November 07, 2016


aging ›   grandmothers ›   menopause ›  

We Are the Orca!

What Killer Whales Can Teach Us about Menopause

Can anyone guess what we have in common with female orcas (killer whales}?


That’s it. We share menopause with only two species on the planet, and both are whales: the orca (killer whale) and the pilot whale (which is technically a dolphin). All other mammals, including gorillas, chimpanzee, elephants, dogs, cats, and camels continue to bear young, albeit with decreasing frequency, until they die. No other mammal experiences literally decades of post-reproductive life.

Except us and the whales.

Of course, the big question biologists ask is, Why? From a Darwinian perspective, bearing young assures the continuation of the species. Decades of life without fertility makes no evolutionary sense. (According to biologists; we, on the other hand, might feel otherwise.)

Now, after decades of closely observing a specific pod of killer whales in the Pacific Northwest, biologists have greater understanding of the role female elders play in the whale community. The almost eerie parallels to our human experience have piqued the interest of scientists and writers, who think perhaps the way of the orca may shed light on human menopause.

For years, scientists thought human menopause was simply due to medical advances that enabled women to outlive their normal genetic lifespan. Without the intervention of modern medical technology, so the thinking goes, we too would bear children until we died, like our close mammalian cousins. Evolution, remember, favors traits that support the passing on of a species’ genes.

Enter the orca.

Female orcas stop calving in their 30s and 40s, but they continue to live for many decades beyond that—well into their 80s. “Granny,” the oldest of the Northwest orcas, is thought to be over 100 years old. After decades of observation, including hundreds of hours of underwater video, scientists began to understand that these old gals weren’t just freeloading on their sons and daughters. They were critical to their survival.

Orcas mostly hunt salmon, stocks of which vary, sometimes greatly, from year to year. It is the older female orcas that tend to lead the pods, and this is especially noticeable when the salmon stock is low. During lean years, the older females more frequently lead the clan. At those times, the accumulation of knowledge and experience by the older females give the orca a critical edge.

“That kind of knowledge is accumulated over time—accumulated in individuals,” said Darren Croft, professor of animal behavior at the University of Exeter in this article.

Studies of death rates were also revealing. The whale clans are matrilineal, with sons and daughters staying with the mother for life. Mature sons are so dependent, in fact, they are called “mummy’s boys.” They leave the clan periodically to mate, but they return to follow their mothers. When an older female dies, her sons and daughters are more likely to die as well. In fact, a son is eight times more likely to die within the year after losing his mother.

While these characteristics don’t exactly parallel human experience (we don’t tend to enjoy having our aging sons follow us around), they do point to the critical role of older females to the survival of the clan, whether whale or human.

Recent studies of hunter-gatherer societies reinforce this hypothesis. Given the long and costly job of raising human children to adulthood, grandmothers play a critical role in the well-being of the family, often taking on the role of forager-in-chief and caregiver for a daughter’s children.

It’s called the “grandmother effect.” Evolutionary biologists hypothesize that these contributions of an older woman offsets the decades of infertility. The grandmother assures that her genes are passed along by making sure that her grandchildren survive.

By no means do the grandma orcas take a back seat to the kids. They remain spry, vital, and active into their advanced years, maintaining their role as guide and coach. But the old gals have also been seen cavorting sexually with young males, presumably to teach them a thing or two about the birds and bees—and the cetaceans.

“Besides being the repository of knowledge about where to go in case of lack of food, they also lead very rich lives,” says Deborah Giles, director of the Center for Whale Research.

And so do we. This evolutionary state of affairs wherein we enjoy decades of vigorous, post-reproductive life while contributing to the well-being of our kin and the world in general is a pretty happy state of affairs, I’d say.

If the whales are any indication, far from being redundant, useless, or invisible, we continue to fill important and meaningful roles after menopause, which we have garnered through years of experience.

“We complain, women of my age, of becoming invisible, and it's trueyou realize how very much you're defined by sexuality. But I have a sensegalvanized by stories about the killer whalesthat now is the time when you become the person you really want to be," writes journalist Christa D’Souza, author of The Hot Topic, a book about menopause.

“The idea of women passing on information; the idea of wisdom with agethere's a beauty in that that is about something other than being able to reproduce.”


