What Happens to Sex in Midlife? A Look at the “Bedroom Gap” | Maria Sophocles | TED

Summary

The transcript highlights the often overlooked issue of sexual problems during menopause, termed the 'bedroom gap'. It discusses the impact of reduced estrogen on women's sexual health, leading to symptoms like dryness and discomfort, and contrasts this with the well-established treatments for erectile dysfunction in men. The speaker advocates for increased awareness, better medical education, and the use of solutions like vaginal estrogen to improve women's sexual well-being and close the bedroom gap, promoting a broader conversation about gender equality in sexual health and pleasure.

Takeaways

• 👩‍⚕️ A gynecologist highlights the lesser-known impact of menopause on women's sexual health, beyond hot flashes.
• 🛌 The 'bedroom gap' refers to the disparity in sexual expectations and capabilities between men and women in midlife, exacerbated by menopause.
• 🧬 Estrogen decline during menopause affects collagen and blood vessels in the vagina, leading to dryness and discomfort.
• 🚫 Cultural and historical gender roles contribute to the bedroom gap by perpetuating the idea that women's role is to please men sexually.
• 💊 Vaginal estrogen can help alleviate menopause-related sexual issues without the risks associated with systemic estrogen use.
• 🔍 Medical training often lacks comprehensive education on menopause and sexual health, leaving doctors unprepared to address these issues.
• 🌍 Menopausal women globally face sexual issues that are widespread and underreported, affecting their quality of life.
• 💪 Advocacy for sexual health and education is crucial to closing the bedroom gap and achieving sexual equality.
• 📚 Millennials and Gen Z should prioritize learning about and discussing sexual health to foster open dialogue and understanding.
• 🔄 Reframing sexual and genital health as a lifelong project can empower individuals to seek solutions and maintain sexual well-being.
• 👫 Gender-neutral approaches to sexual pleasure and education are essential for promoting long-term health and well-being for all.

Q & A

What is the term used in the script to describe the difference in sexual expectations and capabilities of men and women in midlife?

The term used is the 'bedroom gap'.

What are the two main effects of the loss of estrogen in the vagina during menopause?

The two main effects are the decrease in collagen production and the deterioration of blood vessels, which leads to issues like dryness and lack of lubrication.

Why do blood vessels in the vagina play a crucial role in sexual arousal?

Blood vessels are needed for lubrication and arousal because they provide the necessary fluid that moves through the vaginal wall to create lubrication when a woman is sexually aroused.

How has Viagra and other medical options for erectile dysfunction potentially widened the bedroom gap?

Viagra and similar medications have optimized male sexual performance, but there has not been an equivalent advancement for women's sexual issues, leading to a disparity in sexual satisfaction and performance between men and women.

What is the main issue with medical training programs' approach to menopause and sexual issues according to the speaker?

The speaker states that medical training programs are outdated and often provide insufficient education on menopause, resulting in doctors feeling uncomfortable discussing these topics and being unable to provide adequate care.

What is the misconception about vaginal estrogen that the speaker aims to correct?

The misconception is that vaginal estrogen carries the same cancer risks as systemic estrogen. The speaker clarifies that vaginal estrogen, when used properly, has not been shown to cause cancer and should not be equated with systemic estrogen.

How does the speaker suggest we can start to close the bedroom gap?

The speaker suggests increasing education on sexual health, advocating for better medical care for menopausal women, and reframing sexual and genital health as a lifelong maintenance project.

What are the long-term health benefits of maintaining an active and satisfying sex life?

Maintaining an active and satisfying sex life can reduce blood pressure, improve cardiovascular health, decrease stress and depression, and is linked to longevity.

How does the speaker propose we should evolve our approach to sex education?

The speaker proposes that sex education should progress beyond basic contraception and prioritize equal sexual pleasure for both men and women, teaching comprehensive and gender-neutral sexual health from the beginning.

What is the overarching goal the speaker has for addressing the bedroom gap?

The speaker's overarching goal is to promote gender equality in sexual pleasure and to ensure that both men and women have the right to comfortable and pleasurable sex throughout their lives.

Outlines

00:00

👩‍⚕️ Introduction to the 'Bedroom Gap'

The speaker, a gynecologist and sexual medicine specialist, introduces the concept of the 'bedroom gap' by sharing a humorous yet insightful anecdote about a woman's complaint of betrayal by her body during menopause. The 'bedroom gap' refers to the disparity in sexual expectations and capabilities between men and women in midlife, which is often exacerbated by the physical changes brought on by menopause, such as loss of libido and painful intercourse. The speaker emphasizes the importance of understanding these changes, which include the decline in estrogen production affecting collagen and blood vessels in the vagina, leading to issues with lubrication and arousal. The segment also touches on the societal implications of this gap, including the impact of Viagra on male sexual performance and the lack of equivalent options for women.

05:02

📚 Medical Training and the 'Bedroom Gap'

This paragraph discusses the inadequate medical training regarding menopause and sexual issues faced by women post-menopause. The speaker points out that many doctors feel unprepared to address these topics due to insufficient training, which is reflected in the lack of comprehensive education in medical programs. The speaker cites a study highlighting that most medical training programs in the US only provide a single lecture on menopause. This lack of knowledge contributes to the pervasive issue of women leaving doctors' offices without the help they seek. The speaker calls for a change in this system, emphasizing the global scale of the problem and the need for better education and resources for both medical professionals and women experiencing menopause.

