Tuesday, June 11, 2013

Darwinism, Sex and Midlife

Today's blog post is dedicated to the millions of people, who, through no fault of their own, suffer in silence about their changing, aging bodies and the role and place of sex in midlife and beyond. We all have questions we are afraid to ask about changes that are happening to our bodies that they don't talk about on tv, or any where else for that matter. 

So many couples present in couple therapy complaining of a low sex drive and/or unsatisfactory sex. Women come in saying they don't feel (sexually) like they used to, husbands complain that they don't perform like they once did. Couples feel alienated from each other, confused, and sometimes scared.

No one seems to be getting the information they need that explains the physical changes they are going through. So lets begin with the basics. 

As women enter the period of menopause things begin to shift physiologically. When menstruation stops, we are no longer ovulating because we no longer have any (ovum) eggs left. This brings about a cessation in the production of progesterone and a significant reduction in the amount of oestrogen we produce. Changes to the body due to this hormonal shift include but are not limited to hot flushes and night sweats; migraines; thinning of the vaginal walls; dryness in the vagina, bladder incontinence; lower libido (although its a bit of a chicken and egg story when considering the aforementioned changes); difficulty achieving orgasm; changes in how orgasms feel all together; insomnia and other sleep disturbance; body aches and joint stiffness .... And this is a short list.

Now there are any number of ways to deal with the above: certainly exercise and diet help a lot, as much as 40% of symptoms are helped by regular exercise and eating well. Some women can tolerate hormone replacement therapy, some women find other solutions. Some, decide not to treat this as an event in need of medical intervention. 

Its important to remember things are not the same for everyone and we need to respect those differences. That being said, within a given continuum, we all age and change accordingly as per our species.

As for men. Research shows that for most men, testosterone is no longer produced as it was, often declining to 50% of what it might have been in your 30's. Consequences of this lowered testosterone and aging can be seen in a lower libido, thinning hair, weight gain, difficulty getting or maintaining an erection, quicker ejaculation. Now of great import .. Aging and lower testosterone MAY NOT BE THE ONLY CAUSE OF THESE SYMPTOMS SO PLEASE GET CHECKED BY A PHYSICIAN. For example, sometimes, difficulty getting and maintaining an erection is a sign of a more serious illness such as dangerously high cholesterol for example. 

What's it like to go through this stuff? How does it feel? Why is it so hard to talk about?
Here is a common enough scenario: 

A couple has been together for quite a number of years. In the past year their sex life has been dwindling. The husband is having difficulty "getting it up", and / or keeping it up. This leads to anxiety for him because he doesn't know - geez is it my prostate? What is "wrong" with me? Who the hell can he talk to? He makes an appointment with his GP, gets a physical (probably first time in a number of years), goes for a blood test, stress test... Everything checks out. He doesn't ask the doctor this time about his waning sex drive or difficulty with the erections, figured he'd wait to see if something came up in the physical. He goes back home with the same worry, same unknowing about what's happening. Months go by. The frustration in the couple is mounting because its not being talked about, partners are becoming further alienated. All this stress is just not very sexy! Finally the wife explodes and demands something be done. He goes back to GP and asks for a script. He comes home and puts it away. A few months pass and another blow up. In the meantime all these months upon months have been harming both parties. His anxiety building, her frustration mounting. Finally he tries the medication. It works. And months and sometimes years, of shame and worry and alienation and loneliness are all of a sudden easier to talk about. Sort of.

Another scenario:

As the kids have grown and there is less need of her, mom finally starts to feel a bone crushing fatigue setting in. As well, over that past year she's noticed her periods have been less and less regular. As a matter of fact if she thinks about it, she hasn't had one for at least four months. Husband has been pursuing her but she is just not in the mood. Besides, last time they did it, things were so dry down there is was painful. Ugh. Who needs it?? And yet ... She sees the images on tv, women her own age or older, and they appear to be sexual, sexy, womanly and energetic, why not me? Whats wrong with me? She worries about the changes happening to her body; her vagina seems so much drier, the walls seem thinner, these hot flashes are terrible, and I'm soooo tired, can't he see whats happening to me? And yet.... She misses being close, misses being held, sometimes misses having sex, misses how easy it used to be between them. She wonders if other couples go through this. She wonders if other women lose their sex drive to some degree, if other women feel their orgasms are not what they used to be, if other women take so much longer to get aroused. She doesn't know who to go to to talk about these issues. Would be nice if she could turn to her husband.... 

One of the conversations I see people having a hard time with is what is normal? I'd like to introduce a few Darwinian notions at this point. We are one of the few species that pursue sex for pleasure. Wiki will tell you some 150 species do, that pigs and dolphins do, but I doubt that those animals are as affected by the society they live in and the sexual scrutiny of that society. In our society and culture everyone has sex. All the time. Except the very old and the very young. If you're not in either of those two groups you're supposed to want to have sex - often. 

Yet if we were to think of ourselves biologically for a moment things might seem a wee bit more compassionate. Our changing appetites are linked to the end of our reproductive capacity. Its been known that during the perimenopausal period, some women go through moments of very intense arousal. We can understand this as the bodies last chance.. This might be your last egg so get at her! If we were animals in the jungle we would possibly be looking at doing what we could to get that egg fertilized, propagate the species. Biologically thats our (species) job. Once we run out of eggs .. Thats it. We are done. And if sex were only about propagation we would never have reason to do it again. 

Humans are a species that is wired to be in a bonded pair. Its good for the species to have similar requirements among the sexes. So if her drive slows down because there are no more eggs to fertilize, it would behoove the couple if his drive went down too.  He could go out and find a younger female, but that would require him to fight off younger and stronger males and not every male of the species is up to the task. So again, we see biologically, the wisdom of our bodies, slowing down to accommodate what is demanded of us.

Now lets move out of the cave and into the 21st century. Sex in the life of the couple is about so much more than procreation. Its about love, playfulness, contact and comfort, connection, lust, sometimes on the dark side about control and power. Its how we express our need to be close. Those who have grown up with challenges about articulating feelings sometimes use sex as the conduit to expression. 

Whats important to learn and understand is that sex changes. For all of us. Its not just happening to you, its happening to both of you. Things slow down, the rhythm changes, touch changes, shape changes, sensitivities change, tastes change.... If we can accept that.. We give ourselves the room and compassion to move into something new. With no shame. With no anxiety. With grace and love and together.

If you have any questions, a need for a referral, comments, or if you'd like to pass some info along -  please do so. We are all cope so much better when we remain connected. 

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