News Flash! Grandma’s Still a Hottie

Every year or so, it seems a new study “discovers” that the stereotype about women becoming less interested in sex as they grow older is, in fact, only a very persistent falsehood. Older women like sex! And, given a steady partner, they’re as satisfied with it as any 30- or 40-year-old. And nearly as active.

That’s the word from last year’s study, conducted by Dr. Holly Thomas, an assistant professor of medicine at University of Pittsburgh Medical Center. In a national survey of almost  2100 women between 28 and 84, but mostly clustered in their 60s and 70s, two-thirds of the older women were sexually active and were as satisfied as ever with their sex lives.

Having a committed partner appeared to be the critical factor: Women were eight times more likely to be sexually active if they had a partner. In fact, sexual satisfaction was unrelated to age, but was more strongly linked to the degree of contentment within a relationship, ease of communication, and the importance the couple placed on sex.

“It's good to see that menopause is not nearly as important [to sexual satisfaction] as their relationship with the person they're having sex with,” said Lynnette Leidy Sievert, board member of the American Menopause Society, “because menopause is blamed for so many things.”

Yet, to disrupt the stereotype even further, thirteen percent of sexually active women in Thomas’s study didn’t have a steady partner, so “we shouldn't look at a woman who's not married and 60, and assume she's not sexually active,” says Thomas.

What used to work in the past may not now.These high levels of sexual activity and satisfaction with sex have actually been fairly consistent over time, according to Thomas. A much larger study of 27,347 women between 60 and 79 that was conducted in 2011, also found that over 60 percent were happy with their sex lives, and of those who weren’t, almost 60 percent said they wished they had a more active sex life. The most common reasons for lack of sex were death of a partner, depression, and health problems.

Granted, our approach to sex and what gives us pleasure at 60 is different from sex at 30. For one thing, the physical element, such as attaining orgasm, is no longer as important as emotional aspects, such as intimacy and the feeling of connection with a partner. For another, the mechanics may—or may not—change with age, according to Thomas.

Some older women in Thomas’s study experienced the very predictable issues with libido and orgasm that we discuss all the time at MiddlesexMD. “Many women I talk to say, ‘What used to work for me doesn’t work for me anymore,’ ” noted Thomas.

But other women reported that sex was actually more satisfying than when they were younger, which they often attributed to greater self-confidence in knowing what they liked and in asking for it. Yet other women said that their sexual experience had remained fairly consistent throughout the years.

Apparently, in the absence of health issues or the death of a partner, satisfying sex can continue for a long time. A 2015 British study examined the sexual activity and satisfaction of men and women over 70—and into their 80s. While percentages of sexual activity had declined (to 54 percent for men and 31 percent for women), satisfaction levels for women continued to increase as they aged.

So, while sexual heat may gracefully fade from a red-hot boil to a comfortable simmer, satisfaction levels seem only to increase. Which is kind of sweet and hopeful, don’t you think?



Sex and the Sharper Mind

A recent Wall Street Journal headline read, “Sex in Old Age May Lead to a Sharper Mind.” The article describes a study in which Dutch researchers looked into the way cognitive function and attitudes toward sexuality might be related among older people. Nearly 2,000 adults, with an average age of 71, were given a variety of cognitive tests. They were also asked a series of questions about sex—whether it was important for older people generally or themselves personally, whether they found it pleasant or unpleasant. They were asked whether they still benefited from intimacy and touching.

Quite a few—41 percent—said that their current sexuality wasn’t important, but 42 percent said it was important for older people in general. A quarter considered sex important or very important. Only 6 percent found sexual activity unpleasant. More than two-thirds believed that intimacy and touching were still vital.

The results of these questions and the cognitive tests were correlated. Both men and women who thought sex was important and were satisfied with their current sex lives tended to do better on the cognitive tests.

The Wall Street Journal article points out that the study made no claim that sex improves brain function, or vice versa: only that the two are associated. It can be difficult to disentangle cause and effect.

Another study looked at how cognitive function affects sexual behavior interest and sexual behavior among the elderly. The 352 Italians studied were between 65 and 105 years old. They were asked, “Are you interested in sex?” and “Do you have sexual relations?” They were also given two tests of cognitive functioning. One third were still having sex and 40 percent were still interested. This study suggested that a sharper mind might help keep a sex life going.

It could be that older people who are healthy enough to have sex are also healthy enough to do well on cognitive tests. Generally, whatever is good for the brain is also good for sex. That’s a good reason to keep on exercising, or to start.

