Dr. Ruth K. Westheimer - Sex For Dummies

Abnormal bleeding may cause your gynecologist to order an endometrial biopsy and/or a dilation and curettage (or D&C). An endometrial biopsy is done in your gynecologist’s office. A small tube is inserted through the cervix into the uterus, and a sample of the endometrium , the lining of the uterus, is extracted for microscopic evaluation. A D&C is an invasive scraping of the uterus done in the operating room under anesthesia.

But new techniques using sonograms are now available that can prevent you from having to go through a D&C, so talk to your doctor extensively before agreeing to any procedure. If your doctor doesn’t have the necessary equipment to perform the new, less invasive procedures, then you may want to find one who does.

Just being aware of perimenopause can bring you great relief because you’ll at least know that you’re not going crazy.

A classic symptom of menopause is the hot flash , a sudden feeling of heat that takes over the entire body. This can happen at any time of the day or night, and the number of hot flashes and their duration is different for every woman. Because the woman’s face usually also becomes flushed, these hot flashes may be visible to the entire world and can be embarrassing, though she certainly has no need to feel embarrassed. Although not every woman experiences hot flashes, the normal duration for this symptom is two years. About 25 percent of women have hot flashes for a longer period of time if they go untreated, right into their 90s. (Skip ahead to the section on hormone replacement therapy to learn more about the treatment.)

The decrease in hormone production during menopause also causes changes in the vagina and bladder. The vaginal walls thin out, causing vaginal dryness. This dryness, in turn, can cause burning, irritation, and decreased lubrication, which can result in painful intercourse (see Chapter 19). Similar changes in the bladder can cause a woman to feel the urge to urinate more frequently.

Many women also experience some psychological changes, although these haven’t been medically proven to be tied to the effects of menopause. They may, in part, be due simply to interruptions in sleeping patterns caused by the hot flashes, or to a woman’s reflections on this permanent physical change in her life, which signals the end of youth.

Some harmful side effects of menopause may be osteoporosis — a loss of bone strength caused by lower levels of calcium being retained — and possible heart problems.

If you know any families who have two or three children grouped around one age bracket and then another child who arrived ten years later, the odds are that this last child was a “mistake” caused by the onset of menopause. As I said, menopause takes a few years to settle in, and during that time a woman who had regular periods all her life may find that they suddenly become irregular. So if you are of menopausal age and your periods stop for two or three months, don’t assume that you won’t have any more. You very well may ovulate again, and if you have unprotected sex, then you may find yourself changing diapers at a much later age than you ever intended. Under the medical definition, a woman reaches menopause when she hasn’t had a period for 12 months, so never consider yourself to be into the menopausal years until that period of time has elapsed.

Medical science found a way of alleviating many of the symptoms of menopause through hormone replacement therapy (HRT). Studies proved that having a woman take estrogen to replace that hormone she is no longer producing alleviated many of the symptoms of menopause, as well as protected against certain kinds of cancers, especially cancer of the cervix. But other studies subsequently have shown an added risk of various diseases, including heart attack and breast cancer, for some women using HRT. This very confused picture means that any woman beginning menopause should consult her doctor to find out what options are available to her. You may decide against HRT, or if you have severe menopausal symptoms, you may opt for short-term therapy. To relieve vaginal dryness only, a very small dose of estrogen applied directly into the vagina can relieve this problem without adding significant risk (see Chapter 19).

Because I’m not a medical doctor, and because the news about HRT seems to change regularly, that’s all I’m going to say about the physical effects of menopause. (If you’re a woman approaching the proper age bracket, I recommend that you go out and buy Menopause For Dummies , 2 ndEdition, by Marcia Jones, PhD; Theresa Eichenwald, MD; and Nancy Hall, MS [Wiley] to better understand all the changes happening to your body. Then talk to your gynecologist to get the latest information about HRT and to help you decide whether to use the treatment.) The issue of menopause and sex, however, is a topic that I cover in Chapter 19. I’ll give you a preview of that discussion by saying that my philosophy is a very positive one concerning sex in the later years.

I certainly can’t give you a road map to the intimate female anatomy without giving you at least a quick tour of the Alps — or, for some of you, the Appalachians. As you should realize, breast size is of no consequence, except to those men who’ve spent too much time staring at so-called men’s magazines. Breasts are certainly an erogenous zone, however, and because they do stick out, even while under wraps, they’re one part of the body that gets noticed whether you’re clothed or not.

The main purpose of breasts is to feed babies because after a mother gives birth she lactates (that is, makes milk) provided that the baby starts to suck at the nipples. This miraculous process is not only good for the baby’s health but also for the mother’s because breast-feeding gets rid of the excess fat she accumulated during her pregnancy.

Strangely, for a period of time in the 20th century, Western women gave up the process of feeding their babies from the breast. But more and more women are returning to this method.

If any of you have heard that a mother who is breast-feeding can’t get pregnant, think again. Women have a tendency not to ovulate while breast-feeding, but this tendency isn’t an absolute, as many a woman has discovered too late.

The breasts of male and female children are the same. But when a girl reaches puberty, first her nipples and the areola , the darker skin around the nipple, begin to enlarge. As her levels of the hormone progesterone increase, the underlying tissue grows, producing a full breast.

The nipples hold a concentration of nerve endings, and most women’s nipples get erect when they become aroused. As an erogenous zone, a woman’s breasts serve both the male and the female; men get excited by looking at and fondling breasts, but women also enjoy the sensations.

Many women who masturbate fondle their own breasts and nipples.

The bulk of the breast is composed of fatty tissue. Because our bodies often store any toxins that we absorb in fatty tissues, the breasts are a common cancer site for women.