Sexual activity as a choice. (Women Growing Older).

Has science contributed to our "knowledge" of sexuality during and after menopause? Smith-Rosenberg provides a 19th century view of women's sexuality during menopause:

   `My experience teaches me that a
   marked increase of sexual impulse
   at the change of life is a morbid impulse,'
   Edwards Tilt wrote ... `Whenever
   sexual impulse is first felt at the
   change of life, some morbid ovario-uterine
   condition will be found to
   explain it ... It, therefore, is most imprudent
   for women to marry at this
   epoch without having obtained the
   sanction of a medical man.' (1)

Contrast this with the 20th century view of sexuality in menopausal women: "Most women after the menopause, if they're reasonably happy and healthy, do not experience a diminution in sex drive," says Dr. Ramey, the senior physiologist at Georgetown University. (2) "... We have every reason to believe that staying in training sexually will help to improve the quality of life in later years." (3)

Scientists claim to be disinterested, objective observers as they reveal "facts." Science, according to the scientists, works by collecting information--each bit brings us closer to the "truth." Thus, we might assume that extensive scientific research is responsible for the dramatic difference in medical opinions on sexuality and menopause between the 19th and 20th centuries. On the contrary, only three of the 1700 pages of the two Kinsey reports were devoted to sexuality in older people; a computer search for research articles concerned with sexuality and menopause in the medical literature published between 1988 and 1992 yields eight entries; a similar search of the psychological literature between 1986 and 1992 yields 1424 entries about sexuality, four of which were concerned with menopause!

Although the "scientific research" is almost nonexistent, the social context has changed, changed significantly, and changed in such a way as to be consistent with current views of sexuality and menopause. The definition of sex, the ages between which one should engage in sex, the gender of the partners, the appropriate order of events, the appropriate timing--all information which physicians readily provide in the guise of "scientific truth"--are essentially determined by the morals, values, beliefs and politics of the culture.

Today, it is dogmatically asserted--by the medical profession and the official opinion-makers of our society--that it is healthy or normal for people to enjoy sex, that the lack of such enjoyment is the symptom of a sexual disorder, that such disorders can be relieved by appropriate medical interventions, and that they ought, whenever possible, to be so treated. This view, though it pretends to be scientific, is in fact moral or religious: it is an expression of the medical ideology we have substituted for traditional religious creeds. (4)

Most scientific research and statements are based upon certain assumptions which are not tested but which are presumed to be true. For example, a scientist may conduct a study to evaluate the effectiveness of hormone supplements on the sexual problems of menopausal women. This appears perfectly reasonable until we realize that there is no evidence that menopausal women, in particular, have sexual problems. Similarly, a physiologist states that "... a very large number do [experience a diminished sex drive]--maybe 30%--but since we're all living longer, this large number of women who face a diminished sex drive can be a very serious matter." (5) Why is this a serious matter? We are not told why it is important that 30% of menopausal and postmenopausal women prefer less sex. And, in delineating the "problem" further: "... a single woman without a regular sexual partner faces a particular dilemma in menopause since she must be motivated [i.e., have a sex drive] if she wants to find a mate." (6) Why must we assume that a single woman wants or needs a mate or that she can find one only if her motive is sexual?

In order to study sexuality in the elderly, the obvious source of information is the elderly--yet their views are dismissed. Since the current medical opinion is "sex is healthy," an elderly person expressing a lack of interest in sexual activity is accused of harboring underlying psychological problems:

   The most vociferous opponents of
   elderly sexuality can be elderly persons
   themselves, who have a compelling
   need to defend their own
   antisexual stance. For persons with
   lifelong sexual conflict or disinterest,
   age provides a plausible alibi
   to release themselves from anxiety-provoking
   sexual situations. (7)

They may also be accused of being social misfits:

   Women in their fifties and sixties
   who discontinue sex abstain primarily
   for sociological reasons, not biological
   factors, since they do not
   seek partner replacements unless
   they are unusually attractive and
   secure. (8)

