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Menopause/Part 4

Land of lost libido

Physical changes can, and often do, affect a woman's sexual desire. But sometimes emotions play an even more powerful role.
Gail Rosenblum, Star Tribune

Elsa Batica passed a mirror in her bathroom seven years ago and saw a woman she didn't recognize.

That woman was Elsa.

Her husband, Addi, was knocking on the door, but she wouldn't let him in. "Maybe I was being dramatic," says Batica, now 54 and manager of cross-cultural health development and training at Children's Hospital and Clinics of Minnesota. "But, when I close my eyes, I always think of myself in college. In the mirror, where did the wrinkles come from? It scared me. I touched my face, my eyelids, my cheeks. 'Oh, my God,' I thought. 'I'm getting old.' "

What, you might wonder, does this have to do with a story on midlife sexuality? Plenty.

For many women, it is impossible to separate sexuality from self-image. Yes, many physical changes occur as women enter menopause, due largely to wildly fluctuating hormone levels: irregular periods, hot flashes and night sweats, sleep disturbances, vaginal and urinary problems and skin wrinkling, among them. The good news is that women can find help through many traditional and bioidentical hormones; many women also have found relief in acupuncture, black cohosh, Vitex, soy and herbal teas.

But the emotional piece is more complex. "Some women are shy. The social norm is they're not supposed to talk about sex," said Diane Petersen, who practices obstetrics and gynecology at Women's Health Consultants in Minneapolis and is vice chairwoman of Obstetrics and Gynecology at Abbott Northwestern Hospital.

"Occasionally, a woman will come to me specifically for help with sexuality," Petersen said. Other women circle "sexual concerns" as a reason for their visit, but won't bring it up unless Petersen does. She tries to broach the subject gently during an exam, mentioning physical changes she notices that might be causing a woman pain during sex, or even pain while walking. "I talk about it as a comfort issue," she said. Sometimes, she learns that the problem isn't with the woman; it's with her partner's impotence or, in lesbian couples, differences in sexual desire. Much can be dealt with if a woman just asks, Petersen said.

But she knows that low self-esteem and poor body image can be bigger culprits than hormones. Sagging bellies and breasts, loss of hair, wrinkling skin and irritability due to lack of sleep lead many women to lean over in bed and say, "Sex? Are you joking?"

Karen Jenniges, 54, of Wanda, Minn., about 20 miles southwest of Redwood Falls, dreamed of getting to this point in her life, when the kids would be grown "and our sex life was going to be super." Then her hot flashes and night sweats "just got terrible." Now her husband, Nick, reflexively pins down his arms on the blanket at night just before she has one. "It's like he has a sensor," she said, laughing. Her weight is up, too. "I just don't feel sexy," she said, even though Nick tells her constantly how beautiful she is. "He has all the right words. There's just a block there. It goes into my head and it goes into my heart but, somehow, when it hits my ovaries, the lack of desire just takes over."

Ange Hwang, 43, is experiencing decreased libido, too, among other perimenopausal symptoms. "You just don't feel that kind of desire," said Hwang. "I wear my husband's T-shirt and we share socks." The mother of two children, ages 10 and 5, laughs: "I hadn't thought of it as menopause. I thought of it as motherhood."

For many women, the two are inextricably linked.

Linda Henning began to experience perimenopausal symptoms at age 50, just as her "absolutely gorgeous" daughter, Katharine, was moving into womanhood.

"Kat started her period at 15, as I began to experience the erratic cycling of mine," Henning wrote to the Star Tribune after we asked women to share their experiences. "She was gaining hair; I was losing it, or gaining it in places that aren't particularly attractive, like my toes and face. Her body was becoming more womanly and rounded; mine was giving way to gravity, resulting in a frustrating squarish shape. She was in danger of becoming a sex object. I was no longer the recipient of a furtive glance ..."

It was surprising to Henning, also the mother of two sons, how deeply she mourned the loss of her sex appeal. "I consider myself a feminist," said Henning. "I was surprised that part of my identify was how I looked. I wondered, 'Is there any depth to me?' "

Kat, 18, a freshman at New York University studying studio art, thinks her mom shouldn't be so hard on herself.

"When I look at my mom, I think she looks better than most women her age. She's taking a lot better care of herself now that she's going through menopause. I hope, especially with kids out of the house, that she stays busy and does what she wants to do. I hope she gets to Paris."

Single at midlife

Midlife women who are single have their own concerns. If they are sexually active, they have a host of sexually transmitted diseases to avoid, which is best accomplished if difficult conversations about protection aren't avoided. Many are extremely surprised to discover they still can get pregnant -- half of the nearly 100,000 pregnancies annually among women over age 40 are unintended, according to the National Surveys of Family Growth. "It should be a full year of no periods before they can trust that they're past the change," said Robbie Weisel, sexuality educator for Planned Parenthood Minnesota, North Dakota and South Dakota.

Recently divorced or widowed women may wonder if they ever will be in another sexual relationship. Weisel is empathetic, and encouraging. "There is a time where you may not feel sexual or may feel that this is never going to be apart of your life again," she said. "As you heal and come to know yourself, it evolves. Give yourself time."

For some, the heat is on in another way

It's important to say, though, that for some women, midlife sex is great. Part of that may be due to empty nests (at last!) and no worries about birth control. For some, testosterone levels actually increase. Meet Julie Hella, 51, married to Ross for 30 years and the mother of four grown boys (who might want to skip over this section).

Hella can't figure out who turned up her libido, but her husband, who was recently dealing with Lyme's disease, told their doctor that she's now "an 18-year-old's dream and a 50-year-old's nightmare." Ross said she's too aggressive, that once a week is enough. "If that's true," Julia said, "I want four weeks now! This is the only time in my life when I've had more zip than Ross. It's the darndest turnaround."

She wonders if the cause is physiological, such as fluctuating hormones, or psychological -- the fear that the decline in hormones will end all desire.

Either way, she ponders that age-old question of biology: "Why can't we both be the same, ever? One's up, one's down. One's ready to snore."

True, it's the lucky couple who find a level playing field. The rest of us are left to high-level negotiations.

Christiane Northrup, author of "The Wisdom of Menopause: Creating Physical and Emotional Health and Healing During the Change," offers plenty of advice on how to reclaim the spark that has little to do with medicine. A big one is communication: Tell your partner what you're thinking and feeling. Be proactive: Figure out together what gets you in the mood and do it. Be adventurous and spontaneous. (One of the best ways to pump up libido, by the way, is through regular sexual activity -- sort of a friendly reminder for your body.)

And, try to love your body. Because if you do, you'll find your way to a partner who does, too. Elsa Batica made it through menopause with the help of acupuncture and one very patient husband. Intimacy with Addi is great, she said, but the best part is that they still hold hands.

A healthy, intimate relationship, sexual or not, Petersen said, "helps us live a long time. It helps us in terms of heart disease. Sharing a wonderful sexual relationship is just about the closest people can come to being one."

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