The Wisdom of Menopause

by Christiane Northrup

  I was so fascinated by the connection between pleasure and nitric oxide that I wrote a small book called The Secret Pleasures of Menopause (Hay House, 2008) along with Drs. Murad and Taub and publisher David Oliphant. This little book tells the whole nitric oxide story, and along with its companion, The Secret Pleasures of Menopause Playbook (Hay House, 2009), it gives women all kinds of ideas for enhancing their levels of nitric oxide by deliberately pursuing pleasure in their lives.

  Nothing illustrates the parallel circuitry between sexual energy and life energy better than the power of sexuality to heal when it is able to express itself freely. In Reclaiming Goddess Sexuality: The Power of the Feminine Way (Hay House, 1999), Linda Savage, Ph.D., writes about her experience of recovering from Crohn’s disease, a chronic condition involving inflammation of the gastrointestinal tract that can result in weight loss, bloody stools, bloody diarrhea, and an increased risk of bowel cancer. Her weight had dropped to eighty pounds when she met a man with whom she began a very remarkable relationship. Within a few weeks all traces of her Crohn’s were gone. She attributes her recovery entirely to the healing power of sexual energy, which is simply one of the many forms the life force takes.

  This doesn’t mean I’d recommend running right out and having sex in order to heal yourself of a disease. The only way sexual energy can act as a healing force is if you experience it in the context of an unconditionally loving relationship in which your body, your soul, and your psyche are all cherished by another—or by yourself. Remember, you do not have to have a partner to experience the rejuvenating energy of your own sexuality. You simply have to start thinking of yourself as a sexually desirable woman!

  With all this in mind, it is also important to remember that as a woman traverses the perimenopausal transition and all the changes it invites, her libido may seem to go underground for a time, while she reprioritizes her life and the manner in which she uses her energy on a day-to-day basis. This is a perfectly normal diversion of life energy—an investment that can yield great dividends—but it is only temporary. There is no reason for a diminished sex drive to become a permanent feature in the life of a menopausal woman.

  MIDLIFE CHANGES IN SEXUAL UNCTION

  All of the following changes in sexual function have been associated with perimenopause. Reading through the list, you can quickly appreciate that change itself—and not the nature of the change—is one common theme.

  ~ Increased sexual desire

  ~ Change in sexual orientation

  ~ Decreased sexual activity

  ~ Vaginal dryness and loss of vaginal elasticity

  ~ Pain or burning with intercourse

  ~ Decreased clitoral sensitivity

  ~ Increased clitoral sensitivity

  ~ Decreased responsiveness

  ~ Increased responsiveness

  ~ Fewer orgasms, decreased depth of orgasm

  ~ Increase in orgasms, sexual awakening

  SEXUALITY AT MENOPAUSE:

  OUR CULTURAL INHERITANCE

  Like it or not, our sexuality has been, and continues to be, influenced by a male-dominated culture with an inherent double standard. In a recent bestselling book on how to slow the aging process, for example, the quality of a man’s sex life and its purported effect on his health were determined solely and meticulously by the annual number of orgasms—with a figure over three hundred being considered the most healthful. When it came to women, the author never bothered to tabulate or quantify how many orgasms a year could promote longevity. We got points only for being “satisfied with quantity and happy with quality” of orgasms. Happily, the data on women are starting to catch up to the data on men!

  Still, the double standard is also apparent in the fact that men can buy Viagra at any of hundreds of Internet sites without seeing a doctor, while women still can’t get birth control pills anywhere without a doctor’s visit and a prescription. There are even television ads addressed to the one-third of men who allegedly suffer from erectile dysfunction, letting them know they can buy themselves a cure in the perfect form: take a pill and get a reliable erection without having to connect your heart with your penis in any way. It’s no wonder the most notorious side effect of this medication is sudden cardiac arrest.

  Along those same lines of phallocentric reasoning, I once read about an ongoing study testing Premarin vaginal cream as a kind of “female Viagra” for women whose husbands are already on Viagra. The premise is that women’s sex drive decreases at midlife because of vaginal thinning and dryness. Inserting Premarin cream in the vagina, the researchers posit, would result in a reestrogenization of the vagina, making the experience of sex more comfortable for the woman (who, we assume, is already having intercourse regularly with a Viagra-enhanced penis). This is like reducing the vagina and female sexuality to a runway that requires de-icing for the plane to be able to take off more comfortably. For most women, sexual desire is related to far more than the estrogenic state of the vagina (though estrogen cream has been found to help some women).15

  I am reminded that our word vagina is derived from the Latin word meaning “sheath for a sword.” It would appear that we have not come very far in this respect since the ancient Romans. Too many women still see female sexuality predominantly in terms of how well our bodies meet and satisfy the needs and desires of males, rather than ourselves. That attitude, and the beliefs associated with it, finds its way into every aspect of our lives, including the medical research upon which women’s health treatments are based.

  In a study entitled “Vaginal Changes and Sexuality in Women with a History of Cervical Cancer,” the authors note that women who had been treated for cervical cancer experienced changes in their vaginal anatomy and function that had negative effects on their sexual function, including decreased lubrication, decreased elasticity, and decreased genital swelling during arousal. The authors said that the women experiencing these changes reported them to be “distressing,” and then went on to make the following observation.