When religion was in charge, sexuality was clearly linked to reproduction so there was no "reason" for menopausal women to be sexual. Current scientific opinion, however, severs the link between sexuality and reproduction and views sexual activity as a sort of symbol of physical and psychological fitness. Menopause is described as

   ... Nature's intent not to have older
   human beings become parents.
   Granting that is so, sex activity as
   an interpersonal communication, as
   a manifestation of affection, and as
   an experience with overtones of
   youth, continue and have more
   dominant meanings in the middle
   and later life. (9)

Unfortunately, by expanding the reasons for having sex, more contradictions appear. Sex is typically and historically defined as intercourse. However, if we accept the definition of sex as being an expression of love and intimacy, perhaps sex needs to be redefined:

   ... for the majority of women, intercourse
   itself doesn't necessarily
   lead to orgasm, although clitoral
   stimulation does. Therefore, we are
   forced to ask ourselves whether sex
   was "created" for pleasure and intimacy,
   or simply for reproduction. If
   the former, then the fact that the kind
   of stimulation the majority of women
   need for orgasm should be included
   in the definition of sex forces us to
   consider redesigning sex. (10)

By defining certain sexual acts as acceptable, and others as sick, by defining some as sick who have sex, others as sick if they don't have sex, we are attempting to control a human behavior in a manner similar to religious doctrines. Medicine does have a role in sex--to treat sexually transmitted diseases and to treat diseases of the reproductive tract; however, helping a woman to restore health to her vagina does not then give a physician the right to tell her how and when and how often and with whom to use it.

Many middle-aged and elderly women choose not to be sexually active. Is this acceptable? Can this be--psychologically and physically--a healthy choice? Or must we assume there is a "problem"? (11)

Many authors, while claiming "scientific objectivity," stereotype, label or outright blame by subtly implying that not to be sexually active is "sick." Runciman has suggested that menopausal women may use:

   ... the excuse of advancing years to
   avoid the personal embarrassment
   of inadequate sexual performance
   or the frustrations of unresolved
   sexual tensions. What I am saying
   is that there are many men and
   women who, through no fault of their
   own, do look forward to a respectable
   reason for the ending of sexual
   relations. That applies particularly to
   those who have always felt that sex
   was something they "had to go
   through." Many unconsciously welcome
   the advancing years to abandon
   the function that has been unpleasant
   since childhood. (12)

Others suggest that lack of sexual interest in older women may be a defense mechanism or due to not being able to find a man. (13)

Is it not possible that someone chooses not to have sex because he or she would rather not or because they have something better or more interesting to do? Does there have to be a reason? Cannot a decision not to be sexual be just a decision not to be sexual? Can we not accept that: "There is nothing unhealthy about losing interest in genital sexual activity; we are not sex machines obligated to keep our bodies perpetually in condition for potential partners"? (14) By assuming there needs to be a reason not to be sexual--an unsupportive spouse or a restrictive society--we are implying that the only natural, healthy course is to be sexual and, in most subcultures, heterosexual and social.

MacKinnon not only accepts the choice not to be sexual as not "sick," but accepts that a refusal to be sexual is a healthy response, perhaps the only healthy response, for the woman who is truly aware of those crimes against women--rape, incest, pornography--committed with permission, if not enthusiasm, by proponents of the patriarchy: (15)

   Kinsey and his followers, for example,
   clearly thought (and think) the
   more sex the better, trivialize most
   of those cases of rape and child
   abuse they discern as such, decry
   women's sexual refusal as sexual
   inhibition, and repeatedly interpret
   women's sexual disinclination as
   "restrictions" on men's natural sexual
   activity, which left alone would
   emulate some animals (p. 71).

   The assumption that in matters sexual,
   women really want what men
   want from us, makes male force against
   women in sex invisible. It
   makes rape sex. Women's sexual
   "reluctance, dislike and frigidity,"
   women's puritanism and prudery in
   the face of this sex, is "the silent rebellion
   of women against the force
   of the penis"--an ineffective rebellion
   but a rebellion nonetheless (p. 79).