10:04

💊 Solutions and Advocacy for the 'Bedroom Gap'

The speaker presents potential solutions to address the 'bedroom gap,' starting with the option of vaginal estrogen to counteract the drying effects of menopause. The speaker dispels common fears about the use of estrogen due to misconceptions about cancer risks, clarifying the difference between systemic and vaginal estrogen. The speaker encourages women to view sexual and genital health as a lifelong maintenance project and to advocate for themselves in terms of sexual pleasure and comfort. The speaker also calls for a broader societal change, urging younger generations to engage in open conversations about sex, to seek education and healthcare that prioritizes sexual pleasure for all genders, and to challenge traditional gender roles in sexual relationships. The speaker concludes with a call for gender equality in sexual health and pleasure as a fundamental aspect of overall well-being.

Keywords

💡Menopause

Menopause is a natural biological process that marks the end of a woman's menstrual cycles and fertility. It is characterized by a decrease in the ovaries' production of estrogen, which can lead to various symptoms such as hot flashes and sexual issues. In the context of the video, menopause is central to the discussion of the 'bedroom gap' and its impact on women's sexual health and relationships during midlife and beyond.

💡Sexual Issues

Sexual issues refer to a range of problems that can affect a person's sexual function, desire, or satisfaction. In the video, the speaker highlights that over half of menopausal women experience sexual issues such as loss of libido, painful intercourse, and difficulties in sexual relationships, which contribute to the 'bedroom gap' between men and women.

💡Bedroom Gap

The 'bedroom gap' is a term coined by the speaker to describe the disparity in sexual expectations and capabilities between men and women in midlife. This gap is influenced by the physical changes of menopause and cultural and historical gender roles, leading to dissatisfaction and challenges in intimate relationships.

💡Estrogen

Estrogen is a primary female sex hormone that plays a crucial role in the development of female reproductive tissues and secondary sexual characteristics. In the video, the decline in estrogen production during menopause is discussed as a significant factor affecting vaginal health and sexual function in women, leading to issues like dryness and loss of elasticity.

💡Collagen

Collagen is a type of protein that provides strength and structure to various body tissues, including the skin and connective tissues. The speaker mentions that reduced estrogen levels during menopause lead to less production of collagen and a deterioration in its quality, which affects the health and function of the vaginal tissue.

💡Lubrication

Lubrication refers to the natural wetness of the vagina that occurs during sexual arousal and helps facilitate comfortable intercourse. In the video, the importance of blood vessels for lubrication is emphasized, as their decline during menopause can lead to dryness and discomfort during sex.

💡Viagra

Viagra is a medication used to treat erectile dysfunction in men by improving blood flow to the penis. The speaker discusses Viagra as an example of the gender-biased medical options available for sexual performance enhancement, which has contributed to widening the 'bedroom gap' between men and women.

💡Vaginal Estrogen

Vaginal estrogen is a form of estrogen therapy that is used locally to treat menopausal symptoms affecting the vagina, such as dryness and atrophy. The speaker argues for the benefits of vaginal estrogen in closing the 'bedroom gap' and addresses common misconceptions about its safety and association with cancer risks.

💡Advocacy

Advocacy in the context of the video refers to the act of supporting or promoting a cause, particularly in the realm of sexual and genital health. The speaker encourages advocacy for better education, medical training, and societal attitudes towards women's sexual health, emphasizing the importance of open dialogue and sexual equality.

💡Sexual Pleasure

Sexual pleasure is the positive and enjoyable feelings that arise from sexual activity or stimulation. The video emphasizes the right to sexual pleasure as a critical aspect of overall well-being and calls for a more equitable approach to sexual health that prioritizes pleasure for both men and women.

💡Gender Roles

Gender roles are the societal expectations and norms associated with being male or female. In the video, the speaker discusses how deeply entrenched cultural and historical gender roles contribute to the 'bedroom gap' by perpetuating the idea that a woman's role in the bedroom is to please and serve, rather than experiencing equal pleasure.

Highlights

The speaker, a gynecologist and sexual medicine specialist, shares a humorous yet insightful story about a woman's complaint about menopause affecting her sexual health.

Menopause is not just about hot flashes; over half of menopausal women face sexual issues such as loss of libido and painful intercourse, which can lead to relationship problems.

The concept of the 'bedroom gap' is introduced, highlighting the discrepancy in sexual expectations and capabilities between men and women in midlife.

The speaker explains the genital effects of menopause, such as the decrease in estrogen production, leading to less collagen production and deterioration in collagen quality.

The importance of blood vessels for lubrication and arousal is discussed, and how their decline due to estrogen loss affects sexual function.

The speaker shares a personal anecdote from a patient to illustrate the emotional impact of menopause on sexual relationships, including the use of humor as a coping mechanism.

The speaker points out the gender disparity in medical treatments, noting that men have had reliable options for erectile dysfunction for 25 years, while women have been left with limited options.

