Menopause

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The climacteric or menopause, the cessation of menstruation, occurs by age 50 in most women and marks the end of the childbearing years. Some women manage to give birth during their fifties and even sixties, but for most, the period of fertility ends sometime during the fifth decade.

Associated with menopause is a sharp drop in the production of estrogen and consequent changes in the structure and functioning of certain body tissues and organs. Among the structural changes are a decrease in the size of the cervix and uterus; cells in the vaginal walls also atrophy, causing the walls to become thinner. The reduction in estrogen contributes to the difficulty of uptaking calcium to strengthen the bones and a consequent thinning of the bones ( osteoporosis ).

The degree of vasocongestion of the breasts, clitoris, and vagina is also affected, and vaginal lubrication is reduced with menopause. The decreased acidity of vaginal secretions also increases the likelihood of infection. These changes in the vagina may result in pain and discomfort during sexual intercourse and an aching, burning sensation afterward. A minority of meno-pausal women experience these symptoms to any great degree, and they can, of course, be treated (Corby & Solnick, 1980). For example, vaginal irritation can be treated with a water-based lubricant such as K-Y, and by enhancing lubrication by means of estrogen creams and estrogen replacement therapy (ERT). However, because of the increased risk of uterine and breast cancer associated with ERT, this treatment is usually reserved for severe cases and consists of a minimum dosage for the shortest possible time to be effective. The risk of cancer is also reduced by combining ERT with the administration of progestin.

Another unpleasant experience associated with menopause are sensations of extreme heat, particularly in the upper part of the body. These so-called "hot flashes," which are often accompanied by a drenching sweat, diminish gradually and usually disappear altogether within a year or two following their onset.

Along with a drop in testosterone in approximately half of all meno-pausal women, the aforementioned changes presumably contribute to a decline in the sex drive reported by 30% or so women after menopause (Sheehy, 1993). Perhaps an even more important factor in the reduced sexual activity of widows, however, are social mores that view sex as something that older women should not be interested in. Despite the decline in sexual activity for most older women, the increased independence and assertiveness experienced by many postmenopausal women are often accompanied by a renewed interest in sex.

The term "male menopause" is sometimes applied to the structural and functional changes that occur with age-related reductions in the production of testosterone during later life, but there is no scientific justification for this term (Kolodny, Masters, & Johnson, 1979). Changes in the structure and functioning of the sex organs are also typical of older males, but the notion that all men eventually experience a "male menopause" akin to that in women is inaccurate. Among the changes that occur in older men are a slight shrinkage of the testes, the production of fewer sperm, and an increase in the size of the prostate gland. Older men require longer to achieve an erection, have a softer erection, and lose it more quickly after ejaculation. They experience fewer genital spasms, the force and volume of the ejaculate are less, and the refractory period is longer (Burt & Meeks, 1985; Masters et al., 1991; Spence, 1989). Secondary sex changes, such as a loss of hair, increased flabbiness, and an elevated voice pitch, also occur in later life.

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