In the absence of any reason to the contrary, I suggest that the proper, correct, psychologically and medically healthy manner for menopausal and postmenopausal women to express their sexuality is exactly as they please.

Menopause is not, contrary to popular belief, universally associated with diminished sexual activity; some women report a decrease, others an increase, but the majority report no change. This conclusion is consistent with literature focusing on the relationship between hormones and sexuality--that sexuality and hormones are not related to a significant degree, neither statistically nor clinically, is apparent from the lack of association between phases of the menstrual cycle and sexuality, from the lack of a universal impact of menopause on sexuality, and from the ineffectiveness of hormone supplements to influence sexual satisfaction, frequency or desire. There are, however, in middle and old age, changes in relationships inside and outside the family, professional concerns and challenges, physical illnesses, normal aging, and a continual resetting of priorities that could, and probably do, impact a woman's sexuality. Sexuality is but one of the many aspects of life which develop and grow as one progresses through adulthood.

The unspoken rules of what one ought or ought not do regarding sexuality are a product of the social, political and moral environment. This is particularly true for the menopausal women for whom even the suspect logic of biological imperatives has no meaning. In the 19th century, menopause was seen as a sign that sexuality was at an end; women who felt healthy, vigorous and sexy enough to marry were labeled "sick" and advised to see a physician. Today, menopausal women who prefer not to be sexual are advised to see their physician for help in restoring their lost sexuality. Since this "enlightenment" was not the product of intensive scientific research, what caused this change? Unfortunately, the focus of interest with regard to sexuality (and most other topics as well) has been the young, heterosexual adult; thus, we are left to speculate about the rest of the population.

Regardless of time and place, menopause has meant, among other changes, an increased freedom for women (16, 17)--if only freedom from pregnancy and childrearing. In the 19th century, social roles restricted women to such an extent that this freedom was, perhaps, not apparent or threatening to the social order. However, in the recent 20th century, with an emphasis on health and fitness and with greater social and professional opportunities available to women, the menopausal woman, still healthy and vigorous, may strive for increased personal independence and compete with men in the workplace. Science and medicine may be serving the need of the patriarchy by encouraging women to stay at home, stay dependent and stay in bed. We cannot, of course, ignore the "coincidence" that menopausal women were informed that "sex is healthy" about the same time that it became possible for them to spend their money on hormones which promised to restore beauty, youth, charm and sexuality.

In conclusion, I would like to mention that a discussion of menopause and sexuality is perhaps relevant to far fewer women than we might expect. The economic, social, and medical problems of many of the elderly take precedence over any serious consideration of or interest in sex. The Boston Women's Health Book Collective has clarified the significance of some of the immediate concerns of the elderly:

   ... poor medical care due to high
   cost, lack of insurance coverage, inadequate
   medical understanding of
   aging and maldistribution of doctors
   ... Money worries due to being
   on a small, limited income.... Inadequate
   income also makes it harder
   to take care of our bodies in simple
   but crucial daily ways. It is difficult,
   for instance, to get enough exercise
   if we don't feel safe on the streets
   or have little access to indoor exercise
   facilities. A worsening economic
   situation and drastic cuts in social
   programs make it more difficult each
   month for thousands of older women
   to get adequate calories, let
   alone vitamins and special diets.
   Some already subsist partly on pet
   food. Many are starving ... Four million
   American women between 55
   and 65 have no health insurance. (18)

The position in the hierarchy of needs occupied by the expression and enjoyment of sexuality should not be of concern to physicians or psychologists nor should they dictate "proper" or "healthy" sexual behavior. Some elderly women will place great emphasis on sexuality, others will choose to abstain--in either case, we need not assume their choices or their reasons are poor ones. And, for many elderly women who are struggling to survive, sexuality is simply irrelevant.

References

(1.) Smith-Rosenberg C. (1985). "Puberty to menopause: The cycle of femininity in Nineteeth-Century America." In C. Smith-Rosenberg, ed., Disorderly Conduct. N.Y.: Knopf.

(2.) Sheehy G. (1992). The Silent Passage: Menopause. N.Y.: Random House, p. 821.

