Secrets for Our Daughters (and When to Fire Your Doctor)

The United State of Women “Healthy Women. Healthy Families.” summit in Washington D.C. didn’t focus specifically on perimenopausal and menopausal women, yet my conversation with attendee Marta Hill Gray naturally circled around to the topic of women, aging, and sexuality.

Marta, a women’s health advocate, worked behind the scenes to promote “pink viagra,” and she continues to be an insightful observer of women’s issues.

What have you observed about society’s view of women beyond the childbearing years?

As women age, society says we are supposed to suck it up and get on with it, but that doesn’t mean we are healthy and actually taking care of ourselves. For so many women, when you get to menopause no one has taken time to tell us what to expect.

After attending the event, what advice do you have for my readers?

Talk to daughters, sisters, nieces, and friends about the changes that are coming.Younger women need to know the time will come to a time when their bodies are going to change. As older women, we need to talk to daughters, sisters, nieces, and friends about the changes that are coming. Let them know that once you have your babies, it’s not over. We should really mentor them in being diligent about their bodies, so they ask better questions and they’re smarter than we were.  

Your mom may tell you about having their period but not about menopause… It is a big deal. And women need to know there are doctors like you, menopause providers, who can make it manageable, who can give you treatment options and care and guidance so you move through it gracefully.

Not all doctors are comfortable with women in menopause.

That’s true. And if you don’t have health care providers you can talk to you, you need to fire them and find one you can talk to. Yes, you can fire your doctor, it’s all right! Just because they wear a white lab coat doesn’t mean they know how to help. You should be able to comfortably discuss any topic including bowel movements, urine, sexuality … all of that is important.

There seems to be more openness to talking about sexuality and sexual health today than when I began my practice.

I agree. The fact is that we’re living longer, we look better, and we are more involved than previous generations of women our age.

We're living longer and are more involved than previous generations.It is such a life-affirming thing to be a sexual creature, yet so many women have painful intercourse, and then they shut down, which can hurt relationships. I think that women going through menopause should definitely be able to depend on their health care provider to give them information and tools to overcome the challenges. It is different for everybody and, just as it is when you’re younger, it is very personal. A lot of women don’t know they have options and choices.

Women’s health and women’s sexual health isn’t behind the curtain anymore. It is being forced out on the table partially by the fact that our world is smaller and we know so much about girls as slaves, genital cutting, sexually transmitted diseases... everything is discussed and it will continue to be so discussed because these are facts. It’s an open discussion now, and the word vagina can be said. Women make up 50 percent of the population, and we are full citizens.

Younger women are leading the charge and they will not be denied. They have no fear. I think it’s fantastic, and it’s going to get better and better.

July 25, 2016

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Women’s Health: We Won’t Be Denied

You can't talk about women's empowerment without talking about health.My good friend and women’s health advocate Marta Hill Gray recently attended the first summit of The United State of Women, a gender equality movement with high-profile support from Michelle Obama, Warren Buffet, Oprah, Meryl Streep, Amy Poehler and other well-known celebrities. (To learn more, watch this two-minute film.) Naturally I was interested (and very curious) to hear all about this event, which was convened by the White House in Washington D.C. Here are highlights of my recent conversation with Marta:

I understand the topic of this summit was ‘Healthy Women, Healthy Families.’

Yes, you can’t talk about women’s empowerment in any fashion without talking about their health—it’s one and the same, and it hasn’t been given enough attention and respect. It was exciting to see 5,000 women who took time to fly from around the world for this event.

It was a tsunami of attention around women’s issues.

What was your main take-away?

There was a lot of sizzle with big-name celebrities… but more importantly, it really put a spotlight on younger women who are dedicating their lives to women’s issues

Millennials are really stepping up and very much engaged in ways we may not have been at that age. The younger women are leading the charge and they will not be denied. They have no fear. I just think it’s fantastic, and I think it’s going to get better and better.

What kinds of speakers did you encounter?

I saw some wonderful health care professionals who are working with underserved communities, helping women get the support and education they need, and helping them understand their rights are in terms of pregnancy, treatment options and even what insurance will (and will not) cover.

For example, The Women’s Law Center spends all of their time answering the phone and explaining to women what their rights are, like the right of all women to have breast reconstruction surgery after a mastectomy.

Those are the kinds of things that many of us take for granted, but not all women get the same information or the same treatment.

What surprised you?

I am seeing a real shift in the language and the public perception about women’s health. This isn’t just a women’s problem—it’s a problem for men, for boys, for sons. This impacts families and it impacts lives.

