, Aristotle (384 BC – 322 BC) had a view of women that would be viewed as rather peculiar today.  He considered women to be unfinished males, ‘deformed’.  

In his Treatise On the Generation of Animals, he viewed menstrual blood as being a lesser sort of semen, writing on male and female secretions: 

“…This much is evident: the menstrual fluid is a residue, and it is the analogous thing in females to the semen in males.  Its behavior shows that this statement is correct.  At the same time of life that semen begins to appear in males and is emitted, the menstrual discharge begins to flow in females, their voice changes and their breasts begin to become conspicuous; and similarly, in the decline of life the power to generate ceases in males and the menstrual discharge ceases in females…”

A novel invention by the Ancient Greeks was a tampon make from a piece of wood entwined with lint wrapped around it; based on written records, these were believed to be used primarily for contraception.  I don’t know, but it sounds like those would hurt.  No wonder they were used for contraception, as the woman was probably injured afterwards and could not have sexual intercourse, I thought.

The Ancient Egyptians are credited with the invention of disposable tampons made from papyrus that were softened (The Period Blog; Utian, 2008).  Tampons were also used by the Byzantine women, who made them out of wool that was softened.  I can’t help but wonder if they knew when to pull them out.  Did they get toxic shock syndrome back then, from keeping them in too long and acquiring bacteria and then sepsis and then death?

Jump to the 1700’s, where the French considered menstrual blood to be seductive, and also a measure of female fertility (Corbin, 1986).  In 1986, Corbin writes:

 “…in 18^th century France, menses was considered to be ‘impregnated with subtle vapors transmitted by the essence of life.  These were particularly seducing, as a woman was ‘dispersing seductive effluvia’ and ‘making an appeal for fertilization.’  Thus societies have celebrated the seductive aroma of menstruation, rather than stifled (it).”

In the early 1800’s, remember that women probably menstruated for less of their lifetime versus now.  Menarche started later, at 17 years of age, and women breastfed much longer, they were pregnant more often, menopause started earlier, and they were more likely to be ill or malnourished.   Today, the age for a girl’s first period is now 13 years old.  The common notion during the 1800's was that menstruation was controlled by lunar phases of the moon (Covington, 2007). 

The attitude of menstruation certainly has changed from the time of Aristotle, yet perhaps Aristotle was ahead of his time in simply talking about it. In talking about it, he gives it credence even though his perceptions were, in today's society, rather primitive. Nonetheless, we can learn from these ideas and use them to recreate our own attitudes. What exactly do we think about menopause today? 

References:

The Period Blog: View The Period Blog here

Alain Corbin.  The Foul and the Fragrant: Odor and the French Social Imagination. Cambridge, Mass.: Harvard University Press, 1986.

Covington, Sharon N.  Infertility Counseling.  A Comprehensive Handbook for Clinicians, 2^nd Edition.  Georgetown University School of Medicine, Washington DV.  Linda Hammer Burns. View Book Here

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Additional Chapters by Dr. Margaret Aranda
in
Archives of the Vagina: A Journey through Time

Menopause and Painful Intercourse

The Cochran Report

What Aristotle Thought of Menstruation

From Menarche through Menopause

The History of Menopause

The Different Types of Hysterectomies

Surgical Menopause and Testosterone Therapy

Bears Can Smell the Menstruation: Or Can They?

An "Anti-Inflammatory" Meal

The Ovaries: Endocrine and Reproduction

Women Helping Women

The Virgin and the Maiden Tribute

Menopause, Painful Intercourse, and Vaginal Dryness

Chapter One: From Menopause through Menarche ~ A Journey through Time

Research Questions on Menopause

Research Questions on Menstruation

Medical Disclaimer: Nothing on this website is meant to diagnose, treat, or practice medicine. You must be seen in person by a physician for appropriate and individual medical treatment. If you have an emergency, call 9-1-1 in the USA.

Link Disclaimer: We are not responsible for any links that go outside of this website.

Understanding Low Sexual Desire in Women

by Margaret Aranda, MD, PhD

Hypoactive Sexual Desire Disorder (HSDD) is a term used to describe a decrease in sexual desire in women.  How do you know if your woman has HSDD?  How many women fake orgasm or pretend to enjoy sex with their husbands, when post-menopausal symptoms of vaginal dryness may be "knife-blade", painfully sharp?  Every menopausal woman deserves a work-up to determine hormonal causes as a primary cause of sexual dysfunction, decreased quality of life, or psychosocial satisfaction.

First of all, HSDD is a term describing sexual dysfunction.  There is a lack or complete absence of sexual fantasies, and a lack of desire for sexual activity.  The diagnosis comes from a clinician, not the patient.  No 'partner' is required to make the diagnosis.

Requirements include that the patient has distress or relationship problems.  It has to be a perceived problem.

The topic of female sexuality is of paramount interest for not only 'the female', but for you men. By default, it is also a topic of mental health, quality of life, Family Matters, Marital Relationships, procreation, and aging through menopause.

Men are affected by any decrease in libido that their partner has, no matter the cause.  It is important to discuss the topic openly, as this could provide relief of the situation.  There is one main fact that seems to stand out amongst all: #1) women are reluctant to volunteer information on sexual dysfunction, and #2) doctors are reluctant to ask women about sexual dysfunction.

Think of females and their sexual health. Now think of female sexual disorders. What is the most common female sexual disorder? It is Low Desire, with Laumann et al  estimating a stunning prevalence of 30% (1) in a 1999 study done in the United States of America.

Masters and Johnson were the first to describe a female model of the sexual response. Their paramount study was done in 1966 (2). It categorized, in a linear fashion, four stages of the sexual response: Excitement, Plateau, Orgasm, and Resolution. In 1977, Kaplan added Sexual Desire to this scenario (3).