February 28, 2014


aging ›   culture ›   sexuality ›   The Good Stuff ›  

Aging—and Loving—in America

I don’t always catch AARP The Magazine, I suspect because I’m still adjusting to thinking of myself as part of their demographic. But the most recent issue contained an article I’m glad I saw: “You’re Old, I’m Not,” a report on an AARP survey on “Aging in America.”

Among the findings are a few you’ll accept as common wisdom: People in their 40s define “old” as younger (63) than people in their 70s (75). As we grow older, we find that the process is “easier than I thought,” that we’re not held back from doing what we want to do. Older people appreciate old-folks humor more than younger folks do.

One section of the results, though, sparked my interest in a different way. There’s a difference by gender in agreement with this statement: “I know I’ll enjoy sex no matter how old I am.” Seventy-one percent of men agreed; only 51 percent of women did. Gender mattered much more than age: There’s only a 7-point difference between people in their 40s (66 percent) and people in their 70s, 59 percent of whom still expect to enjoy sex.

Given my line of work, I take that difference by gender as something as a battle cry. I certainly don’t want women to be like menvive la différence! But I take it as a personal, professional, and generational challenge to see more women look forward to enjoying sex!

I doubt that AARP was able to delve into the thinking behind people’s responses to that question. My guesses about why women are less optimistic than men are based on my years as a menopause care provider, not on AARP’s data. But here are my theories:

First, we’re young at understanding menopause. The average age for menopause is now 50; until 1900, few women lived past that age. We’re living longer now, and have much more experience with menopause, but we have no deep cultural expectation of conversation about it.

And that leads to the second factor: In the absence of good information, the worst-case scenario tends to take over our imaginations. Have you noticed that talk about child birth and root canals nearly always leads to the sharing of horror stories—the labor that lasted four days, the excruciatingly painful dental experience? Even though those stories are the exception, not the rule? I’ve seen the same thing happen with women talking about menopause, and the women who hear those stories are more willing to accept limitations and less empowered to take control of their own sex lives!

There’s one more factor, too: We as women start to receive messages that sex and older don’t compute. For some reason, “sexy woman” conjures a young woman in our media and culture—and, for some reason, we’re susceptible to that suggestion!

I don’t know when AARP will conduct this survey again. But when they do, my hope is that women agree just as often as men that “I’ll enjoy sex no matter how old I am.” Because we can, when we take the time to understand what’s happening as our bodies change. And we want to, when we recognize what sex means to our health, our well-being, and our relationships—and all the ways those intertwine.

And, okay. Because we women can be a little bit competitive, too.

View from the Trenches

Dr. Susan Kellogg Spadt on Sex and Aging

Have I mentioned recently what a great team of medical advisors is associated with MiddlesexMD? We regularly draw from the wisdom and experience of leaders in the field of aging and sexuality. In the next two posts, we’ll hear from Dr. Susan Kellogg, who is not only one of our esteemed advisors, but who also co-founded and directs the Pelvic and Sexual Health Institute in Philadelphia. Read on as Dr. Susan shares with us some of the barriers to sexuality for older women. And thanks, Susan!

In my practice I regularly see women in their 60s and 70s. What often impresses me is how unique each is in her experience of sexuality.

Some still like sex and remain sexually active, while others just aren’t interested—even if they have a functional partner.

Of course, there’s been a lot of research, mostly on the age-related changes men experience. I think this is because male sexuality is more straightforward. With women, as has been said elsewhere on MiddlesexMD, it’s complicated.

So, let’s look at some of the impediments to sexuality for women as they age.

Internalized ageism. We absorb cultural messages all our lives. They bombard us from the media, from religion, maybe from the region we live in or the ethnic group we belong to. The messages can be subtle (“Good girls don’t…”) or they can be in-your-face (“You’ve come a long way, Baby.”)

While the messages have shifted over the years, some are inconsistent and some remain the same. For example, one consistent message is that “real” men remain sexually active as they age. (Which, I’m thinking, can be pretty tough on men, too.) For example, an older man’s ability to attract (and, presumably, to satisfy) the “trophy” wife is a status symbol synonymous with wealth, virility, and power. The messages are mixed for older women. It’s desirable to be a “cougar” in your 40s and 50s, but the ground shifts subtly after that. Despite the sexual older woman portrayed by the Golden Girls, or by Diane Keaton in Something’s Gotta Give, or Meryl Streep in Mamma Mia, the word on the street is that we older women ought to settle gracefully into our roles as the sexless Grandma. A foxy granny just doesn’t play well.