The speaker argues that Viagra and similar medications may have inadvertently widened the bedroom gap, as they primarily benefit men and do not address women's sexual health issues.

The speaker emphasizes that women do have options for addressing sexual issues during menopause, but there may be barriers to accessing these options, including doctors' discomfort in discussing these issues.

The outdated state of medical training is highlighted, with the revelation that many programs offer only one lecture on menopause.

The global scale of the issue is presented, with statistics showing that 1.1 billion women have reached menopause, many of whom suffer from sexual issues.

The speaker addresses the societal and cultural factors contributing to the bedroom gap, including deeply ingrained gender roles and sexual scripts.

A potential solution to the bedroom gap is proposed: replacing the deficient vaginal estrogen to alleviate dryness and discomfort.

The speaker dispels common fears about the use of estrogen, clarifying that vaginal estrogen has not been linked to cancer and is often misunderstood due to confusion with systemic estrogen.

The importance of sexual and genital health as a lifelong maintenance project is emphasized, encouraging women to seek solutions and maintain open communication about sexual health.

The speaker calls for a revamp of sex education and medical training to prioritize equal sexual pleasure for men and women and to better serve the growing population of menopausal women.

The talk concludes with a call for gender equality in sexual health and the recognition of sexual health as an integral part of long-term human health.

Transcripts

So the other day,

a woman walked into my office and exclaimed:

"My vagina has betrayed me!"

(Laughter)

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.

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.

(Laughter)

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.

(Laughter)

Now I'm excited.

(Laughter)

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.

(Laughter)

So where does this leave you?

Well, you feel dried up,

you can't get wet,

your vagina seems to be on fire and --

(Laughter)

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."

(Laughter)

Oh, you know it?

(Laughter)

"Ring of Fire."

(Laughter)

"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 --

(Laughter)

things are a little different.

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.

(Laughter and applause)

So here's the good news, women do have options,

but they just don't seem to avail themselves of them.

Why?

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.

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.

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.

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.

Uh-oh, I see the look on your face.

(Laughter)

I know what you're thinking.

You're thinking, "Estrogen?

What about the cancer risk?"

Well, I get it.

We have to address this collective fear of estrogen and cancer.

That fear stems from the Women's Health Initiative,

the media storm that surrounded the release

of that data 20 years ago.

That study examined the risks of oral estrogen

and cancer, among other things,

not vaginal estrogen.

So here's the key point.

Estrogen behaves differently

depending on where and how it's used.

Check it out.

Vaginal estrogen works genitally, locally and has positive effects.

Systemic estrogen can have positive or potentially negative effects

depending on the target tissue.

Vaginal estrogen has been out since 1946

and studied extensively

and has never been shown to cause breast or other cancer.

But we, the big we,

have made vaginal and systemic estrogen falsely equivalent.

We have thrown the baby out with the bathwater.

Our fear does not discriminate.

And now far too many women don't use estrogen at all.

So where does this leave us?

Well, the thing is,

we have a right to comfortable sex.

And a right to pleasurable sex.

(Applause)

Yeah.

(Cheers and applause)

So the thing is,

we talked about vaginal and systemic estrogen,

and there are even other medications we can use, vaginal and oral,

that will help us

to close our bedroom gap.

The other avenue to close the bedroom gap is advocacy.

How can you close your bedroom gap

so that you can enjoy sex?

Or better yet, how can you never have one happen in the first place?

I’m talking to you, millennials and Gen Zers.

Well, one, get educated.

Read credible sources.

Find clinicians invested in sexual health.

Two,

talk about it to each other,

to your clinicians, to your partners.

Talk without shame or blame and get specific.

What hurts?

What feels good?

Get sexually creative.

And don't do anything that doesn't feel good.

(Applause)

And number three, reframe sexual and genital health

as a lifelong maintenance project.

And don't think that just because you can't get wet

or you have wimpy orgasms

that that can't be fixed.

Because, here's the deal,

which you already heard in this talk.

We have a right to comfortable sex

and a right to pleasurable sex.

So let's move

the sexual equality needle forward.

Let's start with young people,

young men and women.

It is time

for sex ed to progress beyond getting a condom on a banana.

(Cheers and applause)

It is time for sex ed to prioritize

equal sexual pleasure for men and women.

So they learn it right from the beginning

when they're starting to have sex.

And it is time to revamp medical education

to keep up with the demographic explosion of menopausal women.

So that doctors have the tools

and the information they need to provide to women

so they don't leave empty-handed.

And it is far past time

for the concept of sexual pleasure to be gender-neutral.

Because it's never too early to start.

It's never too late to improve equal sexual pleasure for men and women.

And let's face it,

sexual health is part of long-term human health.

We know that staying sexually active reduces blood pressure,

improves cardiovascular health,

decreases stress and depression and anxiety

and is linked to longevity.

And we, women,

we must emancipate ourselves

from the rigid roles of sex for procreation

or male pleasure.

My big hope

is that in closing the bedroom gap,

we take one small sexual step

towards gender equality for all of us.

Thank you.

(Cheers and applause)