The lack of sexual desire is usually one of the most frequent queries that the gynecologist and sexologist Sandra Magirena receives from women who are approaching menopause. Is it a consequence of decreased estrogen production? Or are there other factors at play? “Does the gentleman or lady you are with turn you on or not?” is the question that she tries to get her “consultants” –as she prefers to name her patients- to answer. She has the same recommendation for all of them: stay erotic, regardless of age, and not abandon sexual activity. And for that, he has a recipe.
Magirena integrates in its approach the traditional medicine of the West with Chinese, Ayurvedic, homeopathic medicine and ancestral knowledge of native peoples. She is the author of the book return to me Living a conscious menopause (Editorial El Ateneo) that he created during the pandemic and on Instagram (@magirenaconsultorio) makes live to answer about sexuality, menopause and climacteric.
“That?” “As?” “Already?” “It can’t be that fast!” With these exclamations, women who are around 49 or 50 years old and come to his office with some alteration of the menstrual cycle find out, with perplexity, that they are approaching menopause. They did not imagine that possibility, Magirena tells me: she has practiced the profession of gynecologist and sexologist in the City of Buenos Aires for forty years, during which she has been accompanying hundreds of women from adolescence to climacteric. Those comments gave her the pattern of the little information they have about the arrival of menopause. “They don’t know what changes are going to happen to them. And like in any other situation, knowledge is power, and in this case, knowing will allow those transformations that come with menopause to not be so strong ”, she warns.
The personal is political: talk about menopause too
Given the avalanche of comments I received after the publication, at the beginning of February, of the article Menopause: a natural process that there is no reason to suffer in silence, I decided to continue with the topic. Many of the messages –which came to me through my Instagram profile and also through WhatsApp- were of thanks: for putting the big M in the conversation. So here we are, –this time with the word of another specialist– to get menopause out of the closet among all of us.
Magirena decided to write her book come back to me… from her personal experience of menopause and climacteric and from listening to so many women go through her office, arriving at that stage with so little information about what was going to happen to them. It addresses the issue from four fundamental pillars, to seek well-being: food, physical activity, sexuality and spirituality.
“Let’s agree that the changes produced by menopause are not only in the physical body. The impact of the drop in estrogen is quite abrupt unlike what happens to male bodies where testosterone drops very slowly. Therefore it is felt a lot in the physical body. There are changes at the level of the skin, in the mood, in the dream; the emotional and mental apparatus also undergoes changes, ”she explains.
Magirena is in favor of hormone replacement therapies (HRT), to go through the menopause, but – she clarifies – those scientifically validated. She also offers her “consultants” alternatives that come from Ayurvedic, homeopathic medicine, acupuncture and ancestral knowledge of native peoples. She recommends yoga and meditation.
Personally, he specifies, he does not indicate the use of the so-called “sex chip” because it is neither approved by the National Administration of Medicines, Food and Medical Technology (ANMAT) nor by the FDA (the United States government agency responsible for regulating of food and medicines and vaccines).
She clarifies that she is talking about the population that passes through her office, mostly heterosexual, cisgender women, and from the middle and upper sectors. A very frequent question that she receives among those in their 50s is about the loss of sexual desire: many blame it on menopause. They come to the consultation with the concern that they don’t feel like having sex, they say that they are having a hard time in this aspect and they think that it is the responsibility of the hormonal drop. “They don’t look at the context and the couple situation they are going through. They say, “No, it’s me.” This is the reason for consultation that catches Magirena the most because it opens a very interesting door, she says, to begin to unravel the story of that woman, how she learned love as a child, what her sexuality was like in adolescence, how she lived it in the reproductive stage, if she has had children or not, how is her relationship with that bond and how is she standing today at this moment in life.
“I am in an attempt – and the book talks a lot about that – to depathologize the lack of sexual desire. I usually say that you have to investigate the context because it is highly probable that this woman is bored, unmotivated. That what he had been doing up to now he no longer wants and that taking the weight off reproduction and entering a stage of life in which the children are already older, –if he had them– he can dedicate himself to fully to creative activity. But it is a moment of change, of inflection, where you have to look for new horizons and new motivations ”, she points out.
She also says that spreading these issues, putting words to it, will allow more and more women to investigate what happens to their bodies and be encouraged to ask what they like and what they don’t. And fundamentally, what things are willing to change.
Vaginal dryness, she warns, will affect 75 to 80 percent of women after the 10th year of menopause. It is a condition that progressively increases from the time of the last period until the age of 70 is reached. “Among those who have vaginal dryness, a high percentage may also have the so-called genitourinary syndrome, which is a very annoying health condition, which causes repeated cystitis, burning, urinary infections, and that is what must be prevented. So, every woman entering menopause, who knows that she has a high chance of having vaginal dryness, has to do three things: massage her vagina, with a massager, with her fingers, or with a gentleman or lady if she is sexually active. Use water-based vaginal moisturizers and hydrators that may have aloe vera or hyaluronic acid, coconut oil works too, and third, apply an estrogenic derivative that is promesin, which can be used by virtually all women (some restrictions may apply). in those who have or have had breast cancer), and come in suppository or cream form. There is also another product, which is a testosterone precursor, which is dehydroepiandrosterone (DHEA). With that, you guarantee a healthy sexual life”, explains the gynecologist and sexologist. Of course, the indicated thing is to make a consultation.
It must be taken into account, Magirena emphasizes, that if a woman does not have her vagina in good condition and begins to have dryness, that brings pain as the first symptom. So when she goes to have intercourse she loses sexual desire.
But above all, when there is a drop in sexual desire, Magirena asks her “consultants” to think about the context. First, he asks them:
–Does the gentleman or lady you are with now warm you or not?
Because it can happen that you stopped getting excited with your partner.
You have to know, he explained didactically, that the arousal process takes a while, and for women more than for men –because filling the erectile tissue of the vulva with blood is not as fast a process as filling the penis. “In addition, the vulva does not have containment valves, which contain the blood, so the entire arousal phase is slower, and if the woman introduces her fingers or penis and is not completely wet, it will hurt and if she it hurts, the desire goes away”.
–And why can desire go down if Mr. or Mrs. or Mrs. continues to warm it up? -asked.
— Desire can come down. I often use the analogy with sports. I also play tennis. It is one thing to play with other 40-year-old women and another, with 60-year-olds. Of course, at my age -63 years– I feel more comfortable with 60-year-olds and the rhythm we have on the court is much lower than the that those of 40 have. So there are changes in the body that are going to occur, desire and sexual activity decrease as time goes by. But if the conditions in which the encounter takes place are satisfactory, the woman has a good time, has fun, has time, enjoys, whether or not she has orgasms, she feels satisfied, pleasant, she will want to do it again.
The recommendation always, he says, is not to abandon sexual activity. With a partner, with sex toys, with a massager, masturbating. “Another analogy: the same thing that happens with your cell phone, when you don’t use an application you have to reload it. If you masturbate with a certain periodicity, the brain will not have to go looking for the orgasm application to make it appear. So, masturbate, eroticize. Eroticism does not only pass through the sexual. Eroticism is having a good wine with friends, going out to enjoy a landscape in nature, painting, listening to music, going dancing. That is, stay erotic. So when the meeting appears, or one wants to be with someone or alone, things are more fluid and pleasant. And not think that this is the end of the world.
Talking about the subject allows us to remove layers of the stigma that still surrounds the big M. Let’s continue generating conversation and tearing down prejudices.