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Although many couples report they maintain sexual relationships as they age, social attitudes towards sex have changed drastically over the lifetimes of today’s menopausal, and even more for post-menopausal, women. Television and motion picture depictions of nudity and sexual intercourse that were banned thirty years ago are commonplace today. Cable television stations carry pornographic material, and, on the internet, pornography sites are among those most frequently visited. While most women, menopausal or post-menopausal, would not have dreamed of discussing explicit sexual issues with their mothers, their daughters take sexual discussions for granted. While post-menopausal women grew up believing that sex before marriage was unacceptable (though they may have engaged in it anyway), today’s young women, with the exception of fundamentalists of various faiths, probably consider premarital sex normative. Ingrained reticence about sexuality inhibits many menopausal women from presenting their sexual concerns to their physicians.
Physicians and other clinicians, with very little data with which to establish norms, tend to resort, consciously and unconsciously, to their own experiences, beliefs, and prejudices when counseling patients. Given the current state of knowledge, it is not possible to state that any given level of sexual activity is or is not normal. We can only know what distresses a patient.
For many people, maintaining sexual interest and activity into and beyond menopause is a sign of vitality. Sexual attractiveness is a cardinal value for women. Popular media advertisements for hormone therapies and other menopause "remedies" stress their positive impact on sexiness. Losing sexual desirability is synonymous with becoming old, which, in North America, is synonymous with becoming ugly, irrelevant to the culture, and facing impending death.
The youth culture
Images of beautiful young women are used to sell products. Youth and beauty are synonymous. However, the social stature of mature women in the Eastern Hemisphere differs markedly from that in the West. Young women may be regarded as beautiful, but in patrilineal societies they move to their husbands’ family homes at marriage, and are subjugated to their mothers-in-law. Only as they bear children – or sons in particular – do they acquire status and power, especially as they acquire daughters-in-law of their own.
The medical profession, in its zeal to adopt the use of hormones at menopause, has contributed significantly to the youth culture by advancing the concept that it is only through the miracles of modern medicine that women survive beyond menopause at all. They cite and misinterpret statistics about average life expectancy in the past as compared with today. Those averages, however, are the products of high infant and maternal mortality, and infectious disease and not of the spontaneous disintegration and death of women as they reach menopausal age. The survival of women beyond menopause is advantageous to the survival of the species. Children require nurturing in order to reach reproductive age. If women died at menopause, in the absence of effective contraception, they would leave children behind. Women are sources of knowledge and support for childbearing and childrearing that are critical to future generations. Even now, many grandmothers are called upon to assume part or all of the childrearing responsibilities for their grandchildren.
Social prejudice against aging is not only culturebound, but also gender-bound. The thought of an older woman with a younger man is disgusting to many people, while couples consisting of older men and younger women are not only accepted, but even admired. The use of new technologies by menopausal women wanting to bear children is viewed negatively, while fatherhood among men in their eighties is often viewed as a sign of vigor and virility.
The empty nest
There are several other realities confronting women at the same time that their children are leaving home. Some women are widowed. Some husbands leave their wives, inflicting a narcissistic injury, as well as loss of companionship, loss of
An increasing number of middle-aged women in the United States find themselves in a paradoxical situation. Their children may or may not leave home for a time, but, after their mothers adapt to a new stage of life, the children return, often with their own children. Sometimes the adult child has become a drug addict or has been incarcerated for some other crime. This faces the mother with a sense of failure and crushing disappointment about her own childrearing. Sometimes the adult child’s relationship or marriage has ended in separation or divorce, or the adult child has lost his or her job. The adult child may expect his or her mother to care for grandchildren while the adult child looks for a new job or returns to school for further education; the mother may feel she has no choice but to care for her grandchildren. There are several programs around the country for grandmothers caring for young children.
- Stotland, NL; Menopause: social expectations, women’s realities; Archives of Women’s Mental Health; Aug 2002; Vol. 5; Issue 1.
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