Today's nonlinear description by Basson takes into account: psychosocial and psychocultural matters, relationship satisfaction, emotional intimacy, and sexual stimuli (4).

The American Psychiatric Association classifies female sexual dysfunction into these categories:

Desire, Arousal, Orgasm, or Pain. We aim to focus on Desire, specifically Low Sexual Desire. But before we leave this item, we retain the stance that another reclassification is perhaps under way. Brotto suggests that Desire and Arousal be more of a 'combined' issue of Sexual Interest/Arousal Disorder (5).

To get to our final point here, what is low sexual desire? Both the World Health Organization and the DSM-IV (the Psychiatrist's book of diagnoses) have similar descriptions for Hypoactive Sexual Desire Disorder, or HSDD. It is a recurrent or persistent absence or deficiency of sexual fantasies and desire for sexual activity, causing marked distress or interpersonal difficulty (6, 7).

_________________________________________________

So, it can be that:

(A) Decreased Sexual Desire  + (B) Problems  ~  HSDD.

_________________________________________________

(A) = No sexual fantasies, recurrent lack of sexual fantasies, no sexual desire, and/or recurrent lack of sexual desire;

(B) = Personal Problems/Distress, or Relationship Problems

_________________________________________________

How big is this problem? In the 2006 Women's International Study of Health and Sexuality (WISHeS), HDSS was determined across the USA, Canada, Germany, Italy, and France.

In America, the prevalence of HSDD ranged from 9% to 26% (8).

In Europe, the prevalence of HSDD was from 6 to 16% (9).

Age and menopause mattered.

While many of the studies on female sexual dysfunction were done by telephone interview, this is to suggest that such anonymity is the result of ongoing female discomfort in talking face-to-face with her health care provider(s). So if a personal relationship or marriage is encountering difficulties due to 'mismatching' of sexual drive, low libido, chronic illness, or other matters having to do with sex, what is the husband or man to do? First, let us provide encouragement that the patient needs to feel comfortable telling her partner about sexual issues.  Then, it is good to disclose these problems to her doctor.

And if your female partner has a low libido or you are a partner whose sex drive far succeeds hers, and this is causing you marriage or relationship problems, perhaps you do not know that she could have a diagnosis of HSDD. Talk to her doctor about it.  Go to the appointment with her.

Possible treatment?  Possibilities include diet, exercise, and hormones (e.g., testosterone, estrogen, progesterone, thyroid hormone) as initial, corrective treatment.  

Let's open the door to some frank discussion.

It is time.

Medical Disclaimer: Nothing in this content is meant to advise, diagnose, treat, or cure any medical condition whatsoever. Please speak to your health care professional for medical advice. 

Full Disclosure: Dr. Margaret Aranda Ferrante was an Institute Physician with Cenegenics Medical Institute, specializing in Age Management Medicine. 

REFERENCES:

(1) Laumann  EO, Paik A, and Rosen RC. Sexual dysfunction in the United States. Prevalence and Predictors. JAMA Vol 281(6), pp 537 - 544; 1999.

(2) Masters WH and Johnson VE. Human Sexual Response. Little, Brown & Co.; Boston, MA. USA (1866).

(3) Kaplan HS. Hypoactive Sexual Desire. J. Sex Marital Ther: Vol 3 (1), pp 3 - 9; 1977.

(4) Basson R. Using a Different Model for Female Sexual Response to Address Women's Problematic Low Sexual Desire. J. Sex Marital Ther: Vol 27(5); pp 395 - 403; 2001.

(5) Brotto LA. The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in women. Arch. Sex Behav. Vol 39(2), pp 221 - 239; 2010.

(6) World Health Organization. International Statistical Calculation of Diseases and Related Health Problems, 10th Revision. World Health Organization, Geneva, Switzerland; 1992.

(7) Basson R, Leiblum S, Brotto L, et al. Definitions of Women's Sexual Dysfunctions Reconsidered: Advocating Expansion and Revision. J Psychosom. Obstet. Gynaecol Vol 24(4), pp 221 - 229; 2003.

(8) Leiblum SR, et al. Hypoactive Sexual Desire Disorder in Postmenopausal Women. US Results from the Women's International Study of Health and Sexuality (WISHeS).  Menopause Vol 13(1), pp 46 - 56; 2006.

(9) Dennerstein L, et al. Hypoactive Sexual Desire Disorder in Menopausal Women: A Survey of Western European Women. J. Sex. Med. Vol 3(2), pp 212 - 222; 2006.

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Articles by Dr. Margaret A. Ferrante:

Promoting the Concept of Having it All

Understanding Low Sexual Desire in Women

My! What Long Telomeres You Have!

Eating for Anti-Inflammatory Benefit: The IF Tracker

What a Man Should Know about Menopause

Male Menopause: Andropause

Eating for Anti-Inflammatory Benefit: The IF Tracker

The Waist-to-Hip Ratio: To Save or to Kill

Heart Attacks in the USA: Call 911

The History of the Low-Glycemic Index Diet

The Prostate: Genetic Marker for Cancer

Medical Disclaimer: Nothing on this website is meant to diagnose, treat, or practice medicine. You must be seen in person by a physician for appropriate and individual medical treatment. If you have an emergency, call 9-1-1 in the USA.

Link Disclaimer: We are not responsible for any links that go outside of this website.

Full Disclosure: Margaret A. Ferrante, M.D.  is an Institute Physician with Cenegenics Medical Institute.  She receives no monetary compensation for hosting this website you are on, which is independent and not affiliated with Cenegenics. The information presented is for education and awareness.  Dr. Ferrante currently sees patients out of the Cenegenics office in Beverly Hills, CA. 

To book an appointment for a free Consultation, please email her at: mferrante@cenegenics.com