We, in turn, can be very sensitive to these cultural expectations, and we can allow them to define us. We can internalize them.

In fact, research suggests that gay men and heterosexual women are highly susceptible to internalizing cultural messages that equate aging with loss of interest in sex.

When we implicitly assent to the message that we’re old and therefore no longer sexually attractive or viable, it can affect our self-esteem and our experience of sex and intimacy. The message is false, and believing it is a shame.

Sexual scripts from families-of-origin. Just like societal messages, we absorb beliefs and assumptions about sex from our families. They can be deeply imprinted on our young minds, and they don’t have to be clear or verbalized. In fact, our families are often the first place we learned about sex.

Did our parents smooch and cuddle or were they cold and distant? Did sex seem natural and loving or was it something shameful and dirty? Did the sex stop at some point? Did they move to separate beds or separate bedrooms? Did this seem to be expected at a certain age?

Women commonly internalize direct and indirect messages about aging and sexuality from family members. Usually, we’re not even aware of it.

Low self esteem. It’s hard enough to maintain a strong sense of self-worth in this world without the added insult of getting old in a culture that absolutely idolizes youth and beauty.

We may have survived the adolescent jungle and our family of origin with, I hope, few scars. Many of us have struggled with self-esteem, and that struggle has only changed, not ended.

Now we’re hit with an entirely new challenge: how to maintain our confidence and positive self-image as we grow old in a culture that seems to have no use for us simply because we’re not young.

It’s unfair and it’s insulting, and it takes a strong sense of self to stand against that bias.

Unfortunately, for some women, feelings of low self-worth become an impediment to sex. I think this is why some women complain about feeling unattractive and losing desire. It’s hard to feel sexy when you feel dowdy and useless.

One client even said that when she saw her sagging breasts in the mirror she felt that she did not “deserve to have sex.”

The truth is, of course, that beauty has a lot more to do with confidence and creativity than with perfectly taut skin. Cover up the mirrors. Be proud of your wrinkles! You’ve earned them. To be continued…

Sex: Deciding to Just Do It

We are learning more and more about what motivates women to have sex -- enough to know that we still don't know that much.

We do know that our motivations change with our situations. What motivates us when we're young and single is very different from what motivates us when we're older, and in long-standing relationships, or older and single.

So when we suffer from lack of desire -- are we missing the sort of drive we had when we were teenagers? And is it possible we just haven't found a new motivation for sex?

The more we learn from women, the more it seems that for us sex doesn't always begin with lust, but instead starts in our hearts and minds. We engage in our heads first, decide to have sex, and then with enough mental and emotional stimulation, our genitals respond. The older we grow, the more this is true. Age and maturity bring a new game into the bedroom.

For us, having sex is less an urge than a decision. One we can choose to make and then act upon. When we decide to say yes instead of no, decide to schedule sex instead of waiting (perhaps for a very long time…) for our body to spontaneously light on fire, decide to engage with media or methods that will put us in the mood rather than wait for romantic moments to happen along, we're using our heads to keep sex in our relationships.

Deciding to be intimate unlocks the pleasure. And the more sex we decide to have, the more sex we will feel like having. That's the secret to regular bonding.

Why just decide to do it? This much we know:

* Sex leads to a longer life.
* Sex, like all exercise, helps protect us against heart attack and possibly stroke.
* Hormones released during sex may decrease the risk of breast cancer and prostate cancer.
* It bolsters the immune system.
* Sex before bed helps us get to sleep.
* Of course, sex burns calories.
* Sex can help relieve chronic pain, including migraines.
* An active sex life is closely correlated with overall quality of life.
* Good sex can protect us against depression.
* Good sex reduces stress and increases self-esteem.
* Sex with your significant other stimulates feelings of affection, intimacy and closeness.

Making sex a focus in your life as you get older doesn't make you unusual. A study by AARP found that 66% of women age 45-59; 48% of women age 60-74 and 44% of women over the age of 75 believe that a satisfying sexual relationship is important to their quality of their life.

We think those numbers would be higher if women knew they could engage in thoroughly satisfying sex without waiting around for desire. Just by using their heads.