  Although numerous studies have documented the distress associated with the loss of a breast, changes in the vagina have been neglected in this respect. A [literature] search performed in mid-1998 with the combined terms “cancer,” “breast,” and “distress” yielded 197 references. In contrast, a search in which the term “vagina” was substituted for “breast” yielded only 2 references. One might assume that vaginal changes would affect sexual function at least as much as the loss of a breast. An obvious reason for the predominant interest in the breast is that, in developed countries, breast cancer is more common than cancer of the female genital organs. Nevertheless, the paucity of literature on the effect of vaginal changes is noteworthy, and it may not be irrelevant to speculate about nonscientific reasons. For men, female breasts have aesthetic as well as sexual value, which may influence research policies in academic medicine, where male investigators predominate.16

  Identifying and Awakening Your

  Female Erogenous Anatomy

  Women are, by design, orgasmatrons—capable of far more sexual pleasure at any age than we’ve been led to believe. We have as much erogenous erectile tissue as men do. It’s just that it’s mostly on the inside. And, unfortunately, the full extent of this anatomy and how to stimulate it is virtually unknown, even to most gynecologists! I am eternally grateful to registered nurse and midwife Sheri Winston, author of Women’s Anatomy of Arousal: Secret Maps to Buried Pleasure (Mango Garden Press, 2009), for her work in waking women up to the fullness of their erotic potential. The first step toward awakening this potential is knowing where it is. (See Figure 14, on page 332).

  FIGURE 14: THE CLITORAL SYSTEM

  Let’s start with the clitoris. This organ has 8,000 nerve endings whose sole function is pleasure. And it’s connected to the so-called G-spot (Grafenberg spot) by a rich network of nerves that run throughout the pelvis. I like to think of the clitoris as the north pole and the G-spot (called the sacred spot in tantric yoga traditions) as the south pole.
You can stimulate both together. But know this: if a woman has had a history of sexual abuse, stimulation of the G-spot may well be incredibly painful at first, or the spot may be numb. A woman can awaken this area and work through the pain with loving massage from a partner or from herself. Over time, the pain and numbness will leave, and she will feel exquisite pleasure. (For full instructions, see Freeing the Female Orgasm, a three-CD audio course with accompanying booklet by Charles and Caroline Muir, available at www.divine-feminine.com.)

  Here’s another thing to realize: only about 25 percent of women have orgasm with intercourse alone. Most need other forms of stimulation. Yet our culture—and popular movies—almost never reflect this! One of the most reliable ways to reignite a woman’s libido is to let her know that she is desirable and loved. In Women’s Anatomy of Arousal, Winston gives many tips for lovers. I recommend this book highly (as well as The Illustrated Guide to Extended Massive Orgasm by Steve and Vera Bodansky, mentioned earlier in this chapter). What a great way for a couple to rekindle their sex life together.

  Overcoming Cultural Barriers:

  The First Step Toward Waking a Sleeping Libido

  Although progress is being made, change in our culture’s attitude about women and sexuality is slow in coming, and many women have never felt as though they had permission to explore their own sexual energy on their own terms. In Reclaiming Goddess Sexuality, Dr. Savage writes:

  [Women] want the beauty of the context of sexual encounters to be more important than the act. They want to be touched in slow, sensual ways. They want to be ravished with intense pas-sion that demonstrates how much their partners need them, rather than just needing an orgasm to relax. All in all, women want to be adored as precious feminine beings.17

  The fact that this need is incompletely met for women in our culture is what drives the multimillion-dollar romance novel industry, with books that have increasingly explicit and very erotic sexual content. Many women are absolutely addicted to these stories (which a friend of mine calls “cliterature”), because they invariably show women being adored for who they are, not just for their bodies. Novelist Isabel Allende writes that the G-spot is in the ears and that anyone who looks for it anywhere else won’t find it. I so agree. Women fall in love through words and being talked to!

  LORI: What I Did for Love

  Over the years, Lori had become gradually aware that her sex life with her husband, Roy, was not meeting her needs. “There was never any cuddling, caressing, nothing to get me in the mood. And he wanted it at least once a day—the harder his day had gone at work, the more he needed it. For him it was a tension reliever. For me it had become mechanical and pretty much unsatisfying.” With the help of a marriage counselor, Roy became aware of Lori’s needs, and together they learned techniques that opened up a whole new world for them both. “The sex became great,” Lori wrote. But Roy’s needs for regular “pressure release” after work didn’t go away, and to engage in that sort of sex seemed to Lori like a step backward. “To be honest, it made me mad,” she reported. “I felt like screaming, ‘Haven’t you been listening?’” Their counselor, in subsequent sessions, led Lori to believe that to be in a fair partnership, she must be willing to meet Roy’s needs, too.

  Generally speaking, Lori’s counselor was correct. All couples must learn how to compromise in order to satisfy the needs of each person, and sex is no different from any other area of need. But there were parts of Lori and Roy’s story that deeply concerned me when I first spoke to Lori, who came to see me about hormone replacement at the age of forty-five, when she started skipping periods.