(3.) Pfeiffer E. (1978). "Sexuality in the aging individual." In R.L. Solnick, ed., Sexuality and Aging. L.A.: Southern California Press, p. 31.

(4.) Szasz T. (1980). Sex by Prescription. N.Y.: Anchor Press/Doubleday, p. 165.

(5.) Sheehy, op. cit., p. 82.

(6.) Sheehy, op. cit., p. 86.

(7.) Sviland M.A. (1978). "A program of sexual liberation and growth in the elderly." In R.L. Solnick, ed., Sexuality and Aging. L.A.: Southern California Press, p. 99.

(8.) Sviland, op. cit., p. 102.

(9.) Rossman I. (1978). "Sexuality and aging: An internist's perspective" In R.L. Solnick, ed., Sexuality and Aging. L.A.: Southern California Press, p.77.

(10.) Hite S. (1987). The Hite Report: Women and Love. N.Y.: Knopf, p.xxxv.

(11.) The same question may be asked of women and men of any age. Is choosing not to be sexual an acceptable, healthy alternative? Although I have focused on older women, the same discussion would apply to this broader question.

(12.) Runciman I. (1978). "Sexual problems in the senior world." In R.L. Solnick, ed., Sexuality and Aging. L.A.: Southern California Press, p.86.

(13.) Corby N. and J.M. Axrit (1983). "Old and alone: The unmarried in later life." In R.B. Weg, ed., Sexuality in the Later Years: Roles and behavior. N.Y.: Academic Press.

(14.) Boston Women's Health Book Collective (1984). The New Our Bodies Ourselves. N.Y.: Simon & Schuster, p.452.

(15.) MacKinnon C.A. (1987). "A Feminist/ Political Approach: `Pleasure under the patriarchy'" In J.H. Geer & W.T. O'Donohue, eds., Theories of Human Sexuality. N.Y.: Plenum.

(16.) Gannon L. (1985). Menstrual Disorders and Menopause: Biological, Psychological and Cultural Research. N.Y.: Praeger.

(17.) Smith-Rosenberg C. (1985). "Puberty to menopause: The cycle of femininity in nineteenth-century America." In C. Smith-Rosenberg, ed., Disorderly Conduct. N.Y.: Knopf.

(18.) Boston Women's Health Book Collective, op. cit., p. 453.

RELATED ARTICLE: Loss of libido: a dissenting voice.

I am 56 years of age. I entered menopause about five years ago, had hot flashes frequently, sleeplessness, mood swings and crying jags. I have had hypothyroidism for the last thirty years, but with thyroid medication it is under control. I have been on hormone therapy for four years and am extremely comfortable with it.

I have been happily married for 36 years and had been looking forward to the sexual freedom all the articles point to when presenting the postmenopause. No one mentions the lack of interest in sex, or loss of libido, which I am experiencing. I have been to four different gynecologist in five years, three of them female, thinking that other women might have been more open about this problem with a woman doctor. Two doctors put me on testosterone, and one gave me an anabolic steroid. I gained fifteen pounds in three months but still have a diminished sex drive and an inability to have orgasm.

Please use my letter in any fashion you wish. I am anxious to share my experience with others.

Source: A Friend Indeed, vol. 10, no. 8, January 1994.

The author is a psychologist and professor at Southern Illinois University in Carbondale, Illinois (USA). She has published many articles about menopause as well as the book Menstrual Disorders and Menopause: Biological, Psychological and Cultural Research (NY: Prager, 1985). The following article is based on a chapter of Psychology and Biology of Female Sexuality, edited by Precilla Y.L. Choi and Paula Nicolson, and published by Harvester Wheatsheaf (London, 1993). This version is reprinted with permission from A Friend Indeed, vol. 10, no. 8, January 1994. A Friend Indeed is a newsletter published in Canada for women approaching or experiencing menopause. A one-year subscription (six issues) is US$40. For more information contact: A Friend Indeed, PO Box 260, Pembina, North Dakota 58271-0260 USA, or e-mail: [e-mail]