Why this special focus on women’s health?

Women's bodies need to be understood separatelyHere’s an epiphany: Women’s bodies are not like men’s bodies. They need to be respected and understood separately. Yet, women don’t know about their bodies, there is often shame about it and there many cultural nuances. The question is, ‘How can we support women who need this kind of care?’ 

But the good news is that things are changing. This summit was full of vibrant conversations instead of the shame of years ago.

I was encouraged by the young women. To them, it’s so important that there’s no thought of repercussions. It gave me great hope to see women who are so sharp and directed and capable.

My conversation with Marta went beyond the summit to the topic of women, aging, and sexuality. Watch for my next blog to learn more.

STDs for Grownups: What You Don’t Know Can Hurt You. A Lot

Sit down, Girlfriend. We need to talk.

Remember those uncomfortable discussions you had with your kids back in the day? You know, the birds-and-bees and how-not-to-get-pregnant talks?

Well, now it’s your turn to listen. This is your middle-age sex talk.

At some point in life, you’ll probably be alone, demographics and life expectancies being what they are. Maybe you already are. Maybe you’re newly divorced. Or widowed.

And maybe, after being married for many years you’re not ready to write off a relationship—or sex—for the rest of your life.

That’s great! We’ve already discussed the health benefits of sex. And we’ve talked about the research that shows that older women really like sex and are good at it.

But the singles scene is now a completely different ball game from those long-ago days when you were a player. “When I was younger we only worried about getting pregnant or getting crabs. Now that I’m divorced, I realize it’s a whole new world!” said a woman on one health website.

“In my practice I see a lot of older single women who don’t know the rules of dating,” says Mary Jo Rapini, psychotherapist and MiddlesexMD advisor. “They’re looking for someone to desire them again, and they’re much too easy with letting sex happen. They aren’t comfortable with demanding that the guy wear a condom.”

You may not need protection against pregnancy any more, but you sure need protection against a cornucopia of STDs that has flourished since your first date.

STDs affect every age group, but rates of infection are growing fastest among older people. According to the Centers for Disease Control, 15 percent of new HIV infections are in those over 50—and death rates are rising, too. In 2008, the journal Sexually Transmitted Infections noted that infection rates among those over 45 had doubled in less than 10 years. Research at Indiana University in 2010 indicated that condom use was lowest in that age group. Maybe there’s some connection there?

Besides general lack of awareness, a few physiological factors make it easier for older women to become infected. The thin, dry vaginal walls that accompany loss of estrogen create small tears and microscopic vaginal bleeding during sex, thus offering a warm welcome to invading nasties. Further, our pH balance tends to be less acidic after menopause, creating a friendly environment for bacterial infection.

So what’s a newly single older gal to do?

Empower yourself, says Rapini. Take a page from your kids’ playbook and insist on safe sex. This isn’t about being difficult or demanding, it’s about your health, and you have every right to safeguard it. Here are the safe sex rules:

  • Wait to have sex. Isn’t this the advice you give your kids? What’s the rush? Date for a while and get to know the person. A lusty first date could fizzle on the second or third. And then you might be stuck with an unpleasant reminder of a fleeting passion.
  • Get tested. And insist that your partner does as well. How can I ask that? you’re thinking. Girlfriend, this is how you empower yourself. You don’t take chances. “If the guy has nothing to hide, he shouldn’t resist.” says Rapini.
Once you’ve decided that sex is on the horizon, you could say something like, “I’m getting tested for STDs, and I think it’s a good idea for you as well.” That creates a level playing field and opens the door to discussion later.
  • Share the results of your screening. This gently opens the door to honest talk about sex. If you’ve never talked openly about sex before, it’s time to change. “If you stay passive you’re less likely to have good sex.” says Rapini.
  • Continue to use condoms for at least six months after a screening. Some infections, such as HIV, don’t show up immediately. Always keep latex condoms with you, just in case. If a condom is used correctly, it provides 90 percent protection. It’s less effective against the genital herpes virus or the HPV virus because those viruses are more widespread on the genital area.
  • Take care of your vagina. We’ve talked (and talked) about good vaginal hygiene. In addition to the infection-fighting properties of a healthy vagina, the sex will be better and more comfortable, too.
  • Keep communicating. This may be uncomfortable at first because our generation didn’t talk about sex, but this is the time of life for discovery. Learn what you like, and learn to ask for it.

Empowerment, remember? Respect yourself enough to insist on safe sex.

Let us know how it goes.