  I wanted to be sure Lori didn’t believe that it was her “job” to relieve Roy’s tension and stress by allowing her body to be used in this way every day. I validated her anger at this and told her that it was her barometer, letting her know that the problem it signaled was real and needed to be addressed. Second, I suggested that when an individual needs that much sex to medicate his (or her) stress, something is wrong in his (or her) life. I asked if their therapist had suggested that Roy examine his life, his job, and his stress levels. Lori said that she had raised this in therapy but had been told that this was an individual issue, not a couples issue. Since Roy had refused individual therapy, there was nothing further she could say on this subject during their sessions.

  This is a perfect example of what can happen when couples therapy goes awry. Fully 96 percent of all couples therapy involving heterosexual relationships is initiated by the woman, who usually holds it over her husband’s head as a last-ditch effort to save the marriage. He goes in, usually reluctantly, often feeling, “It’s her problem, but I’ll go along,” and unable or unwilling to understand that his own issues are part of the couples dynamic.

  Candidly, many therapists have told me that if the man’s issues were addressed directly, he’d be sufficiently uncomfortable that he’d probably terminate therapy altogether. So the therapist tries to keep him engaged with so-called couples issues. Too often, the woman’s individual concerns also get subverted to the needs of the “couple.” This kind of therapy can go on for years, relieving the relationship tension just enough so that the couple stays together, while the fundamental power dynamic of the relationship never changes because key individual behaviors never change. When this happens, there’s no chance for the transformational power of true partnership.

  To create a true partnership, Roy needed to see that he was using Lori sexually as an opiate, to medicate himself for stress. There was no way Lori could have a sense of true communion or of being cherished by him as long as stress relief was the main energy driving his lovemaking. Though it would be perfectly reasonable for them to compromise with a “quickie” now and again, for Roy to make a daily pattern of using sex to self-medicate for stress sounded like sexual addiction and dysfunction to me. It was certainly undermining Lori’s ability to feel good about their sexual relationship. Roy needed to take responsibility for his own stress reduction needs, and he needed a wider repertoire of behaviors to accomplish this. This might include exercise, meditation, or even masturbation. Though wives have been expected to serve their “wifely duty” in this way for centuries and have acquiesced for fear that he might go elsewhere to “get his needs met,” there is no place for these assumptions today if a couple is to reach the joyful communion that’s possible at midlife.

  At the time of her next annual exam, Lori told me that over the past year Roy had begun to realize he needed to change his job if he didn’t want to follow in the footsteps of his father, who had died at age sixty, only one year after retiring from a job he had hated. He had also found several ways of achieving stress reduction, including going to twice-weekly yoga classes and joining a basketball league at work. Thanks to these changes, Roy’s blood pressure and cholesterol dropped to normal, and he began to feel better about himself, knowing that he had been able to assert this kind of control over his life and free himself of the pattern that had probably helped bring about his father’s premature death. Once Lori saw that he had become more emotionally self-sufficient, she found him more sexually attractive—to the point that she was actually initiating sex.

  What Viagra Tells Us About Our Sexuality

  Viagra and the enormous publicity surrounding it speak volumes about the values of our culture. There is no question that Viagra and related drugs such as Cialis can be a boon to quality of life for many couples in which the male partner suffers from erectile dysfunction. (Note, however, that these drugs have been linked with an increase in a condition called ischemic optic neuropathy, which leads to vision loss. In October 2005, Public Citizen petitioned the FDA to immediately require a black-box warning on the labels for each of the three erectile dysfunction drugs. If your partner relies on these drugs, take heart—there are all kinds of ways to treat erectile dysfunction with nutrition, herbs, and exercise.) There are also other ways to enjoy sexual fulfillment besides intercourse. Enhanced sexual performance through medical manipulation
of the male’s genitals only cannot heal a relationship that needs more love and attention or may need to end.

  Our culture is quick to forget the holistic nature of sexual function and how profoundly it is enhanced when a couple is truly connected via their hearts and minds. It is well documented, for example, that the excitement and plateau phase of the sexual response can be prolonged if the connection between the man and woman is not only genital but also related to heart and mind. In fact, both men and women are capable of experiencing far more sexual pleasure and fulfillment than most currently enjoy. A first step toward experiencing this pleasure is knowing that it’s possible and health-enhancing.18 At midlife many couples find that they have the time and the desire to be fully present to each other in this way, and as a result they experience the best sex of their lives. This is in part because older, more experienced women tend not to be as inhibited as when they were younger. They know their bodies better. I’ve heard their stories repeatedly in my office. But for some, making love is just another task on the to-do list. Sex therapist Patricia Love, Ed.D., wrote:

  Sensuality—the ability to be comfortable in one’s body, suspend time, and communicate through the skin—is what is missing in many marriages…. All too often husbands and wives go to bed feeling distracted and numb, reflexively groping for each other’s genitals. The unspoken goal is to go from neutral to orgasm in fifteen minutes, like a car zooming from zero to sixty.19