Here is the full transcript of gynecologist Maria Sophocles’ talk titled “What Happens to Sex in Midlife? A Look at the “Bedroom Gap”” at TEDWomen 2023 conference.
Listen to the audio version here:
TRANSCRIPT:
So the other day, a woman walked into my office and exclaimed: “My vagina has betrayed me!” Not what most of us hear on a Monday morning before coffee, but welcome to my world as a gynecologist and sexual medicine specialist. You know, everybody thinks of menopause as hot flashes, but for over half of menopausal women, it’s accompanied by sexual issues. Things like loss of libido or painful intercourse, even total destruction of a relationship.
It’s what I call the “bedroom gap,” the difference in sexual expectations and capabilities of men and women in midlife. Now the bedroom gap is a combination of the genital effects of menopause and deeply entrenched cultural and historical gender roles. To understand how to close the bedroom gap and to get the sex we want, we have to examine its root causes.
The Science of Menopause
So let’s start with some science. In menopause, the ovaries make estrogen less consistently and eventually stop making it altogether. And this loss of estrogen has two huge effects in the vagina. The first is on collagen. Less estrogen means less collagen is made, and the quality of that collagen deteriorates from strong and stretchy to brittle. Ouch.
The second effect of the loss of estrogen in the vagina is on blood vessels. We need blood vessels for lubrication. When I’m examining a patient, I can literally see if she’s deficient in estrogen. The deterioration from thick, ridgy, dark pink, elastic, moist tissue to thin, dry, inelastic, pale pink, even yellowish white tissue. We also need blood vessels for arousal. This is where you’re supposed to wake up.
Now I’m excited. When we’re aroused, fluid moves… Fluid moves from the blood vessels through the vaginal wall to make lubrication. Without blood vessels, you’re not going to get wet no matter how turned on you are.
The Impact on Women
So where does this leave you? Well, you feel dried up, you can’t get wet, your vagina seems to be on fire and — Your partner perceives your discomfort, then you feel bad, then your partner feels guilty, and then you feel as if you have wrecked the whole moment.
I will never forget, a patient said to me once, “Dr. Sophocles, when my partner and I have sex, we sing this Johnny Cash song.” Oh, you know it? “Ring of Fire.” “We sing it, I sing it because I have to sing and laugh, or else I would cry and it would spoil the moment for him.” For him. So while women are living in this ring of fire, mercy sex world, on the other side of the mattress — things are a little different.
The Bedroom Gap
See, for 25 years, men have had a relatively safe, reliable, available medical option for erectile dysfunction. What was first invented to firm up a floppy penis has now become a global phenomenon to optimize male sexual performance. Now, Viagra did not cause the bedroom gap, but I believe it has widened it.
And by the way, it’s not men’s fault. They are just availing themselves of what gender-biased modern medicine has on offer. True. But while middle-aged men are benefiting from a rock hard, medically enhanced erection, their female partners are literally left hung out to dry. So here’s the good news, women do have options, but they just don’t seem to avail themselves of them. Why?
Outdated Medical Training
What’s the hold up? Well, one problem may be that many doctors don’t feel comfortable talking to female patients about menopause and sexual issues because they feel they were never properly trained. And I think this is true.
Our medical system is woefully outdated. In fact, one study showed that two-thirds of medical training programs in the US have just one lecture on menopause, one. Which may explain why doctors are uncomfortable and why 75 percent of women who go to doctors to seek care for menopausal problems come away empty-handed.
This has to change. Because every one of us is going to go through menopause and experience the loss of estrogen. And there are a lot of us right now.
Global Impact
Globally, there are 1.1 billion women right now who’ve reached menopause and post-menopause. And almost half of them are suffering from sexual issues largely quietly, and it’s probably underreported. I know because for 28 years I have listened to your stories on five continents, and I can tell you that the bedroom gap cuts across race, ethnicity, economics, education and geography.
It is universal and ubiquitous. It’s also lasting a lot longer. See, women are outliving men by five to six years, and they’re spending more than a third of their lives after menopause. So there are more postmenopausal women who are single, widowed, divorced. Some of them want to be intimate. They go online, they swipe left, they swipe right, they start dating, they start having sex.
Cultural and Historical Factors
And this is great. But between the issues inherent in the bedroom gap, Viagra widening that gap, and the complexities of online dating, it’s no wonder you feel your vagina has betrayed you. But it’s not your vagina’s fault. No. What has betrayed you is not only the biology of aging but history and culture. And gender roles etched in sexual stone over millennia.
Sexual dogma that decrees that a woman’s role in the bedroom is to please, to serve. To not impede the sexual pleasure that a man is entitled to. Now, we’re not going to change a millennia of sexual scripting in a TED Talk.
Vaginal Estrogen as a Solution
But I can offer you this. Since we know that deficiency of estrogen makes the vagina dry and unpleasant, then maybe one solution to closing the bedroom gap might be to replace that vaginal estrogen.